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Moshynets OV, Baranovskyi TP, Iungin OS, Krikunov AA, Potochilova VV, Rudnieva KL, Potters G, Pokholenko I. Therapeutic Potential of an Azithromycin-Colistin Combination against XDR K. pneumoniae in a 3D Collagen-Based In Vitro Wound Model of a Biofilm Infection. Antibiotics (Basel) 2023; 12:antibiotics12020293. [PMID: 36830203 PMCID: PMC9952533 DOI: 10.3390/antibiotics12020293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
A therapeutic combination of azithromycin (AZM) and colistin methanesulfonate (CMS) was shown to be effective against both non-PDR and PDR Klebsiella pneumoniae biofilms in vitro. These anti-biofilm effects, however, may not correlate with effects observed in standard plate assays, nor will they representative of in vivo therapeutic action. After all, biofilm-associated infection processes are also impacted by the presence of wound bed components, such as host cells or wound fluids, which can all affect the antibiotic effectiveness. Therefore, an in vitro wound model of biofilm infection which partially mimics the complex microenvironment of infected wounds was developed to investigate the therapeutic potential of an AZM-CMS combination against XDR K. pneumoniae isolates. The model consists of a 3D collagen sponge-like scaffold seeded with HEK293 cells submerged in a fluid milieu mimicking the wound bed exudate. Media that were tested were all based on different strengths of Dulbecco's modified Eagles/high glucose medium supplemented with fetal bovine serum, and/or Bacto Proteose peptone. Use of this model confirmed AZM to be a highly effective antibiofilm component, when applied alone or in combination with CMS, whereas CMS alone had little antibacterial effectiveness or even stimulated biofilm development. The wound model proposed here proves therefore, to be an effective aid in the study of drug combinations under realistic conditions.
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Affiliation(s)
- Olena V. Moshynets
- Biofilm Study Group, Department of Cell Regulatory Mechanisms, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Zabolotnoho Str. 150, 03680 Kyiv, Ukraine
- Correspondence: (O.V.M.); (G.P.)
| | - Taras P. Baranovskyi
- CeMM, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Lazarettgasse 14, A-1090 Vienna, Austria
| | - Olga S. Iungin
- Biofilm Study Group, Department of Cell Regulatory Mechanisms, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, Zabolotnoho Str. 150, 03680 Kyiv, Ukraine
- Department of Biotechnology, Leather and Fur, Faculty of Chemical and Biopharmaceutical Technologies, Kyiv National University of Technologies and Design, Nemyrovycha-Danchenka Street 2, 01011 Kyiv, Ukraine
| | - Alexey A. Krikunov
- National Amosov Institute of Cardio-Vascular Surgery Affiliated to National Academy of Medical Sciences of Ukraine, Amosov Str. 6, 02000 Kyiv, Ukraine
| | | | - Kateryna L. Rudnieva
- Kyiv Regional Clinical Hospital, Baggovutovskaya Str. 1, 04107 Kyiv, Ukraine
- Department of Microbiology, Virology and Immunology, Bogomolets National Medical University, Shevchenka Blvd. 13, 01601 Kyiv, Ukraine
| | - Geert Potters
- Antwerp Maritime Academy, Noordkasteel Oost 6, 2030 Antwerp, Belgium
- Department of Bioscience Engineering, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
- Correspondence: (O.V.M.); (G.P.)
| | - Ianina Pokholenko
- Department of Cell Regulatory Mechanisms, Institute of Molecular Biology and Genetics, National Academy of Sciences of Ukraine, 150 Zabolotnoho Str., 03680 Kyiv, Ukraine
- The Polymer Chemistry & Biomaterials Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281, S4-Bis, 9000 Ghent, Belgium
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Lu X, Zhong C, Liu Y, Ye H, Qu J, Zong Z, Lv X. Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections. Front Med (Lausanne) 2022; 9:1067548. [PMID: 36643845 PMCID: PMC9834999 DOI: 10.3389/fmed.2022.1067548] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/13/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Polymyxins are currently the last line of defense in the treatment of carbapenem-resistant organisms (CRO). As a kind of polymyxin available for clinical use in China, we aim to explore the efficacy and safety of colistin sulfate (Polymyxin E sulfate, PES) in this study. Methods This real-world retrospective study included 119 patients diagnosed with CRO infection and treated with PES for more than 72 h, from May 2020 to July 2022 at West China Hospital. The primary outcome was clinical efficacy at the end of treatment, and secondary outcomes included microbial response, in-hospital mortality and incidence of nephrotoxicity. Results The effective clinical and microbiological responses were 53.8% and 49.1%, respectively. And the in-hospital mortality was 27.7%. Only 9.2% of patients occurred with PES-related nephrotoxicity. Multivariate analysis revealed that duration of PES was an independent predictor of effective therapy, while age-adjusted Charlson comorbidity index (aCCI) and post-treatment PCT(p-PCT) were independent risk factors for poor outcome. Conclusions PES can be a salvage treatment for CRO-induced infections with favorable efficacy and low nephrotoxicity. The treatment duration of PES, aCCI and p-PCT were factors related to the clinical effectiveness of PES.
