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Shakerimoghaddam A, Moghaddam AD, Barghchi B, Pisheh Sanani MG, Azami P, Kalmishi A, Sabeghi P, Motavalli F, Khomartash MS, Mousavi SH, Nikmanesh Y. Prevalence of Pseudomonas aeruginosa and its antibiotic resistance in patients who have received Hematopoietic Stem-Cell Transplantation; A globally Systematic Review. Microb Pathog 2023; 184:106368. [PMID: 37769854 DOI: 10.1016/j.micpath.2023.106368] [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: 08/12/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Gram-negative bacteria are infectious and life-threatening agents after hematopoietic stem cell transplantation (HSCT). So, this study aimed to investigate the prevalence of Pseudomonas aeruginosa and its antibiotic resistance in patients who have received Hematopoietic Stem-Cell Transplantation through a systematic review. The systematic search was done with key words; Pseudomonas aeruginosa, hematopoietic stem cell transplantation from 2000 to the end of July 2023 in Google Scholar and PubMed/Medline, Scopus, and Web of Science. Twelve studies were able to include our study. Quality assessment of studies was done by Appraisal tool for Cross-Sectional Studies. The most of the included studies were conducted as allo-HSCT. Infections such as respiratory infection, urinary infection and bacteremia have occurred. The rate of prevalence with P. aeruginosa has varied between 3 and 100%. The average age of the participants was between 1 and 74 years. The rate of prevalence of P. aeruginosa resistant to several drugs has been reported to be variable, ranging from 20 to 100%. The highest antibiotic resistance was reported against cefotetan (100%), and the lowest was related to tobramycin (1.8%) followed by amikacin, levofloxacin and ciprofloxacin with the prevalence of 16.6%. Our findings showed a high prevalence and antibiotic resistance rate of P. aeruginosa in Hematopoietic stem cell transplantation. Therefore, more serious health measures should be taken in patients after transplantation.
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Affiliation(s)
- Ali Shakerimoghaddam
- Medical Biotechnology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Arasb Dabbagh Moghaddam
- Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran; Department of Public Health & Nutrition, Aja University of Medical Sciences, Tehran, Iran
| | - Bita Barghchi
- Medical School, Islamic Azad University, Tehran, Branch, Tehran, Iran
| | | | - Pouria Azami
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Kalmishi
- Department of Internal and Surgical Nursing Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Paniz Sabeghi
- Medical School, Shiraz University of Medical Sciences, Shiraz Branch, Shiraz, Iran
| | - Farhad Motavalli
- Medical Biotechnology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | | | - Seyyed Hossein Mousavi
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Yousef Nikmanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Tiwari P, Srivastava Y, Sharma A, Vinayagam R. Antimicrobial Peptides: The Production of Novel Peptide-Based Therapeutics in Plant Systems. Life (Basel) 2023; 13:1875. [PMID: 37763279 PMCID: PMC10532476 DOI: 10.3390/life13091875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The increased prevalence of antibiotic resistance is alarming and has a significant impact on the economies of emerging and underdeveloped nations. The redundancy of antibiotic discovery platforms (ADPs) and injudicious use of conventional antibiotics has severely impacted millions, across the globe. Potent antimicrobials from biological sources have been extensively explored as a ray of hope to counter the growing menace of antibiotic resistance in the population. Antimicrobial peptides (AMPs) are gaining momentum as powerful antimicrobial therapies to combat drug-resistant bacterial strains. The tremendous therapeutic potential of natural and synthesized AMPs as novel and potent antimicrobials is highlighted by their unique mode of action, as exemplified by multiple research initiatives. Recent advances and developments in antimicrobial discovery and research have increased our understanding of the structure, characteristics, and function of AMPs; nevertheless, knowledge gaps still need to be addressed before these therapeutic options can be fully exploited. This thematic article provides a comprehensive insight into the potential of AMPs as potent arsenals to counter drug-resistant pathogens, a historical overview and recent advances, and their efficient production in plants, defining novel upcoming trends in drug discovery and research. The advances in synthetic biology and plant-based expression systems for AMP production have defined new paradigms in the efficient production of potent antimicrobials in plant systems, a prospective approach to countering drug-resistant pathogens.
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Affiliation(s)
- Pragya Tiwari
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Gyeongbuk, Republic of Korea;
| | - Yashdeep Srivastava
- RR Institute of Modern Technology, Dr. A.P.J. Abdul Kalam Technical University, Sitapur Road, Lucknow 226201, Uttar Pradesh, India;
| | - Abhishek Sharma
- Department of Biotechnology and Bioengineering, Institute of Advanced Research, Koba Institutional Area, Gandhinagar 392426, Gujarat, India;
| | - Ramachandran Vinayagam
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Gyeongbuk, Republic of Korea;
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Abdelrahman DH, AbuSara AK, Khabour DS. The Impact of Pharmacist-Led Antimicrobial Stewardship Review of Cultures in the Ambulatory Setting at a Comprehensive Cancer Center. Hosp Pharm 2023; 58:392-395. [PMID: 37360207 PMCID: PMC10288453 DOI: 10.1177/00185787221150920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Background: Several antimicrobial stewardship interventions have demonstrated improved clinical outcomes. Though the impact of a pharmacist-led antimicrobial stewardship review of cultures has been described, studies have not evaluated such an intervention in institutions that primarily serve cancer patients. Aim: To describe the impact of the antimicrobial stewardship pharmacist's review of microbiological cultures from adult cancer patients in the ambulatory setting. Method: A retrospective study at a comprehensive cancer center that included adult cancer patients with positive microbiological cultures treated in the ambulatory setting, between August 2020 and February 2021. The cultures were reviewed in real time by the antimicrobial stewardship pharmacist, and were assessed for appropriateness of treatment. The number of antimicrobial modifications made, type of modifications, and physicians' acceptance rate were recorded. Results: A total of 661 cultures from 504 patients were reviewed by the pharmacist. The mean age of patients was 58 years ± 16 (SD); most had solid tumors (95%), and 34% were recent recipients of chemotherapy. Among the reviewed cultures, 175 (26%) required antimicrobial therapy modification, with an acceptance rate of 86%. The modifications consisted of changing from non-susceptible to susceptible antimicrobials (n = 95, 54%), initiation (n = 61, 35%), discontinuation (n = 10, 6%), de-escalation (n = 7, 4%), and dose modification (n = 2, 1%) of antimicrobials. Conclusion: Around one fourth of the cultures reviewed by the antimicrobial stewardship pharmacist in the ambulatory setting required interventions to optimize therapy. Future studies should evaluate the impact of these interventions on clinical outcomes.
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Youssef A, Mohammed BK, Prasad A, del Aguila A, Bassi G, Yang W, Ulloa L. Splenic SUMO1 controls systemic inflammation in experimental sepsis. Front Immunol 2023; 14:1200939. [PMID: 37520526 PMCID: PMC10374847 DOI: 10.3389/fimmu.2023.1200939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The recent discovery of TAK981(Subasumstat), the first-in-class selective inhibitor of SUMOylation, enables new immune treatments. TAK981 is already in clinical trials to potentiate immunotherapy in metastatic tumors and hematologic malignancies. Cancer patients have more than ten times higher risk of infections, but the effects of TAK981 in sepsis are unknown and previous studies on SUMO in infections are conflicting. Methods We used TAK981 in two sepsis models; polymicrobial peritonitis (CLP) and LPS endotoxemia. Splenectomy was done in both models to study the role of spleen. Western blotting of SUMO-conjugated proteins in spleen lysates was done. Global SUMO1 and SUMO3 knockout mice were used to study the specific SUMO regulation of inflammation in LPS endotoxemia. Splenocytes adoptive transfer was done from SUMO knockouts to wild type mice to study the role of spleen SUMOylation in experimental sepsis. Results and discussion Here, we report that inhibition of SUMOylation with TAK981 improved survival in mild polymicrobial peritonitis by enhancing innate immune responses and peritoneal bacterial clearance. Thus, we focused on the effects of TAK981 on the immune responses to bacterial endotoxin, showing that TAK981 enhanced early TNFα production but did not affect the resolution of inflammation. Splenectomy decreased serum TNFα levels by nearly 60% and TAK981-induced TNFα responses. In the spleen, endotoxemia induced a distinct temporal and substrate specificity for SUMO1 and SUMO2/3, and both were inhibited by TAK981. Global genetic depletion of SUMO1, but not SUMO3, enhanced TNFα production and metabolic acidosis. The transfer of SUMO1-null, but not wild-type, splenocytes into splenectomized wild-type mice exacerbated TNFα production and metabolic acidosis in endotoxemia. Conclusion These results suggest that specific regulation of splenic SUMO1 can modulate immune and metabolic responses to bacterial infection.
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Ray A, Moore TF, Pandit R, Burke AD, Borsch DM. An Overview of Selected Bacterial Infections in Cancer, Their Virulence Factors, and Some Aspects of Infection Management. BIOLOGY 2023; 12:963. [PMID: 37508393 PMCID: PMC10376897 DOI: 10.3390/biology12070963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023]
Abstract
In cancer development and its clinical course, bacteria can be involved in etiology and secondary infection. Regarding etiology, various epidemiological studies have revealed that Helicobacter pylori can directly impact gastric carcinogenesis. The Helicobacter pylori-associated virulence factor cytotoxin-associated gene A perhaps plays an important role through different mechanisms such as aberrant DNA methylation, activation of nuclear factor kappa B, and modulation of the Wnt/β-catenin signaling pathway. Many other bacteria, including Salmonella and Pseudomonas, can also affect Wnt/β-catenin signaling. Although Helicobacter pylori is involved in both gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma, its role in the latter disease is more complicated. Among other bacterial species, Chlamydia is linked with a diverse range of diseases including cancers of different sites. The cellular organizations of Chlamydia are highly complex. Interestingly, Escherichia coli is believed to be associated with colon cancer development. Microorganisms such as Escherichia coli and Pseudomonas aeruginosa are frequently isolated from secondary infections in cancer patients. In these patients, the common sites of infection are the respiratory, gastrointestinal, and urinary tracts. There is an alarming rise in infections with multidrug-resistant bacteria and the scarcity of suitable antimicrobial agents adversely influences prognosis. Therefore, effective implementation of antimicrobial stewardship strategies is important in cancer patients.