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Moshynets OV, Baranovskyi TP, Cameron S, Iungin OS, Pokholenko I, Jerdan R, Kamyshnyi A, Krikunov AA, Potochilova VV, Rudnieva KL, Spiers AJ. Azithromycin possesses biofilm–inhibitory activity and potentiates non-bactericidal colistin methanesulfonate (CMS) and polymyxin B against Klebsiella pneumonia. PLoS One 2022; 17:e0270983. [PMID: 35776759 PMCID: PMC9249213 DOI: 10.1371/journal.pone.0270983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Novel antibiotic combinations may act synergistically to inhibit the growth of multidrug-resistant bacterial pathogens but predicting which combination will be successful is difficult, and standard antimicrobial susceptibility testing may not identify important physiological differences between planktonic free-swimming and biofilm-protected surface-attached sessile cells. Using a nominally macrolide-resistant model Klebsiella pneumoniae strain (ATCC 10031) we demonstrate the effectiveness of several macrolides in inhibiting biofilm growth in multi-well plates, and the ability of azithromycin (AZM) to improve the effectiveness of the antibacterial last-agent-of-choice for K. pneumoniae infections, colistin methanesulfonate (CMS), against biofilms. This synergistic action was also seen in biofilm tests of several K. pneumoniae hospital isolates and could also be identified in polymyxin B disc-diffusion assays on azithromycin plates. Our work highlights the complexity of antimicrobial-resistance in bacterial pathogens and the need to test antibiotics with biofilm models where potential synergies might provide new therapeutic opportunities not seen in liquid culture or colony-based assays.
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Affiliation(s)
- Olena V. Moshynets
- Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
- * E-mail: (OVM); (AJS)
| | - Taras P. Baranovskyi
- Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
- Kyiv Regional Clinical Hospital, Kyiv, Ukraine
| | - Scott Cameron
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | - Olga S. Iungin
- Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
- Kyiv National University of Technologies and Design, Kyiv, Ukraine
| | - Ianina Pokholenko
- Institute of Molecular Biology and Genetics of the National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Robyn Jerdan
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
| | | | | | | | | | - Andrew J. Spiers
- School of Applied Sciences, Abertay University, Dundee, United Kingdom
- * E-mail: (OVM); (AJS)
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Aboumanei MH, Mahmoud AF, Motaleb MA. Formulation of chitosan coated nanoliposomes for the oral delivery of colistin sulfate: in vitro characterization, 99mTc-radiolabeling and in vivo biodistribution studies. Drug Dev Ind Pharm 2021; 47:626-635. [PMID: 33834934 DOI: 10.1080/03639045.2021.1908334] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Colistin sulfate is a very important antibiotic for the treatment of multidrug-resistant Gram-negative infections. Unfortunately, it has low oral bioavailability and several side effects following parenteral administration. The present study aims to develop chitosan-coated colistin nanoliposomes to improve the stability in the gastrointestinal tract and to enhance the oral delivery of colistin. The chitosan-coated colistin nanoliposomes were obtained via thin-film evaporation and electrostatic deposition methods using either Span 60, Tween 65 or Tween 80 as surfactants with different cholesterol: surfactant: soya lecithin ratios. The influence of systems variables was further characterized by vesicle size analysis, zeta potential (ZP), poly dispersibility index (PDI), and also their entrapment efficiency percentage (EE %) was evaluated. Various systems were formed with vesicle sizes in the nano-range, 155.64 ± 12.53 nm to 315.64 ± 15.90 nm, and EE % of 45.2 ± 2.9% to 81.8 ± 2.9%. Moreover, the ZP value of the prepared nanoliposomes switched from a negative to a positive value after chitosan coating. To track the released colistin in vivo, technetium 99m (99mTc) was incorporated into the optimum system (S-3) system via direct coupling with colistin. Chitosan-coated 99mTc-colistin nanoliposome, 99mTc-colistin suspension, and 99mTc-chitosan-coated nanoliposomes (placebo) were administered orally into bacterial infection (Escherichia coli) bearing mice. The biodistribution results showed that chitosan-coated nanoliposome significantly enhanced the bioavailability of colistin compared to colistin suspension (the commercially available). Moreover, the system effectively improved the localization of colistin at the infected muscle. In conclusion, this approach offers a promising tool for enhanced oral delivery of colistin.
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Affiliation(s)
- Mohamed H Aboumanei
- Labeled Compounds Department, Hot Lab Center, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Ashgan F Mahmoud
- Labeled Compounds Department, Hot Lab Center, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - M A Motaleb
- Labeled Compounds Department, Hot Lab Center, Egyptian Atomic Energy Authority, Cairo, Egypt
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Potential dietary feed additives with antibacterial effects and their impact on performance of weaned piglets: A meta-analysis. Vet J 2019; 249:24-32. [PMID: 31239161 DOI: 10.1016/j.tvjl.2019.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
This meta-analysis evaluated the use of potential dietary feed additives (pDFA) with antibacterial effects and their impact on the perfomance of weaned piglets. Twenty-three peer-reviewed in vivo studies, comprising 50 trials, were identified between January 2010 and January 2017. The pDFA in these studies could be grouped in 5 classes: antimicrobial peptides, chitosan, lysozyme, medium chain fatty acids/ triglycerides and plant extracts. Mixed-effect meta-analyses with type of pDFA as fixed effect were performed for the growth parameters 'average daily gain' (ADG) and 'feed conversion ratio' (FCR), which are the two most important and used economic performance parameters for farmers. For each class of pDFA, results of the meta-analysis showed significantly higher average daily gain in the group with pDFA compared to the negative control group, while no significant difference with the positive control group was observed. Furthermore, a positive effect on FCR was found, i.e. significantly less feed was needed to gain 1 kg of body weight in the group with pDFA compared to the negative control group. No significant differences with positive control groups were observed for each class of pDFA, except for plant extracts, where the FCR was also significantly reduced in the treatment group. These results suggest that pDFA could reduce the use of antimicrobials without significant negative effects on performance indicators.
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MacNair CR, Stokes JM, Carfrae LA, Fiebig-Comyn AA, Coombes BK, Mulvey MR, Brown ED. Overcoming mcr-1 mediated colistin resistance with colistin in combination with other antibiotics. Nat Commun 2018; 9:458. [PMID: 29386620 PMCID: PMC5792607 DOI: 10.1038/s41467-018-02875-z] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022] Open
Abstract
Plasmid-borne colistin resistance mediated by mcr-1 may contribute to the dissemination of pan-resistant Gram-negative bacteria. Here, we show that mcr-1 confers resistance to colistin-induced lysis and bacterial cell death, but provides minimal protection from the ability of colistin to disrupt the Gram-negative outer membrane. Indeed, for colistin-resistant strains of Enterobacteriaceae expressing plasmid-borne mcr-1, clinically relevant concentrations of colistin potentiate the action of antibiotics that, by themselves, are not active against Gram-negative bacteria. The result is that several antibiotics, in combination with colistin, display growth-inhibition at levels below their corresponding clinical breakpoints. Furthermore, colistin and clarithromycin combination therapy displays efficacy against mcr-1-positive Klebsiella pneumoniae in murine thigh and bacteremia infection models at clinically relevant doses. Altogether, these data suggest that the use of colistin in combination with antibiotics that are typically active against Gram-positive bacteria poses a viable therapeutic alternative for highly drug-resistant Gram-negative pathogens expressing mcr-1.
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Affiliation(s)
- Craig R MacNair
- Michael G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, L8N 3ZS, Canada
| | - Jonathan M Stokes
- Michael G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, L8N 3ZS, Canada
| | - Lindsey A Carfrae
- Michael G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, L8N 3ZS, Canada
| | - Aline A Fiebig-Comyn
- Michael G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, L8N 3ZS, Canada
| | - Brian K Coombes
- Michael G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, L8N 3ZS, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Eric D Brown
- Michael G. DeGroote Institute for Infectious Disease Research, Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, L8N 3ZS, Canada.