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Affiliation(s)
- Amitabha Ray
- College of Medical Science, Alderson Broaddus University, 101 College Hill Drive, Philippi, WV 26416, USA
| | - Thomas F Moore
- College of Medical Science, Alderson Broaddus University, 101 College Hill Drive, Philippi, WV 26416, USA
| | | | | | - Daniel M Borsch
- Lake Erie College of Osteopathic Medicine at Seton Hill, Greensburg, PA 15601, USA
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Chew C, Shih V, Han Z. Evaluation of antibiotic appropriateness at an outpatient oncology centre. J Oncol Pharm Pract 2023; 29:874-884. [PMID: 35306916 DOI: 10.1177/10781552221087604] [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] [Indexed: 11/15/2022]
Abstract
Current evidence supporting antimicrobial stewardship programs focused largely in inpatient setting. With the shift in cancer management from inpatient to ambulatory setting, it is crucial to examine the prevalence and predictors of inappropriate antibiotics prescribing. This is a retrospective cross-sectional study conducted at the National Cancer Centre Singapore (NCCS). Patients at least 21 years, with an active or past cancer diagnosis and prescribed with at least one oral antibiotic by a NCCS physician from 1st July to 30th September 2019 were included. Antibiotic appropriateness was assessed using institutional antibiotic guidelines or published clinical practice guidelines. For cases where antibiotics appropriateness cannot be ascertained using these guidelines, an independent three-member expert panel was consulted. A total of 815 patients were screened; 411 (59.4% females) were included with mean age of 62.4 years. The top three cancer diagnoses were breast (26.5%), lung (15.6%) and head and neck (13.6%). More than half (58.6%) received appropriate antibiotic choice. Of which, 235 (97.5%), 238 (98.8%) and 194 (80.5%) received appropriate dose, frequency and duration respectively. The presence of non-oncologic immunosuppressive comorbidities (OR 4.890, 95% CI 1.556-15.369, p-value = 0.007), antibiotic allergy (OR 2.352, 95% CI 1.178-4.698, p-value = 0.015) and skin and soft tissue infections (OR 2.004, 95% CI 1.276-3.146, p-value = 0.003) were associated with a higher incidence of inappropriate antibiotic choice. This study highlighted that inappropriate antibiotic prescribing is prevalent in the ambulatory oncology setting. Predicators identified can aid in the design of targeted strategies to optimise antibiotic use in ambulatory oncology patients.
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Affiliation(s)
- Cindy Chew
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Vivianne Shih
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Zhe Han
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
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Douglas A, Thursky K, Slavin M. New approaches to management of fever and neutropenia in high-risk patients. Curr Opin Infect Dis 2022; 35:500-516. [PMID: 35947070 DOI: 10.1097/qco.0000000000000872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Patients receiving treatment for acute leukaemia and haematopoietic cell transplantation (HCT) have prolonged neutropenia and are at high risk of neutropenic fever, with bacterial and particularly invasive fungal infections as feared complications, possessing potentially serious consequences including intensive care admission and mortality. Concerns for these serious complications often lead to long durations of broad-spectrum antimicrobial therapy and escalation to even broader therapy if fever persists. Further, the default approach is to continue neutropenic fever therapy until count recovery, leaving many patients who have long defervesced on prolonged antibiotics. RECENT FINDINGS This article details recent progress in this field with particular emphasis on early discontinuation studies in resolved neutropenic fever and improved imaging techniques for the investigation of those with persistent neutropenic fever. Recent randomized controlled trials have shown that early cessation of empiric neutropenic fever therapy is well tolerated in acute leukaemia and autologous HCT patients who are clinically stable and afebrile for 72 h. Delineation of the best approach to cessation (timing and/or use of fluoroquinolone prophylaxis) and whether this approach is well tolerated in the higher risk allogeneic HCT setting is still required. Recent RCT data demonstrate utility of FDG-PET/CT to guide management and rationalize antimicrobial therapy in high-risk patient groups with persistent neutropenic fever. SUMMARY Acute leukaemic and autologous HCT patients with resolved neutropenic fever prior to count recovery can have empiric therapy safely discontinued or de-escalated. There is an emerging role of FDG-PET/CT to support decision-making about antibiotic and antifungal use in high-risk persistent/recurrent neutropenic fever patients.
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Affiliation(s)
- Abby Douglas
- National Centre for Infections in Cancer.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne
| | - Karin Thursky
- National Centre for Infections in Cancer.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne.,National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Monica Slavin
- National Centre for Infections in Cancer.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne.,Victorian Infectious Diseases Service, Royal Melbourne Hospital.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Magneto-Fluorescent Mesoporous Nanocarriers for the Dual-Delivery of Ofloxacin and Doxorubicin to Tackle Opportunistic Bacterial Infections in Colorectal Cancer. Int J Mol Sci 2022; 23:ijms232012287. [PMID: 36293142 PMCID: PMC9603674 DOI: 10.3390/ijms232012287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/09/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022] Open
Abstract
Cancer-related opportunistic bacterial infections are one major barrier for successful clinical therapies, often correlated to the production of genotoxic factors and higher cancer incidence. Although dual anticancer and antimicrobial therapies are a growing therapeutic fashion, they still fall short when it comes to specific delivery and local action in in vivo systems. Nanoparticles are seen as potential therapeutic vectors, be it by means of their intrinsic antibacterial properties and effective delivery capacity, or by means of their repeatedly reported modulation and maneuverability. Herein we report on the production of a biocompatible, antimicrobial magneto-fluorescent nanosystem (NANO3) for the delivery of a dual doxorubicin-ofloxacin formulation against cancer-related bacterial infections. The drug delivery capacity, rendered by its mesoporous silica matrix, is confirmed by the high loading capacity and stimuli-driven release of both drugs, with preference for tumor-like acidic media. The pH-dependent emission of its surface fluorescent SiQDs, provides an insight into NANO3 surface behavior and pore availability, with the SiQDs working as pore gates. Hyperthermia induces heat generation to febrile temperatures, doubling drug release. NANO3-loaded systems demonstrate significant antimicrobial activity, specifically after the application of hyperthermia conditions. NANO3 structure and antimicrobial properties confirm their potential use in a future dual anticancer and antimicrobial therapeutical vector, due to their drug loading capacity and their surface availability for further modification with bioactive, targeting species.
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Carcò D, Markovic U, Castorina P, Iachelli V, Pace T, Guardo P, Amato G, Galbo F, Scirè P, Moschetti G. C-Reactive Protein Monitoring and Clinical Presentation of Fever as Predictive Factors of Prolonged Febrile Neutropenia and Blood Culture Positivity after Autologous Hematopoietic Stem Cell Transplantation-Single-Center Real-Life Experience. J Clin Med 2022; 11:312. [PMID: 35054007 PMCID: PMC8780345 DOI: 10.3390/jcm11020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Febrile neutropenia (FN) is a medical emergency that requires urgent evaluation, timely administration of empiric broad-spectrum antibiotics and careful monitoring in order to optimize the patient's outcome, especially in the setting of both allogeneic and autologous hematopoietic stem cell transplant (ASCT). METHODS In this real-life retrospective study, a total of 49 consecutive episodes of FN were evaluated in 40 adult patients affected by either multiple myeloma (thirty-eight) or lymphoma (eleven), following ASCT, with nine patients having fever in both of the tandem transplantations. RESULTS Febrile neutropenia occurred a median of 7 days from ASCT. Median duration of FN was 2 days, with 25% of population that had fever for at least four days. Ten patients had at least one fever spike superior to 39 °C, while the median number of daily fever spikes was two. Twenty patients had positive blood cultures with XDR germs, namely Pseudomonas aeruginosa and Klebsiella pneumoniae, present in seven cases. ROC analysis of peak C-reactive protein (CRP) values was conducted based on blood culture positivity and a value of 12 mg/dL resulted significant. Onset of prolonged fever with a duration greater than 3 days was associated with the presence of both a peak number of three or more daily fever spikes (p = 0.02) and a body temperature greater than 39 °C (p = 0.04) based on odds ratio (OR). Blood culture positivity and peak CRP values greater than 12 mg/dL were also associated with prolonged fever duration, p = 0.04, and p = 0.03, respectively. The probability of blood culture positivity was also greater in association with fever greater than 39 °C (p = 0.04). Furthermore, peak CRP values below the cut-off showed less probability of positive blood culture (p = 0.02). CONCLUSIONS In our study, clinical characteristics of fever along with peak CRP levels were associated with a higher probability of both prolonged fever duration and positive blood culture, needing extended antibiotic therapy.
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Affiliation(s)
- Daniela Carcò
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Uros Markovic
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Paolo Castorina
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
- Dipartimento di Fisica, Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
- Faculty of Mathematics and Physics, Charles University, V Holešovičkach 2, 18000 Prague, Czech Republic
- Dipartimento di Fisica e Astronomia, Università di Catania, 95123 Catania, Italy
| | - Valeria Iachelli
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Tecla Pace
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Paola Guardo
- Unità Operativa di Laboratorio Analisi Chimco Cliniche, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (D.C.); (P.C.); (V.I.); (T.P.); (P.G.)
| | - Gabriella Amato
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| | - Federica Galbo
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| | - Paola Scirè
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
| | - Gaetano Moschetti
- Unità Operativa di Oncoematologia e BMT Unit, Mediterranean Institute of Oncology, Via Penninazzo 7, 95029 Viagrande, Italy; (G.A.); (F.G.); (P.S.); (G.M.)
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Galhano J, Marcelo GA, Duarte MP, Oliveira E. Ofloxacin@Doxorubicin-Epirubicin functionalized MCM-41 mesoporous silica-based nanocarriers as synergistic drug delivery tools for cancer related bacterial infections. Bioorg Chem 2021; 118:105470. [PMID: 34814085 DOI: 10.1016/j.bioorg.2021.105470] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 12/20/2022]
Abstract
Mesoporous silica nanoparticles (MNs) emerged as new promising drug-delivery platforms capable to overcome resistance in bacteria. Dual loading of drugs on these nanocarriers, exploiting synergistic interactions between the nanoparticles and the drugs, could be considered as a way to increase the efficacy against resistant bacteria with a positive effect even at very low concentrations. Considering that patients with cancer are highly susceptible to almost any type of bacterial infections, in this work, nanocarriers mesoporous silica-based, MNs and MNs@EPI were synthetized and submitted to single and/or dual loading of antibiotics (ofloxacin - OFLO) and anticancer drugs (Doxorubicin - DOX; Epirubicin - EPI), and investigated regarding their antibacterial activity against Escherichia coli, Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), Enterococcus faecalis and Pseudomonas aeruginosa. Formulations containing ofloxacin such as MNs-OFLO, MNs-EPI + OFLO, MNs-DOX + OFLO and MNs@EPI + OFLO, present antibacterial activity in all bacterial strains tested. All these are more effective in E.coli with MIC and MBC values for MNs-OFLO, MNs-EPI + OFLO and MNs-DOX + OFLO of around 1 and 2 µgnanomaterial/mL, corresponding to ofloxacin concentrations of 0.03, 0.02 and 0.04 µg/mL, respectively. In the cocktail formulations the conjugation of epirubicin with ofloxacin presents a more effective antibacterial activity with more than 3-fold reduction of ofloxacin concentration when comparing to the single ofloxacin system. By far, the most effective synergistic effect was obtained for the system where epirubicin was functionalized at nanoparticles surface (MNs@EPI), where a 40-fold and 33-fold reductions of ofloxacin concentration were obtained, in P. aeruginosa in comparison to the MNs-OFLO and MNs-EPI + OFLO systems, respectively. These effects are shown in all bacterial strains tested, even in strains that have acquired resistance mechanisms, such as MRSA.
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Affiliation(s)
- Joana Galhano
- BIOSCOPE Group, LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, FCT NOVA, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Gonçalo A Marcelo
- BIOSCOPE Group, LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, FCT NOVA, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal
| | - Maria Paula Duarte
- MEtRICs/DCTB, NOVA School of Science and Technology, FCT NOVA, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal.
| | - Elisabete Oliveira
- BIOSCOPE Group, LAQV-REQUIMTE, Chemistry Department, NOVA School of Science and Technology, FCT NOVA, Universidade NOVA de Lisboa, 2829-516 Caparica, Portugal; PROTEOMASS Scientific Society, Rua dos Inventores, Madam Parque, Caparica Campus, 2829-516 Caparica, Portugal.
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Hocking L, Ali GC, d’Angelo C, Deshpande A, Stevenson C, Virdee M, Guthrie S. A rapid evidence assessment exploring whether antimicrobial resistance complicates non-infectious health conditions and healthcare services, 2010-20. JAC Antimicrob Resist 2021; 3:dlab171. [PMID: 34806009 PMCID: PMC8599069 DOI: 10.1093/jacamr/dlab171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antimicrobial resistance (AMR) is one of the greatest public health threats at this time. While there is a good understanding of the impacts of AMR on infectious diseases, an area of less focus is the effects AMR may be having on non-communicable health conditions (such as cancer) and healthcare services (such as surgery). Therefore, this study aimed to explore what impact AMR is currently having on non-communicable health conditions, or areas of health services, where AMR could be a complicating factor impacting on the ability to treat the condition and/or health outcomes. To do this, a rapid evidence assessment of the literature was conducted, involving a systematic approach to searching and reviewing the evidence. In total, 101 studies were reviewed covering surgery, organ transplants, cancer, ICUs, diabetes, paediatric patients, immunodeficiency conditions, liver and kidney disease, and physical trauma. The results showed limited research in this area and studies often use a selective population, making the results difficult to generalize. However, the evidence showed that for all health conditions and healthcare service areas reviewed, at least one study demonstrated a higher risk of death for patients with resistant infections, compared with no or drug-susceptible infections. Poor health outcomes were also associated with resistant infections in some instances, such as severe sepsis and failure of treatments, as well as a greater need for invasive medical support. While there are gaps in the evidence base requiring further research, efforts are also needed within policy and practice to better understand and overcome these challenges.
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Affiliation(s)
- Lucy Hocking
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
- Corresponding author. E-mail:
| | | | | | | | | | - Mann Virdee
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
| | - Susan Guthrie
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, UK
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Nanayakkara AK, Boucher HW, Fowler VG, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA Cancer J Clin 2021; 71:488-504. [PMID: 34546590 DOI: 10.3322/caac.21697] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat against the continuing success of cancer therapy. In this review, the authors focus on recent updates on the impact of antibiotic resistance in the cancer setting, particularly on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). This review highlights the health and financial impact of antibiotic resistance in patients with cancer. Furthermore, the authors recommend measures to control the emergence of antibiotic resistance, highlighting the risk factors associated with cancer care. A lack of data in the etiology of infections, specifically in oncology patients in United States, is identified as a concern, and the authors advocate for a centralized and specialized surveillance system for patients with cancer to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic-resistant infections will have a major positive impact on the care of those with cancer.
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Affiliation(s)
- Amila K Nanayakkara
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amanda Jezek
- Infectious Diseases Society of America, Arlington, Virginia
| | - Kevin Outterson
- CARB-X, Boston, Massachusetts
- Boston University School of Law, Boston, Massachusetts
| | - David E Greenberg
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
- Department of Microbiology, University of Texas Southwestern, Dallas, Texas
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13
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Bloodstream Infections and Outcomes Following Allogeneic Hematopoietic Cell Transplantation: A Single-Center Study. Transplant Cell Ther 2021; 28:50.e1-50.e8. [PMID: 34656808 DOI: 10.1016/j.jtct.2021.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 12/12/2022]
Abstract
This study investigated the single-center incidence and risk factors for bloodstream infections (BSIs) in 651 adults who underwent allogeneic hematopoietic cell transplantation (alloHCT) between 2015 and 2019 and explored the impact of these BSIs on post-transplantation outcomes. Antibiotic prophylaxis with ciprofloxacin was given during the aplastic phase. Overall, the median patient age was 57 years, 79.7% of patients received an alternative donor graft, and 68.7% received post-transplantation cyclophosphamide (PTCy) as part of their graft-versus-host disease (GVHD) prophylaxis. Of the 651 patients, 358 (55.0%) had at least 1 episode of BSI, and the overall mortality rate secondary to this complication was 7.5% (12.6% among those diagnosed with at least 1 episode of BSI). BSI was more often diagnosed during the first 30 days (58.7%), and gram-positive bacteria were the most prevalent microorganisms isolated during the entire post-transplantation follow-up (62%). A high Disease Risk Index (hazard ratio [HR], 1.47; P < .029) and receipt of PTCy-based GVHD prophylaxis (HR, 3.33; P < .001) were identified as risk factors for BSI. Additionally, univariate analysis showed that patients diagnosed with a BSI during post-transplantation follow-up had worse overall survival (HR, 2.48; P < .001) and higher nonrelapse mortality (HR, 2.68; P < .001) than those without BSI. In conclusion, alloHCT recipients with a BSI had a higher risk of mortality compared with those who did not develop BSI. The inclusion of PTCy as part of GVHD prophylaxis was identified as an independent risk factor for BSI during early post-transplantation follow-up. Single-center analyses focused on reporting the incidence and risk factors for BSI highlight the need for active implementation of preemptive strategies to decrease BSI incidence in the alloHCT setting. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Chathuranga G, Dissanayake T, Fernando N, Wanigatunge C. Appropriateness of the Empirical Antibiotics Prescribed and Their Concordance with National Guidelines for Three Selected Infections among Cancer Patients in a Tertiary Care Centre in Sri Lanka. Int J Microbiol 2021; 2021:7572215. [PMID: 34621317 PMCID: PMC8492258 DOI: 10.1155/2021/7572215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Prophylactic and empirical antibiotic use is essential in cancer patients due to the underlying immune deficiencies. We examined the spectrum of causative bacteria and the appropriateness of empirical antibiotic prescription for three selected infections in cancer patients. Methodology. A descriptive cross-sectional study was conducted at the National Institute of Cancer (NIC), Sri Lanka, from June 2018 to February 2019. Bacterial isolates obtained from adult cancer patients with a diagnosis of lower respiratory tract infections (LRTI), skin and soft tissue infections (SSTI), or urinary tract infections (UTI) were included. Causative bacteria were identified and the antibiotic susceptibility was determined by standard microbiological methods. Empirical therapy was defined as appropriate if the isolated pathogen was susceptible in vitro to the given antibiotic. RESULTS A total of 155 bacterial isolates were included in the analysis. LRTI were the most prevalent infections (37.2%, 55/148) encountered during the study period. Majority (90.9%) of the isolated bacteria were ESKAPE pathogens. Klebsiella pneumoniae was the most frequent pathogen causing LRTI (42.4%, 25/59), whereas Escherichia coli (32%, 16/50) and Staphylococcus aureus (26.1%, 12/46) predominated in UTI and SSTI, respectively. Meropenem was the most prescribed empirical antibiotic for LRTI (29.1%, 16/55) and SSTI (26.6%, 11/43) while it was ceftazidime for UTI (36%, 18/50). Only 20.6% (32/155) of the isolated bacteria were susceptible to the empirical antibiotic prescribed while 48.4% (75/155) were resistant to them. The prescribed empirical antibiotic did not have the spectrum of activity for the isolated bacteria in 29% (45/155) of cases. CONCLUSION High resistance rates were observed against the prescribed empirical antibiotics. National empirical antibiotic guidelines should be revised with updated data on causative organisms and their susceptibility patterns to ensure appropriate empirical antibiotic prescription.