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Administration of colistin sulfate in endotoxic model at slow and sustained fashion may reverse shock without causing nephrotoxicity in its optimal concentration. J Glob Antimicrob Resist 2017; 11:40-44. [PMID: 28774864 DOI: 10.1016/j.jgar.2017.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/24/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Despite of proven LPS neutralizing activity, intravenous polymyxin use was waned due to experience of associated nephrotoxicity. But, increasing resistance to all available antibiotics has necessitated their resurgence and the prodrug of colistin sulfate (CS), known as colistin-methanesulfonate (CMS), is increasingly used as the only therapeutic option in many infections. Currently available CMS employ very different dose definitions and thus because of complex pharmacokinetics/pharmacodynamics information and short half-life, this drug use remains confusing. We aimed to expose CS in endotoxic shock models by micro-osmotic pump and evaluated its effectiveness. METHODS We used micro-osmotic pumps to deliver either sterile saline or CS at different dosages ranging from 0.25mg/day to 7mg/day for consecutive 3days in LPS (8mg/kg body weight) induced endotoxic mice and observed their outcome twice daily for a week to determine the survival rate. Serum pro-inflammatory cytokine levels and apoptosis in renal tissues in these models were evaluated. RESULTS We showed endotoxic shock was reversed and all mice survived with a CS administration at a dosage of 2mg/day for 3 days, in comparison to survival rate with saline administration (p≤0.0001) in endotoxic models. CS infusion in shock models using micro-osmotic pump ameliorated rising of serum TNF-α, IL-12p70 and IL-6 levels. Nephrotoxicity was evident only with a higher dosage, but not with a lower dosage which was optimum to control endotoxic shock in models. CONCLUSIONS These results highlighted that an optimal dosage of CS effectively improved outcome in endotoxic shock models without causing nephrotoxicity when administered at a slow and sustained manner. And a higher CS dosage administration was nephrotoxic and fatal. Thus this study bought an opportunity to consider future investigations with CS administration in murine Gram-negative bacterial infections in a novel way.
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Yu W, Zhou K, Guo L, Ji J, Niu T, Xiao T, Shen P, Xiao Y. In vitro Pharmacokinetics/Pharmacodynamics Evaluation of Fosfomycin Combined with Amikacin or Colistin against KPC2-Producing Klebsiella pneumoniae. Front Cell Infect Microbiol 2017; 7:246. [PMID: 28670570 PMCID: PMC5472793 DOI: 10.3389/fcimb.2017.00246] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/26/2017] [Indexed: 01/12/2023] Open
Abstract
Objectives: The emergence of carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae, has become a major concern in clinic settings. Combination therapy is gaining momentum to counter the secondary resistance and potential suboptimal efficacy of monotherapy. The aim of this study was to evaluate the bactericidal effect of fosfomycin (FM), amikacin (AMK), or colistin (COL) alone and combinations against KPC2-producing K. pneumoniae using dynamic model by simulating human pharmacokinetics in vitro. Methods: The Pharmacokinetics Auto Simulation System 400 system was employed to simulate different dosing regimens of FM, AMK, and COL alone and combination. Bacterial growth recovery time (RT) and the area between the control growth and antibacterial killing curves (IE) were used as unbiased and comprehensive means for determining the antimicrobial effect. Results: We observed that COL alone was much pronounced than FM or AMK against KPC-Kp. IE of FM (8 g every 8 h) plus AMK (15 mg/kg once-daily) and FM (8 g every 8 h) plus COL (75,000 IU/kg every 12 h) were higher (>170 and >200 LogCFU/mL·h-1, respectively) than that of monotherapies against sensitive strains. Of note, the rate of resistance was lower when using the combination of FM (8 g every 8 h) plus COL (75,000 IU/kg every 12 h) than using COL (75,000 IU/kg every 12 h) alone. Conclusions: The combination of FM (8 g every 8 h) plus AMK (15 mg/kg once-daily) and FM (8 g every 8 h) plus COL (75,000 IU/kg every 12 h) were effective at maximizing bacterial killing and suppressing emergence of resistance.