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Affiliation(s)
- Gayashan Chathuranga
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Thushari Dissanayake
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Neluka Fernando
- Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Chandanie Wanigatunge
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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15
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Al Saifi SA, Al Adawi B, Burney I. Patterns of Bacterial Isolates and their Resistance to Antibiotics in Patients with Chemotherapy-induced Febrile Neutropenia at a University Hospital. Oman Med J 2021; 36:e290. [PMID: 34497720 PMCID: PMC8406491 DOI: 10.5001/omj.2021.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Febrile neutropenia is a major complication of cytotoxic chemotherapy and is associated with a high rate of mortality and morbidity if not treated appropriately. Consequently, it is important to know the bacterial spectrum and pattern of its resistance in each hospital to formulate an appropriate empiric antibiotic regimen. We sought to study the bacterial spectrum in patients with chemotherapy-induced neutropenia and report their resistance patterns. Methods We conducted a retrospective study on patients admitted with febrile neutropenia between January 2010 and December 2016 in the oncology unit at Sultan Qaboos University Hospital in Oman. Consecutive patients diagnosed with non-hematological malignancies who had febrile neutropenia and positive blood culture were included in this study. Results A total of 76 bacterial isolates were documented in 67 episodes in 62 patients. There were 26 male and 36 female patients. The median age was 51 (14–81) years. The most common cancers were breast cancer (17.7%), non-Hodgkin lymphoma (16.1%), and colon cancer (14.5%). Gram-negative and gram-positive organisms accounted for 73.7% and 26.3% of all isolates, respectively. The most common gram-negative organisms were Pseudomonas aeruginosa (26.8%), Escherichia coli (23.2%), Klebsiella species (17.9%), and Acinetobacter baumannii (12.5%). The most common gram-positive organisms were Staphylococcus aureus (30.0%), followed by coagulase-negative Staphylococcus (25.0%). There were 14 multidrug-resistant organisms and eight extended-spectrum beta-lactamases (ESBL). The resistance among gram-negative organisms to the commonly used broad-spectrum antibiotics was 23.5–55.6%. No resistance was recorded against vancomycin amongst the gram-positive organisms. Eight (12.1%) patients died while neutropenic. Conclusions Gram-negative organisms were the predominant organisms. There is a high rate of resistance to the commonly used antibiotics. Using a combination of antibiotics is warranted in patients presenting with chemotherapy-induced febrile neutropenia.
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Affiliation(s)
- Said Ahmed Al Saifi
- Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Badriya Al Adawi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ikram Burney
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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16
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Clinical prediction of bacteremia and early antibiotics therapy in patients with solid tumors. Infect Control Hosp Epidemiol 2021; 43:1112-1118. [PMID: 34315562 DOI: 10.1017/ice.2021.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate the relationship between the systemic inflammatory response syndrome (SIRS), early antibiotic use, and bacteremia in solid-tumor patients. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective observational study of adults with solid tumors admitted to a tertiary-care hospital through the emergency department over a 2-year period. Patients with neutropenic fever, organ transplant, trauma, or cardiopulmonary arrest were excluded. METHODS Rates of SIRS, bacteremia, and early antibiotics (initiation within 8 hours of presentation) were compared using the χ2 and Student t tests. Binomial regression and receiver operator curves were analyzed to assess predictors of bacteremia and early antibiotics. RESULTS Early antibiotics were administered in 507 (37%) of 1,344 SIRS-positive cases and 492 (22%) of 2,236 SIRS-negative cases (P < .0001). Of SIRS-positive cases, 70% had blood cultures drawn within 48 hours and 19% were positive; among SIRS negative cases, 35% had cultures and 13% were positive (19% vs 13%; P = .003). Bacteremic cases were more often SIRS positive than nonbacteremic cases (60% vs 50%; P =.003), but they received early antibiotics at similar rates (50% vs 49%, P = .72). Three SIRS components predicted early antibiotics: temperature (OR, 1.7; 95% CI, 1.31-2.29; P = .0001), tachycardia (OR, 1.4; 95% CI, 1.10-1.69; P < .0001), and white blood-cell count (OR, 1.8; 95% CI, 1.56-2.14; P < .0001). Only temperature (OR, 1.6; 95% CI, 1.09-2.41; P = .01) and tachycardia (OR, 1.5; 95% CI, 1.09-2.06; P = .01) predicted bacteremia. SIRS criteria as a composite were poorly predictive of bacteremia (AUC, 0.57). CONCLUSIONS SIRS criteria are frequently used to determine the need for early antibiotics, but they are poor predictors of bacteremia in solid-tumor patients. More reliable models are needed to guide judicious use of antibiotics in this population.
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Patel A, Dey S, Shokeen K, Karpiński TM, Sivaprakasam S, Kumar S, Manna D. Sulfonium-based liposome-encapsulated antibiotics deliver a synergistic antibacterial activity. RSC Med Chem 2021; 12:1005-1015. [PMID: 34223166 PMCID: PMC8221259 DOI: 10.1039/d1md00091h] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/01/2021] [Indexed: 12/29/2022] Open
Abstract
The devastating antibacterial infections, coupled with their antibiotic resistance abilities, emphasize the need for effective antibacterial therapeutics. In this prospect, liposomal delivery systems have been employed in improving the efficacy of the antibacterial agents. The liposome-based antibiotics enhance the therapeutic potential of the new or existing antibiotics and reduce their adverse effects. The current study describes the development of sulfonium-based antibacterial lipids that demonstrate the delivery of existing antibiotics. The presence of cationic sulfonium moieties and inherent membrane targeting abilities of the lipids could help reduce the antibiotic resistance abilities of the bacteria and deliver the antibiotics to remove the infectious pathogens electively. The transmission electron microscopic images and dynamic light scattering analyses revealed the liposome formation abilities of the sulfonium-based amphiphilic compounds in the aqueous medium. The effectiveness of the compounds was tested against the Gram-negative and Gram-positive bacterial strains. The viability of the bacterial cells was remarkably reduced in the presence of the compounds. The sulfonium-based compounds with pyridinium moiety and long hydrocarbon chains showed the most potent antibacterial activities among the tested compounds. Mechanistic studies revealed the membrane-targeted bactericidal activities of the compounds. The potent compound also showed tetracycline and amoxicillin encapsulation and sustained release profiles in the physiologically relevant medium. The tetracycline and amoxicillin-encapsulated lipid showed much higher antibacterial activities than the free antibiotics at similar concentrations, emphasizing the usefulness of the synergistic effect of sulfonium-based lipid and the antibiotics, signifying that the sulfonium lipid penetrated the bacterial membrane and increased the cellular uptake of the antibiotics. The potent lipid also showed therapeutic potential, as it is less toxic to mammalian cells (like HeLa and HaCaT cells) at concentrations higher than their minimum inhibitory concentration values against S. aureus, E. coli, and MRSA. Hence, the sulfonium-based lipid exemplifies a promising framework for assimilating various warheads, and provides a potent antibacterial material.
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Affiliation(s)
- Anjali Patel
- Indian Institute of Technology Guwahati, Centre for the Environment Guwahati Assam India
| | - Subhasis Dey
- Biological Chemistry Laboratory, Indian Institute of Technology Guwahati, Chemistry Guwahati Assam India
| | - Kamal Shokeen
- Indian Institute of Technology Guwahati, Biosciences and Bioengineering Guwahati Assam India
| | - Tomasz M Karpiński
- Department of Medical Microbiology, Poznań University of Medical Sciences Wieniawskiego Poznań Poland
| | | | - Sachin Kumar
- Indian Institute of Technology Guwahati, Biosciences and Bioengineering Guwahati Assam India
| | - Debasis Manna
- Indian Institute of Technology Guwahati, Centre for the Environment Guwahati Assam India
- Biological Chemistry Laboratory, Indian Institute of Technology Guwahati, Chemistry Guwahati Assam India
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18
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Gudiol C, Albasanz-Puig A, Cuervo G, Carratalà J. Understanding and Managing Sepsis in Patients With Cancer in the Era of Antimicrobial Resistance. Front Med (Lausanne) 2021; 8:636547. [PMID: 33869250 PMCID: PMC8044357 DOI: 10.3389/fmed.2021.636547] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
Sepsis is a frequent complication in immunosuppressed cancer patients and hematopoietic stem cell transplant recipients that is associated with high morbidity and mortality rates. The worldwide emergence of antimicrobial resistance is of special concern in this population because any delay in starting adequate empirical antibiotic therapy can lead to poor outcomes. In this review, we aim to address: (1) the mechanisms involved in the development of sepsis and septic shock in these patients; (2) the risk factors associated with a worse prognosis; (3) the impact of adequate initial empirical antibiotic therapy given the current era of widespread antimicrobial resistance; and (4) the optimal management of sepsis, including adequate and early source control of infection, optimized antibiotic use based on the pharmacokinetic and pharmacodynamics changes in these patients, and the role of the new available antibiotics.
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Affiliation(s)
- Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Institut Català d'Oncologia (ICO), Hospital Duran i Reynals, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Adaia Albasanz-Puig
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), Instituto de Salud Carlos III, Madrid, Spain
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19
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Quality of inpatient antimicrobial use in hematology and oncology patients. Infect Control Hosp Epidemiol 2021; 42:1235-1244. [PMID: 33517920 DOI: 10.1017/ice.2020.1398] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare antimicrobial prescribing practices in Australian hematology and oncology patients to noncancer acute inpatients and to identify targets for stewardship interventions. DESIGN Retrospective comparative analysis of a national prospectively collected database. METHODS Using data from the 2014-2018 annual Australian point-prevalence surveys of antimicrobial prescribing in hospitalized patients (ie, Hospital National Antimicrobial Prescribing Survey called Hospital NAPS), the most frequently used antimicrobials, their appropriateness, and guideline concordance were compared among hematology/bone marrow transplant (hemBMT), oncology, and noncancer inpatients in the setting of treatment of neutropenic fever and antibacterial and antifungal prophylaxis. RESULTS In 454 facilities, 94,226 antibiotic prescriptions for 62,607 adult inpatients (2,230 hemBMT, 1,824 oncology, and 58,553 noncancer) were analyzed. Appropriateness was high for neutropenic fever management across groups (83.4%-90.4%); however, hemBMT patients had high rates of carbapenem use (111 of 746 prescriptions, 14.9%), and 20.2% of these prescriptions were deemed inappropriate. Logistic regression demonstrated that hemBMT patients were more likely to receive appropriate antifungal prophylaxis compared to oncology and noncancer patients (adjusted OR, 5.3; P < .001 for hemBMT compared to noncancer patients). Oncology had a low rate of antifungal prophylaxis guideline compliance (67.2%), and incorrect dosage and frequency were key factors. Compared to oncology patients, hemBMT patients were more likely to receive appropriate nonsurgical antibacterial prophylaxis (aOR, 8.4; 95% CI, 5.3-13.3; P < .001). HemBMT patients were also more likely to receive appropriate nonsurgical antibacterial prophylaxis compared to noncancer patients (OR, 3.1; 95% CI, 1.9-5.0; P < .001). However, in the Australian context, the hemBMT group had higher than expected use of fluoroquinolone prophylaxis (66 of 831 prescriptions, 8%). CONCLUSIONS This study demonstrates why separate analysis of hemBMT and oncology populations is necessary to identify specific opportunities for quality improvement in each patient group.
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Jiang AM, Shi X, Liu N, Gao H, Ren MD, Zheng XQ, Fu X, Liang X, Ruan ZP, Yao Y, Tian T. Nosocomial infections due to multidrug-resistant bacteria in cancer patients: a six-year retrospective study of an oncology Center in Western China. BMC Infect Dis 2020; 20:452. [PMID: 32600270 PMCID: PMC7324970 DOI: 10.1186/s12879-020-05181-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate the characteristics, antibiotic resistance patterns, and prognosis of nosocomial infections due to multidrug-resistant (MDR) bacteria in cancer patients. METHODS This retrospective observational study analyzed cancer patients with nosocomial infections caused by MDR from August 2013 to May 2019. The extracted clinical data were recorded in a standardized form and compared based on the survival status of the patients after infection and during hospitalization. The data were analyzed using independent samples t-test, Chi-square test, and binary logistic regression. P-values < 0.05 were considered significant. RESULTS One thousand eight patients developed nosocomial infections during hospitalization, with MDR strains detected in 257 patients. Urinary tract infection (38.1%), respiratory tract infection (26.8%), and bloodstream infection (BSI) (12.5%) were the most common infection types. Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) (72.8%) members were the most frequently isolated MDR strains, followed by Acinetobacter baumannii (11.7%), and Stenotrophomonas maltophilia (6.2%). The results of multivariate regression analysis revealed that smoking history, intrapleural/abdominal infusion history within 30 days, the presence of an indwelling urinary catheter, length of hospitalization, and hemoglobin were independent factors for in-hospital mortality in the study population. The isolated MDR bacteria exhibited high rates of sensitivity to amikacin, meropenem, and imipenem. CONCLUSIONS The burden of nosocomial infections due to MDR bacteria is considerably high in oncological patients, with ESBL-PE being the most predominant causative pathogen. Our findings suggest that amikacin and carbapenems actively against more than 89.7% of MDR isolates. The precise management of MDR bacterial infections in cancer patients may improve the prognosis of these individuals.
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Affiliation(s)
- Ai-Min Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xin Shi
- School of Public Health, Xi'an Jiaotong University Health Science Center, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Na Liu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Huan Gao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Meng-Di Ren
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiao-Qiang Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xiao Fu
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Xuan Liang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Zhi-Ping Ruan
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Tao Tian
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China.
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21
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Laporte-Amargos J, Gudiol C, Arnan M, Puerta-Alcalde P, Carmona-Torre F, Huguet M, Albasanz-Puig A, Parody R, Garcia-Vidal C, Del Pozo JL, Batlle M, Tebé C, Rigo-Bonnin R, Muñoz C, Padullés A, Tubau F, Videla S, Sureda A, Carratalà J. Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients: protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE). Trials 2020; 21:412. [PMID: 32423462 PMCID: PMC7236103 DOI: 10.1186/s13063-020-04323-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/10/2020] [Indexed: 12/26/2022] Open
Abstract
Background Febrile neutropaenia (FN) is a very common complication in patients with haematological malignancies and is associated with considerable morbidity and mortality. Broad-spectrum antipseudomonal β-lactam antibiotics (BLA) are routinely used for the treatment of cancer patients with FN. However, the clinical efficacy of BLA may be diminished in these patients because they present with pathophysiological variations that compromise the pharmacokinetic (PK) parameters of these antibiotics. Optimised administration of BLA in prolonged infusions has demonstrated better clinical outcomes in critically ill patients. However, there is a paucity of data on the usefulness of this strategy in patients with FN. The aim of this study is to test the hypothesis that the administration of BLA would be clinically more effective by extended infusion (EI) than by intermittent infusion (II) in haematological patients with FN. Methods A randomised, multicentre, open-label, superiority clinical trial will be performed. Patients with haematological malignancies undergoing chemotherapy or haematopoietic stem-cell transplant and who have FN and receive empirical antibiotic therapy with cefepime, piperacillin-tazobactam or meropenem will be randomised (1:1) to receive the antibiotic by EI (during half the time of the dosing interval) in the study group, or by II (30 min) in the control group. The primary endpoint will be clinical efficacy, defined as defervescence without modifying the antibiotic treatment administered within the first 5 days of therapy. The primary endpoint will be analysed in the intention-to-treat population. The secondary endpoints will be pharmacokinetic/pharmacodynamic (PK/PD) target achievement, bacteraemia clearance, decrease in C-reactive protein, overall (30-day) case-fatality rate, adverse events and development of a population PK model of the BLA studied. Discussion Data on the usefulness of BLA administration in patients with FN are scant. Only three clinical studies addressing this issue have been published thus far, with contradictory results. Moreover, these studies had some methodological flaws that limit the interpretation of their findings. If this randomised, multicentre, phase IV, open-label, superiority clinical trial validates the hypothesis that the administration of BLA is clinically more effective by EI than by II in haematological patients with FN, then the daily routine management of these high-risk patients could be changed to improve their outcomes. Trial registration European Clinical Trials Database: EudraCT 2018–001476-37. ClinicalTrials.gov, ID: NCT04233996.