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Affiliation(s)
- Wei Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China.,Department of Infectious Diseases, Zhejiang Provincial People's HospitalHangzhou, China
| | - Kai Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Lihua Guo
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Jinru Ji
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Tianshui Niu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Tingting Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang UniversityHangzhou, China
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Rhouma M, Fairbrother JM, Beaudry F, Letellier A. Post weaning diarrhea in pigs: risk factors and non-colistin-based control strategies. Acta Vet Scand 2017; 59:31. [PMID: 28526080 PMCID: PMC5437690 DOI: 10.1186/s13028-017-0299-7] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/11/2017] [Indexed: 12/20/2022] Open
Abstract
Post-weaning diarrhea (PWD) is one of the most serious threats for the swine industry worldwide. It is commonly associated with the proliferation of enterotoxigenic Escherichia coli in the pig intestine. Colistin, a cationic antibiotic, is widely used in swine for the oral treatment of intestinal infections caused by E. coli, and particularly of PWD. However, despite the effectiveness of this antibiotic in the treatment of PWD, several studies have reported high rates of colistin resistant E. coli in swine. Furthermore, this antibiotic is considered of very high importance in humans, being used for the treatment of infections due to multidrug-resistant (MDR) Gram-negative bacteria (GNB). Moreover, the recent discovery of the mcr-1 gene encoding for colistin resistance in Enterobacteriaceae on a conjugative stable plasmid has raised great concern about the possible loss of colistin effectiveness for the treatment of MDR-GNB in humans. Consequently, it has been proposed that the use of colistin in animal production should be considered as a last resort treatment only. Thus, to overcome the economic losses, which would result from the restriction of use of colistin, especially for prophylactic purposes in PWD control, we believe that an understanding of the factors contributing to the development of this disease and the putting in place of practical alternative strategies for the control of PWD in swine is crucial. Such alternatives should improve animal gut health and reduce economic losses in pigs without promoting bacterial resistance. The present review begins with an overview of risk factors of PWD and an update of colistin use in PWD control worldwide in terms of quantities and microbiological outcomes. Subsequently, alternative strategies to the use of colistin for the control of this disease are described and discussed. Finally, a practical approach for the control of PWD in its various phases is proposed.
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Sorlí L, Luque S, Segura C, Campillo N, Montero M, Esteve E, Herrera S, Benito N, Alvarez-Lerma F, Grau S, Horcajada JP. Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa. BMC Infect Dis 2017; 17:11. [PMID: 28056821 PMCID: PMC5217330 DOI: 10.1186/s12879-016-2117-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/14/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colistin has a narrow therapeutic window with nephrotoxicity being the major dose-limiting adverse effect. Currently, the optimal doses and therapeutic plasma levels are unknown. METHODS Prospective observational cohort study, including patients infected by colistin-susceptible P. aeruginosa treated with intravenous colistimethate sodium (CMS). Clinical data and colistin plasma levels at steady-state (Css) were recorded. The primary and secondary end points were clinical cure and 30-day all-cause mortality. RESULTS Ninety-one patients were included. Clinical cure was observed in 72 (79%) patients. The mean (SD) Css was 1.49 (1.4) mg/L and 2.42 (1.5) mg/L (p = 0.01) in patients who achieved clinical cure and those who not, respectively. Independent risk factors for clinical failure were male sex (OR 5.88; 95% CI 1.09-31.63), APACHE II score (OR 1.15; 95% CI 1.03-1.27) and nephrotoxicity at the EOT (OR 9.13; 95% CI 95% 2.06-40.5). The 30-day mortality rate was 30.8%. Risk factors for 30-day mortality included the APACHE II score (OR 1.98; 95% CI 1-1.20), the McCabe score (OR 2.49; 95% CI 1.14-5.43) and the presence of nephrotoxicity at the end of treatment (EOT) (OR 3.8; 95% CI 1.26-11.47). CONCLUSION In this series of patients with infections caused by XDR P. aeruginosa infections, Css is not observed to be related to clinical outcome.