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Affiliation(s)
- J Laporte-Amargos
- Infectious Diseases Department Hospital Universitari Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Gudiol
- Infectious Diseases Department Hospital Universitari Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Sevilla, Spain. .,Institut Català d'Oncologia, IDIBELL, Barcelona, Spain.
| | - M Arnan
- Clinical Haematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain
| | - P Puerta-Alcalde
- Infectious Diseases Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - F Carmona-Torre
- Infectious Diseases Department, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - M Huguet
- Clinical Haematology Department, Institut Català d'Oncologia-Badalona, Institut Josep Carreras (IJC), Hospital Germans Trias i Pujol, Barcelona, Spain
| | - A Albasanz-Puig
- Infectious Diseases Department Hospital Universitari Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Sevilla, Spain
| | - R Parody
- Clinical Haematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain
| | - C Garcia-Vidal
- Infectious Diseases Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | - J L Del Pozo
- Infectious Diseases Department, Clínica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - M Batlle
- Clinical Haematology Department, Institut Català d'Oncologia-Badalona, Institut Josep Carreras (IJC), Hospital Germans Trias i Pujol, Barcelona, Spain
| | - C Tebé
- Biostatistics Unit, IDIBELL, Barcelona, Spain
| | - R Rigo-Bonnin
- Clinical Laboratory Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - C Muñoz
- Pharmacy Department, Clinical Trial Unit, Institut Català d'Oncologia, IDIBELL, Barcelona, Spain
| | - A Padullés
- Pharmacy Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - F Tubau
- Microbiology Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - S Videla
- Clinical Pharmacology Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - A Sureda
- Clinical Haematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain
| | - J Carratalà
- Infectious Diseases Department Hospital Universitari Bellvitge, Institut d'Investigació Biomedica de Bellvitge (IDIBELL), Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Disease (REIPI), Instituto de Salud Carlos III, Sevilla, Spain
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22
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Gudiol C, Arnan M, Aguilar-Guisado M, Royo-Cebrecos C, Sánchez-Ortega I, Montero I, Martín-Gandul C, Laporte-Amargós J, Albasanz-Puig A, Nicolae S, Perayre M, Berbel D, Tebe C, Riera J, Sureda A, Cisneros JM, Carratalà J. A Randomized, Double-Blind, Placebo-Controlled Trial (TAURCAT Study) of Citrate Lock Solution for Prevention of Endoluminal Central Venous Catheter Infection in Neutropenic Hematological Patients. Antimicrob Agents Chemother 2020; 64:e01521-19. [PMID: 31712211 PMCID: PMC6985755 DOI: 10.1128/aac.01521-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/28/2019] [Indexed: 12/26/2022] Open
Abstract
Infection of long-term central venous catheters (CVCs) remains a challenge in the clinical management of cancer patients. We aimed to determine whether a lock solution with taurolidine-citrate-heparin would be more effective than placebo for preventing nontunneled CVC infection in high-risk neutropenic hematologic patients. We performed a prospective, multicenter, randomized (1:1), double-blind, parallel, superiority, placebo-controlled trial involving 150 hematological patients with neutropenia carrying nontunneled CVCs who were assigned to receive CVC lock solution with taurolidine-citrate-heparin or heparin alone. The primary endpoint was bacterial colonization of the CVC hubs. Secondary endpoints were the incidence of catheter-related bloodstream infection (CRBSI), CVC removal, adverse events related to the lock solution, and the 30-day case fatality rate. CVC lock solution with taurolidine-citrate-heparin was associated with less colonization of the CVC hubs than that with placebo, with no statistically significant differences: 4.1%, versus 10.1% (relative risk [RR] = 0.41, 95% confidence interval [CI] = 0.11 to 1.52), with a cumulative incidence of 4.17 (95% CI = 0.87 to 11.70) and 10.14 (95% CI = 4.18 to 19.79), respectively. There were no significant differences regarding the secondary endpoints. Only three episodes of CRBSI occurred during the study period. No adverse events related to the administration of the lock solution occurred. In this trial involving high-risk patients carrying nontunneled CVCs, the use of taurolidine-citrate-heparin did not show a benefit over the use of placebo. Nevertheless, the safety of this prevention strategy and the trend toward less hub colonization in the taurolidine-citrate-heparin group raise the interest in assessing its efficacy in centers with higher rates of CRBSI. (This study has been registered in ISRCTN under identifier ISRCTN47102251.).
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Affiliation(s)
- Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Arnan
- Hematology Department, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuela Aguilar-Guisado
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Royo-Cebrecos
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Sánchez-Ortega
- Hematology Department, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Montero
- Deparment of Hematology, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain
| | - Cecilia Martín-Gandul
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Júlia Laporte-Amargós
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Adaia Albasanz-Puig
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Sermed Nicolae
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Perayre
- Pharmacy Department, Clinical Trial Unit, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Damaris Berbel
- Microbiology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Judith Riera
- Hematology Department, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Sureda
- Hematology Department, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Miguel Cisneros
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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23
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Orrapin S, Intorasoot A, Roytrakul S, Dechsupa N, Kantapan J, Onphat Y, Srimek C, Sitthidet Tharinjaroen C, Anukool U, Butr-Indr B, Phunpae P, Intorasoot S. A novel recombinant javanicin with dual antifungal and anti-proliferative activities. Sci Rep 2019; 9:18417. [PMID: 31804594 PMCID: PMC6895105 DOI: 10.1038/s41598-019-55044-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/23/2019] [Indexed: 12/14/2022] Open
Abstract
Resistance to common drugs by microorganisms and cancers has become a major issue in modern healthcare, increasing the number of deaths worldwide. Novel therapeutic agents with a higher efficiency and less side effects for the treatment of certain diseases are urgently needed. Plant defensins have an integral role in a hosts' immune system and are attractive candidates for combatting drug-resistant microorganisms. Interestingly, some of these defensins also showed great potential due to their cytotoxic activity toward cancer cells. In this study, a defensin encoding gene was isolated from five legume seeds using 3' rapid amplification of cDNA ends (3' RACE) with degenerate primers and cDNA cloning strategies. Bioinformatic tools were used for in silico identification and the characterization of new sequences. To study the functional characteristics of these unique defensins, the gene encoded for Sesbania javanica defensin, designated as javanicin, was cloned into pTXB-1 plasmid and expressed in the Escherichia coli Origami 2 (DE3) strain. Under optimized conditions, a 34-kDa javanicin-intein fusion protein was expressed and approximately 2.5-3.5 mg/L of soluble recombinant javanicin was successfully extracted with over 90% purity. Recombinant javanicin displayed antifungal properties against human pathogenic fungi, including resistant strains, as well as cytotoxic activities toward the human breast cancer cell lines, MCF-7 & MDA-MB-231. Recombinant javanicin holds great promise as a novel therapeutic agent for further medical applications.
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Affiliation(s)
- Santhasiri Orrapin
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Amornrat Intorasoot
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sittiruk Roytrakul
- Proteomics Research Laboratory, National Center for Genetic Engineering and Biotechnology (BIOTEC), Thailand Science Park, Pathum Thani, 12120, Thailand
| | - Nathupakorn Dechsupa
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Jiraporn Kantapan
- Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Yanika Onphat
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chutima Srimek
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chayada Sitthidet Tharinjaroen
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Infectious Diseases Research Unit (IDRU), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Usanee Anukool
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Infectious Diseases Research Unit (IDRU), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Bordin Butr-Indr
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Infectious Diseases Research Unit (IDRU), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ponrut Phunpae
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
- Infectious Diseases Research Unit (IDRU), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Sorasak Intorasoot
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Infectious Diseases Research Unit (IDRU), Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
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24
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Mwangi J, Hao X, Lai R, Zhang ZY. Antimicrobial peptides: new hope in the war against multidrug resistance. Zool Res 2019; 40:488-505. [PMID: 31592585 PMCID: PMC6822926 DOI: 10.24272/j.issn.2095-8137.2019.062] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
The discovery of antibiotics marked a golden age in the revolution of human medicine. However, decades later, bacterial infections remain a global healthcare threat, and a return to the pre-antibiotic era seems inevitable if stringent measures are not adopted to curb the rapid emergence and spread of multidrug resistance and the indiscriminate use of antibiotics. In hospital settings, multidrug resistant (MDR) pathogens, including carbapenem-resistant Pseudomonas aeruginosa, vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and extended-spectrum β-lactamases (ESBL) bearing Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae are amongst the most problematic due to the paucity of treatment options, increased hospital stay, and exorbitant medical costs. Antimicrobial peptides (AMPs) provide an excellent potential strategy for combating these threats. Compared to empirical antibiotics, they show low tendency to select for resistance, rapid killing action, broad-spectrum activity, and extraordinary clinical efficacy against several MDR strains. Therefore, this review highlights multidrug resistance among nosocomial bacterial pathogens and its implications and reiterates the importance of AMPs as next-generation antibiotics for combating MDR superbugs.
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Affiliation(s)
- James Mwangi
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
- Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming Yunnan 650204, China
- Sino-African Joint Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Xue Hao
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
| | - Ren Lai
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
- Sino-African Joint Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
- Institutes for Drug Discovery and Development, Chinese Academy of Sciences, Shanghai 201203, China
- KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan Hubei 430071, China
| | - Zhi-Ye Zhang
- Key Laboratory of Bioactive Peptides of Yunnan Province/Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences and Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming Yunnan 650223, China, E-mail:
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25
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Lubwama M, Phipps W, Najjuka CF, Kajumbula H, Ddungu H, Kambugu JB, Bwanga F. Bacteremia in febrile cancer patients in Uganda. BMC Res Notes 2019; 12:464. [PMID: 31362783 PMCID: PMC6668181 DOI: 10.1186/s13104-019-4520-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The aim of this study was to determine the predominant bacterial species causing bacteremia among febrile cancer patients, and their antibacterial resistance profiles at the Uganda Cancer Institute. Results We enrolled in-patients with a documented fever (≥ 37.5 °C). Bacteria from positive blood cultures were identified using standard methods biochemically. Antibacterial susceptibility testing was performed with the Kirby–Bauer disc diffusion method. From a total of 170 febrile episodes, positive blood cultures were obtained from 24 (14.1%). A positive culture was more likely to be obtained from a patient with neutropenia (P = 0.017). Of 22 (66.7%) Gram-negative bacteria isolated, half were E. coli (n = 11). Gram-negative compared to Gram-positive bacteria were most likely to be isolated from patients with a hematologic malignancy (P = 0.02) or patients with neutropenia (P = 0.006). Of the isolated Enterobacteriaceae 85% (n = 20) were resistant to three or more classes of antibiotic and 41% (n = 7) had extended spectrum beta-lactamases. Of the 11 Gram-positive bacteria isolated, the S. aureus isolate was methicillin resistant but susceptible to vancomycin. Multidrug resistant Gram-negative bacteria are the main cause of bacteremia in febrile cancer patients at the Uganda Cancer Institute. There is need for ongoing microbial surveillance, infection prevention and control, and antibiotic stewardship programs.
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Affiliation(s)
- Margaret Lubwama
- Department of Medical Microbiology, Makerere University, Kampala, Uganda.
| | - Warren Phipps
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Henry Kajumbula
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | | | | | - Freddie Bwanga
- Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
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26
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Iliopoulou M, Spyratos D, Kotsiou O, Skouras V, Kalomenidis I. A six-year microbiologic study of hospital-acquired and health-care associated parapneumonic pleural infection. Eur J Intern Med 2019; 63:e12-e13. [PMID: 30862417 DOI: 10.1016/j.ejim.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marianthi Iliopoulou
- 7th Respiratory Medicine Department and Asthma Center, Chest Hospital "Sotiria", 152 Mesogeion Avenue, Athens 11527, Greece.
| | - Dionisios Spyratos
- Pulmonary Department, "G.Papanikolaou" Hospital, Aristotle University of Thessaloniki,Papanikolaou Avenue, Thessaloniki 57010, Greece
| | - Ourania Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa 41110, Greece
| | - Vasileios Skouras
- Department of Pulmonary Medicine, 401 General Army Hospital, P.Kanellopoulou Avenue, Athens 11525, Greece.
| | - Ioannis Kalomenidis
- 1st Department of Critical Care and Pulmonary Medicine, "Evangelismos" Hospital, National and Kapodistrian University of Athens, 45-47 Ipsilantou Street, Athens 10676, Greece.
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27
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Wilson BJ, Zitella LJ, Erb CH, Foster J, Peterson M, Wood SK. Prevention of Infection: A Systematic Review of Evidence-Based Practice Interventions for Management in Patients With Cancer. Clin J Oncol Nurs 2019; 22:157-168. [PMID: 29547616 DOI: 10.1188/18.cjon.157-168] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer-related infections lead to increases in mortality, antibiotic use, and hospital stays. Other adverse outcomes include dose delays and reductions, which can result in suboptimal treatment outcomes. OBJECTIVES Effective implementation of risk assessment and evidence-based interventions for the prevention and treatment of infection are essential to improve care and reduce costs related to infections in patients with cancer receiving immunosuppressive therapy. METHODS The Oncology Nursing Society (ONS) Putting Evidence Into Practice (PEP) prevention of infection resource have been developed and updated to identify and disseminate the best available scientific evidence. FINDINGS Pharmacologic and nonpharmacologic interventions were evaluated, resulting in recommended for practice rating for catheter care bundles, antimicrobial prophylaxis, vaccination for specific populations, and implementation of contact precautions for resistant organisms.
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28
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Garg VK, Mishra S, Gupta N, Garg R, Sachidanand B, Vinod K, Gautam H, Kapil A, Bhatnagar S. Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients Admitted in the Intensive Care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study. Indian J Crit Care Med 2019; 23:67-72. [PMID: 31086449 PMCID: PMC6487614 DOI: 10.5005/jp-journals-10071-23119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Cancer patients in intensive care unit (ICU) are vulnerable for developing multidrug resistant nosocomial infections. The antimicrobial resistance due to inappropriate use of antibiotics results in significant morbidity and mortality in these cancer patients. The present retrospective study was done to describe the antimicrobial sensitivity pattern of common organisms in isolates of clinical samples of patients admitted in ICU at our tertiary care cancer center. MATERIALS AND METHODS The study was carried out at ICU of a regional tertiary care cancer center for a period of 1 year from October 2016 to September 2017. All clinical samples were collected and processed for culture and antibiotic susceptibility testing were carried out on isolates as per Clinical Laboratory Standard Institute guidelines. RESULTS A total of 644 specimens were collected. Escherichia coli, Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp. were most commonly encountered. In positive bacterial cultures, majority were Gram-negative isolates (84.14 %). Klebsiella was the most common gram-negative isolate (34.78%) and Enterococcus spp. were the most common Gram-positive isolates (61.53%). A high level of resistance to various antibiotics was noted among Gram-negative bacteria compared to Gram-positive isolates. Majority of the Gram-negative isolates were sensitive to Imipenem, Meropenem, and Colistin sensitivity among Gram-negative isolates was 100%. Linezolid, Teicoplanin and Vancomycin were most sensitive antimicrobials against the Gram-positive bacteria. CONCLUSION Regular monitoring of the pattern of resistance of bacteriological isolates in cancer patients is critical to develop antibiotic policy to combat these infections and reduce morbidity and mortality. HOW TO CITE THIS ARTICLE Garg VK, Seema M et al. Microbial and Antibiotic Susceptibility Profile among Isolates of Clinical Samples of Cancer Patients admitted in the Intensive-care Unit at Regional Tertiary Care Cancer Center: A Retrospective Observational Study. Indian J of Crit Care Med 2019;23(2):67-72.
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Affiliation(s)
- Vishnu Kumar Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BR Ambedkar, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BR Ambedkar, IRCH, All India Institute of Medical Sciences, New Delhi, India
- Seema Mishra, Department of Oncoanesthesia and Palliative Medicine, IRCH, All India Institute of Medical Sciences, New Delhi, India, Phone: 9899061105, e-mail:
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BR Ambedkar, IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bharti Sachidanand
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumar Vinod
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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29
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Tian X, Sun S, Jia X, Zou H, Li S, Zhang L. Epidemiology of and risk factors for infection with extended-spectrum β-lactamase-producing carbapenem-resistant Enterobacteriaceae: results of a double case-control study. Infect Drug Resist 2018; 11:1339-1346. [PMID: 30214254 PMCID: PMC6120570 DOI: 10.2147/idr.s173456] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Carbapenem-resistant Enterobacteriaceae (CRE) have been increasingly reported worldwide and pose a serious public threat, but the clinical significance of extended-spectrum β-lactamase (ESBL) production in CRE is not well established. Patients and methods A retrospective case–case–control study was conducted to identify the clinical characteristics of patients with ESBL-CRE. The susceptibility of isolates obtained from these patients was assessed. The detection of ESBL and carbapenemase-related genes was performed by PCR methods. Predictors of 30-day mortality in patients with ESBL-CRE infection were also identified in our study. Results A total of 149 patients with CRE infection caused by Enterobacter cloacae (n=74), Escherichia coli (n=38), and Klebsiella pneumoniae (n=37) were identified in Chongqing, Southwestern China, between January 2011 and December 2014. Of the 35 isolates detected with carbapenemase-related genes, 16 isolates had New Delhi metallo-β-lactamase (NDM), nine isolates had K. pneumoniae carbapenemase (KPC), seven isolates had imipenemase (IMP), and four isolates had oxacillinase (OXA)-1. One strain of enterobacter cloacae carried both NDM-1 and IMP-8 genes. ESBL isolates included the genes CTX-M (72/149), SHV (64/149), and TEM (54/149). All ESBL-CRE isolates exhibited ertapenem resistance, and the rate of cephalosporin resistance was relatively high in general. Independent risk factors for infection with ESBL-CRE included previous exposure to β-lactam antibiotics, transfer from another hospital, and some underlying diseases. In addition, solid tumors, hypoalbuminemia, and central venous catheters were independent predictors of mortality in patients with ESBL-CRE infection. Conclusion Physicians should understand the peculiar predictors for the identification of these organisms among high-risk patients.
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Affiliation(s)
- Xiaolang Tian
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China,
| | - Shan Sun
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China,
| | - Xiaojiong Jia
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China,
| | - Hua Zou
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China,
| | - Shuang Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China,
| | - Liping Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China,
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30
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Paulsen MH, Karlsen EA, Ausbacher D, Anderssen T, Bayer A, Ochtrop P, Hedberg C, Haug T, Ericson Sollid JU, Strøm MB. An amphipathic cyclic tetrapeptide scaffold containing halogenated β2,2-amino acids with activity against multiresistant bacteria. J Pept Sci 2018; 24:e3117. [DOI: 10.1002/psc.3117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/26/2018] [Accepted: 07/07/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Marianne H. Paulsen
- Department of Pharmacy, Faculty of Health Sciences; UiT-The Arctic University of Norway; Tromsø Norway
| | - Eskil André Karlsen
- Department of Pharmacy, Faculty of Health Sciences; UiT-The Arctic University of Norway; Tromsø Norway
| | | | - Trude Anderssen
- Department of Pharmacy, Faculty of Health Sciences; UiT-The Arctic University of Norway; Tromsø Norway
| | - Annette Bayer
- Department of Chemistry; UiT-The Arctic University of Norway; Tromsø Norway
| | | | | | - Tor Haug
- Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics; UiT-The Arctic University of Norway; Tromsø Norway
| | - Johanna U. Ericson Sollid
- Department of Medical Biology, Faculty of Health Sciences; UiT-The Arctic University of Norway; Tromsø Norway
| | - Morten B. Strøm
- Department of Pharmacy, Faculty of Health Sciences; UiT-The Arctic University of Norway; Tromsø Norway
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31
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Slavova-Azmanova N, Haddow L, Hohnen H, Coombs G, Robinson JO, Ives A. Admissions for antibiotic-resistant infections in cancer patients during first year of cancer diagnosis: a cross-sectional study. Intern Med J 2018; 47:1306-1310. [PMID: 29105268 DOI: 10.1111/imj.13609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/20/2017] [Accepted: 05/07/2017] [Indexed: 12/01/2022]
Abstract
In this study, linked Western Australian health data were used to determine presence of an antibiotic-resistant infection (ABRI) for all people diagnosed with a primary invasive cancer in 2009. Of 10 858 cancer cases, 154 (1.42%) had an ABRI. Patients with an ABRI were older (71.5 vs 66 years), and more had died in the year following diagnosis (37.7 vs 20.2%, P < 0.001). The ABRI cohort had a higher proportion of colorectal, genitourinary and haematological cancers (19.5 vs 11.9%; 14.3 vs 9.7% and 16.9 vs 5.8%, respectively). Hospital admissions with an ABRI were longer (22.3 vs 2.9 days, P < 0.001) and had a higher proportion of unplanned admissions (60.3 vs 15.2%), admissions through emergency department (36.8 vs 8.3%) and intensive care admissions (14.9 vs 1.7%, P < 0.001). Patients with solid tumours who developed an ABRI were more likely to have received chemotherapy (35.9 vs 27.8%, P = 0.04). In haematological cancer patients, a greater proportion of the admissions with an ABRI occurred after radiation therapy or chemotherapy (P = 0.01 and P = 0.005, respectively). This study is the first to report population-level data on ABRI in cancer patients. Patients with an ABRI had more hospital admissions and poorer outcomes.