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Affiliation(s)
- Luisa Sorlí
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Sonia Luque
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Concepción Segura
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Laboratori de Referència de Catalunya, Prat de Llobregat, Spain
| | - Nuria Campillo
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Milagro Montero
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Erika Esteve
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Sabina Herrera
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Natividad Benito
- InfectiousDiseaseUnit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Francisco Alvarez-Lerma
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain
- CIBERES, Madrid, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- CIBERES, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Disease Service, Hospital del Mar, Barcelona, Spain
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Intensive Care Unit, Hospital del Mar, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
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Rhouma M, Beaudry F, Thériault W, Letellier A. Colistin in Pig Production: Chemistry, Mechanism of Antibacterial Action, Microbial Resistance Emergence, and One Health Perspectives. Front Microbiol 2016; 7:1789. [PMID: 27891118 PMCID: PMC5104958 DOI: 10.3389/fmicb.2016.01789] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/25/2016] [Indexed: 01/08/2023] Open
Abstract
Colistin (Polymyxin E) is one of the few cationic antimicrobial peptides commercialized in both human and veterinary medicine. For several years now, colistin has been considered the last line of defense against infections caused by multidrug-resistant Gram-negative such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Colistin has been extensively used orally since the 1960s in food animals and particularly in swine for the control of Enterobacteriaceae infections. However, with the recent discovery of plasmid-mediated colistin resistance encoded by the mcr-1 gene and the higher prevalence of samples harboring this gene in animal isolates compared to other origins, livestock has been singled out as the principal reservoir for colistin resistance amplification and spread. Co-localization of the mcr-1 gene and Extended-Spectrum-β-Lactamase genes on a unique plasmid has been also identified in many isolates from animal origin. The use of colistin in pigs as a growth promoter and for prophylaxis purposes should be banned, and the implantation of sustainable measures in pig farms for microbial infection prevention should be actively encouraged and financed. The scientific research should be encouraged in swine medicine to generate data helping to reduce the exacerbation of colistin resistance in pigs and in manure. The establishment of guidelines ensuring a judicious therapeutic use of colistin in pigs, in countries where this drug is approved, is of crucial importance. The implementation of a microbiological withdrawal period that could reduce the potential contamination of consumers with colistin resistant bacteria of porcine origin should be encouraged. Moreover, the management of colistin resistance at the human-pig-environment interface requires the urgent use of the One Health approach for effective control and prevention. This approach needs the collaborative effort of multiple disciplines and close cooperation between physicians, veterinarians, and other scientific health and environmental professionals. This review is an update on the chemistry of colistin, its applications and antibacterial mechanism of action, and on Enterobacteriaceae resistance to colistin in pigs. We also detail and discuss the One Health approach and propose guidelines for colistin resistance management.
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Affiliation(s)
- Mohamed Rhouma
- Chaire de Recherche Industrielle du CRSNG en Salubrité des Viandes, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche et d’Enseignement en Salubrité Alimentaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
| | - Francis Beaudry
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche en Pharmacologie Animale du Québec, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
| | - William Thériault
- Chaire de Recherche Industrielle du CRSNG en Salubrité des Viandes, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche et d’Enseignement en Salubrité Alimentaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
| | - Ann Letellier
- Chaire de Recherche Industrielle du CRSNG en Salubrité des Viandes, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche et d’Enseignement en Salubrité Alimentaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Centre de Recherche en Infectiologie Porcine et Avicole, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
- Groupe de Recherche en Pharmacologie Animale du Québec, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-HyacintheQC, Canada
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Le Devendec L, Mourand G, Bougeard S, Léaustic J, Jouy E, Keita A, Couet W, Rousset N, Kempf I. Impact of colistin sulfate treatment of broilers on the presence of resistant bacteria and resistance genes in stored or composted manure. Vet Microbiol 2016; 194:98-106. [DOI: 10.1016/j.vetmic.2015.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/09/2015] [Accepted: 11/12/2015] [Indexed: 11/16/2022]
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Patil S, Zirpe K, Mukherjee D, Hajare A, Korukonda K, Bhargava A. Survival or Safety: Balancing act with Colistin. J Glob Infect Dis 2015; 7:3-4. [PMID: 25722612 PMCID: PMC4338446 DOI: 10.4103/0974-777x.150881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Saiprasad Patil
- Medical Services, Glenmark Pharmaceuticals Ltd., B. D. Sawant Marg, Chakala, Andheri (E), Mumbai, India
| | - Kapil Zirpe
- Neurointensive Care, Ruby Hall Clinic, Pune, India
| | | | - Anoop Hajare
- Medical Services, Glenmark Pharmaceuticals Ltd., B. D. Sawant Marg, Chakala, Andheri (E), Mumbai, India
| | - Krishnaprasad Korukonda
- Medical Services, Glenmark Pharmaceuticals Ltd., B. D. Sawant Marg, Chakala, Andheri (E), Mumbai, India
| | - Amit Bhargava
- Medical Services, Glenmark Pharmaceuticals Ltd., B. D. Sawant Marg, Chakala, Andheri (E), Mumbai, India
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Delgado-Valverde M, Sojo-Dorado J, Pascual A, Rodríguez-Baño J. Clinical management of infections caused by multidrug-resistant Enterobacteriaceae. Ther Adv Infect Dis 2014; 1:49-69. [PMID: 25165544 DOI: 10.1177/2049936113476284] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Enterobacteriaceae showing resistance to cephalosporins due to extended-spectrum β-lactamases (ESBLs) or plasmid-mediated AmpC enzymes, and those producing carbapenemases have spread worldwide during the last decades. Many of these isolates are also resistant to other first-line agents such as fluoroquinolones or aminoglycosides, leaving few available options for therapy. Thus, older drugs such as colistin and fosfomycin are being increasingly used. Infections caused by these bacteria are associated with increased morbidity and mortality compared with those caused by their susceptible counterparts. Most of the evidence supporting the present recommendations is from in vitro data, animal studies, and observational studies. While carbapenems are considered the drugs of choice for ESBL and AmpC producers, recent data suggest that certain alternatives may be suitable for some types of infections. Combined therapy seems superior to monotherapy in the treatment of invasive infections caused by carbapenemase-producing Enterobacteriaceae. Optimization of dosage according to pharmacokinetics/pharmacodynamics data is important for the treatment of infections caused by isolates with borderline minimum inhibitory concentration due to low-level resistance mechanisms. The increasing frequency and the rapid spread of multidrug resistance among the Enterobacteriaceae is a true and complex public health problem.
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Affiliation(s)
- Mercedes Delgado-Valverde
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Jesús Sojo-Dorado
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alvaro Pascual
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, and Department of Microbiology, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, 41009 Seville, Spain
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Dewan A, Shoukat M. Evaluation of risk of nephrotoxicity with high dose, extended-interval colistin administration. Indian J Crit Care Med 2014; 18:427-30. [PMID: 25097354 PMCID: PMC4118507 DOI: 10.4103/0972-5229.136070] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim was to evaluate the risk of nephrotoxicity with high-dose, extended-interval regimen of colistin administration in critical ill patients. Materials and Methods: This prospective study was conducted on patients suffering from sepsis due to Gram-negative infection susceptible only to colistin. The dosing schedule for colistin was 9 million units stat followed by 4.5 million units at 12 hourly interval (adjusted as per body weight and renal functions). The serum creatinine and creatinine clearance were estimated at the start of therapy and daily during therapy. Results: Thirty-one patients suffering ventilator associated pneumonia (61.29%), blood stream infections (29.03%) and urinary tract infections (9.67%) due to Gram-negative multiple drug resistance organisms were assessed. Most commonly isolated organism were Acinetobacter baumannii (54.83%), Klebsiella pneumonia (16.12%) and Pseudomonas (29.03%). Five patients (16.12%) developed acute kidney injury within 4-5 days of start of therapy and returned to baseline after 6 days with no patient requiring renal replacement therapy or discontinuation of colistin. Conclusion: Our study showed that high-dose, extended-interval colistin can be given to critically ill patients without any significant risk of nephrotoxicity.
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Affiliation(s)
- Arun Dewan
- Department of Medicine and Critical Care, Batra Hospital, New Delhi, India
| | - Mujeeb Shoukat
- Department of Medicine and Critical Care, Batra Hospital, New Delhi, India
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Kontopidou F, Giamarellou H, Katerelos P, Maragos A, Kioumis I, Trikka-Graphakos E, Valakis C, Maltezou H. Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options. Clin Microbiol Infect 2014; 20:O117-23. [DOI: 10.1111/1469-0691.12341] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/03/2013] [Accepted: 07/14/2013] [Indexed: 11/27/2022]
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Wertheim H, Van Nguyen K, Hara GL, Gelband H, Laxminarayan R, Mouton J, Cars O. Global survey of polymyxin use: A call for international guidelines. J Glob Antimicrob Resist 2013; 1:131-134. [PMID: 24749079 PMCID: PMC3991322 DOI: 10.1016/j.jgar.2013.03.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 03/20/2013] [Accepted: 03/25/2013] [Indexed: 11/04/2022] Open
Abstract
Polymyxins (polymyxin B and colistin) are older bactericidal antibiotics that are increasingly used to treat infections caused by multidrug-resistant (MDR) Gram-negative bacteria. However, dosing and clinical use of these drugs vary widely. This survey was undertaken to reveal how polymyxins are used worldwide. Data were collected through a structured online questionnaire consisting of 24 questions regarding colistin usage patterns and indications as well as colistin dosage for adult patients. The questionnaire was disseminated in 2011 to relevant experts worldwide and was completed by 284 respondents from 56 different countries. Respondents from 11/56 countries (20%) had no access to colistin; 58/284 respondents (20.4%) reported that in 2010 they experienced that colistin was not available when needed. Formulations of polymyxins used were reported as: colistimethate sodium (48.6%); colistin sulfate (14.1%); both (1.4%); polymyxin B (1.4%); and unknown. Intravenous formulations were used by 84.2%, aerosolised or nebulised colistin by 44.4% and oral colistin for selective gut decontamination by 12.7%. Common indications for intravenous colistin were ventilator-associated pneumonia, sepsis and catheter-related infections with MDR Gram-negative bacteria. Only 21.2% of respondents used a colistin-loading dose, mainly in Europe and North America. This survey reveals that the majority of respondents use colistin and a few use polymyxin B. The survey results show that colistin is commonly underdosed. Clear guidance is needed on indications, dosing and antibiotic combinations to improve clinical outcomes and delay the emergence of resistance. Colistin should be considered a last-resort drug and its use should be controlled. International guidelines are urgently needed.
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Affiliation(s)
- Heiman Wertheim
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Viet Nam ; Nuffield Department of Clinical Medicine, Centre for Tropical Diseases, Oxford, UK
| | | | - Gabriel Levy Hara
- Infectious Diseases Unit, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Hellen Gelband
- Center for Disease Dynamics Economics and Policy, Washington, DC, USA
| | - Ramanan Laxminarayan
- Center for Disease Dynamics Economics and Policy, Washington, DC, USA ; Princeton University, Princeton, NJ, USA
| | - Johan Mouton
- Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Otto Cars
- Action on Antibiotic Resistance (ReAct), Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Dalfino L, Puntillo F, Mosca A, Monno R, Spada ML, Coppolecchia S, Miragliotta G, Bruno F, Brienza N. High-dose, extended-interval colistin administration in critically ill patients: is this the right dosing strategy? A preliminary study. Clin Infect Dis 2012; 54:1720-6. [PMID: 22423120 PMCID: PMC3357480 DOI: 10.1093/cid/cis286] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In critically ill patients with otherwise untreatable nosocomial infection due to gram-negative bacteria susceptible only to colistin, a high-dose, extended-interval colistin dosing regimen is, according to the pharmacokinetic/pharmacodynamic behavior of the drug, associated with low renal toxicity and high efficacy. Background. Gram-negative bacteria susceptible only to colistin (COS) are emerging causes of severe nosocomial infections, reviving interest in the use of colistin. However, consensus on the most effective way to administer colistin has not yet been reached. Methods. All patients who had sepsis due to COS gram-negative bacteria or minimally susceptible gram-negative bacteria and received intravenous colistimethate sodium (CMS) were prospectively enrolled. The CMS dosing schedule was based on a loading dose of 9 MU and a 9-MU twice-daily fractioned maintenance dose, titrated on renal function. For each CMS course, clinical cure, bacteriological clearance, daily serum creatinine clearance, and estimated creatinine clearance were recorded. Results. Twenty-eight infectious episodes due to Acinetobacter baumannii (46.4%), Klebsiella pneumoniae (46.4%), and Pseudomonas aeruginosa (7.2%) were analyzed. The main types of infection were bloodstream infection (64.3%) and ventilator-associated pneumonia (35.7%). Clinical cure was observed in 23 cases (82.1%). Acute kidney injury developed during 5 treatment courses (17.8%), did not require renal replacement therapy, and subsided within 10 days from CMS discontinuation. No correlation was found between variation in serum creatinine level (from baseline to peak) and daily and cumulative doses of CMS, and between variation in serum creatinine level (from baseline to peak) and duration of CMS treatment. Conclusions. Our study shows that in severe infections due to COS gram-negative bacteria, the high-dose, extended-interval CMS regimen has a high efficacy, without significant renal toxicity.
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Affiliation(s)
- Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Emergeny and Organ Transplantion, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
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