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Affiliation(s)
- Neli Slavova-Azmanova
- Cancer and Palliative Care Research and Evaluation Unit, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Livia Haddow
- Cancer and Palliative Care Research and Evaluation Unit, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Harry Hohnen
- Cancer and Palliative Care Research and Evaluation Unit, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Geoffrey Coombs
- School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia.,School of Biomedical Sciences, Curtin University, Perth, Western Australia, Australia.,Pathwest Laboratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - James O Robinson
- Pathwest Laboratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Angela Ives
- Cancer and Palliative Care Research and Evaluation Unit, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Gudiol C, Nicolae S, Royo-Cebrecos C, Aguilar-Guisado M, Montero I, Martín-Gandul C, Perayre M, Berbel D, Encuentra M, Arnan M, Cisneros-Herreros JM, Carratalà J. Administration of taurolidine-citrate lock solution for prevention of central venous catheter infection in adult neutropenic haematological patients: a randomised, double-blinded, placebo-controlled trial (TAURCAT). Trials 2018; 19:264. [PMID: 29720244 PMCID: PMC5932813 DOI: 10.1186/s13063-018-2647-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background Catheter-related bloodstream infection (CRBSI) is one of the most frequent complications in patients with cancer who have central venous catheters (CVCs) implanted and is associated with substantial morbidity and mortality. Taurolidine is a non-antibiotic agent with broad-spectrum antimicrobial activity, which has been used as a lock solution to prevent CRBSI in some settings. However, little is known about its usefulness in high-risk adult neutropenic patients with cancer. This prospective randomised clinical trial aims to test the hypothesis that taurolidine-citrate lock solution is more effective than placebo for preventing catheter infection in neutropenic haematological patients. Methods This study is a prospective, multicentre, randomised, double-blinded, parallel, superiority, placebo-controlled trial. Patients with haematological cancer who are expected to develop prolonged neutropenia (> 7 days) and who have a non-tunnelled CVC implanted will be randomised to receive prophylactic taurolidine-citrate-heparin solution using a lock technique (study group) or heparin alone (placebo group). The primary endpoint will be bacterial colonisation of the CVC hubs. The secondary endpoints will be the incidence of CRBSI, CVC removal, adverse events, and 30-day case-fatality rate. Discussion The lock technique is a preventive strategy that inhibits bacterial colonisation in the catheter hubs, which is the initial step of endoluminal catheter colonisation and the development of infection. Taurolidine is a nontoxic agent that does not develop antibiotic resistance because it acts as an antiseptic rather than an antibiotic. Taurolidine has shown controversial results in the few trials conducted in cancer patients. These studies have important limitations due to the lack of data on adult and/or high-risk neutropenic patients, the type of catheters studied (tunnelled or ports), and the lack of information regarding the intervention (e.g. dwelling of the solution, time, and periodicity of the lock technique). If our hypothesis is proven, the study could provide important solid evidence on the potential usefulness of this preventive procedure in a population at high risk of CRBSI, in whom this complication may significantly impair patient outcome. Trial registration ISRCTN, ISRCTN47102251. Registered on 9 September 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2647-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain. .,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain.
| | - S Nicolae
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Royo-Cebrecos
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - M Aguilar-Guisado
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - I Montero
- Department of Haematology, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain
| | - C Martín-Gandul
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - M Perayre
- Pharmacy Department, Clinical Trial Unit, Institut Català d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Berbel
- Microbiology Department, Bellvitge University Hospital, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Encuentra
- Biostatistics. Clinical Research Unit, Institut Català d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Arnan
- Haematology Department, Institut Català d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J M Cisneros-Herreros
- Department of Infectious Diseases, Microbiology, and Preventive Medicine, University Hospital Virgen del Rocío-Institute of Biomedicine of Seville, Seville, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - J Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, Feixa Llarga SN, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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Ojha RP, Asdahl PH, Steyerberg EW, Schroeder H. Predicting bacterial infections among pediatric cancer patients with febrile neutropenia: External validation of the PICNICC model. Pediatr Blood Cancer 2018; 65. [PMID: 29286572 DOI: 10.1002/pbc.26935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/11/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The Predicting Infectious Complications in Neutropenic Children and Young People with Cancer (PICNICC) model was recently developed for antibiotic stewardship among pediatric cancer patients, but limited information is available about its clinical usefulness. We aimed to assess the performance of the PICNICC model for predicting microbiologically documented bacterial infections among pediatric cancer patients with febrile neutropenia. MATERIALS AND METHODS We used data for febrile neutropenia episodes at a pediatric cancer center in Aarhus, Denmark between 2000 and 2016. We assessed the area under the receiver operating characteristic curve (AUC), calibration, and clinical usefulness (i.e., net benefit). We also recalibrated the model using statistical updating methods. RESULTS We observed 306 microbiologically documented bacterial infections among 1,892 episodes of febrile neutropenia. The AUC of the model was 0.73 (95% confidence limits [CL]: 0.71-0.75). The calibration intercept (calibration-in-the-large) was -0.69 (95% CL: -0.86 to -0.51) and the slope was 0.77 (95% CL: 0.65-0.89). Modest net benefit was observed at a decision threshold of 5%. Recalibration improved calibration but did not improve net benefit. CONCLUSIONS The PICNICC model has potential for reducing unnecessary antibiotic exposure for pediatric cancer patients with febrile neutropenia, but continued validation and refinement is necessary to optimize clinical usefulness.
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Affiliation(s)
- Rohit P Ojha
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.,Center for Outcomes Research, JPS Health Network, Fort Worth, Texas
| | - Peter H Asdahl
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Henrik Schroeder
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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Lambregts MMC, Warreman EB, Bernards AT, Veelken H, von dem Borne PA, Dekkers OM, Visser LG, de Boer MG. Distribution and clinical determinants of time-to-positivity of blood cultures in patients with neutropenia. Eur J Haematol 2017; 100:206-214. [PMID: 29171916 DOI: 10.1111/ejh.13001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Blood cultures (BCs) are essential in the evaluation of neutropenic fever. Modern BC systems have significantly reduced the time-to-positivity (TTP) of BC. This study explores the probability of bacteraemia when BCs have remained negative for different periods of time. METHODS All adult patients with neutropenia and bacteraemia were included (January 2012-February 2016). Predictive clinical factors for short (≤16 hours) and long (>24 hours) TTP were determined. The residual probability of bacteraemia was estimated for the scenario of negative BC 24 hours after collection. RESULTS The cohort consisted of 154 patients, accounting for 190 episodes of bacteraemia. Median age of 61 years, 60.5% were male. In 123 (64.7%) episodes, BC yielded a single Gram-positive micro-organism and in 49 (25.8%) a Gram-negative micro-organism (median TTP 16.7, 14.5 hours respectively, P < .01). TTP was ≤24 hours in 91.6% of episodes. Central line-associated bacteraemia was associated with long TTP. The probability of bacteraemia if BC had remained negative for 24 hours was 1%-3%. CONCLUSIONS The expected TTP offers guidance in the management of patients with neutropenia and suspected bacteraemia. The knowledge of negative BC can support a change in working diagnosis, and impact clinical decisions as soon as 24 hours after BC collection.
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Affiliation(s)
- Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Eva B Warreman
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandra T Bernards
- Department of Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hendrik Veelken
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter A von dem Borne
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Christophy R, Osman M, Mallat H, Achkar M, Ziedeh A, Moukaddem W, Dabboussi F, Hamze M. Prevalence, antibiotic susceptibility and characterization of antibiotic resistant genes among carbapenem-resistant Gram-negative bacilli and yeast in intestinal flora of cancer patients in North Lebanon. J Infect Public Health 2017; 10:716-720. [DOI: 10.1016/j.jiph.2016.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 08/08/2016] [Accepted: 10/01/2016] [Indexed: 11/28/2022] Open
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36
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Al-Otaibi FE, Bukhari EE, Badr M, Alrabiaa AA. Prevalence and risk factors of Gram-negative bacilli causing blood stream infection in patients with malignancy. Saudi Med J 2017; 37:979-84. [PMID: 27570854 PMCID: PMC5039618 DOI: 10.15537/smj.2016.9.14211] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To evaluate the epidemiology, risk factors, and antibiotic resistance of Gram negative bacteria (GNB) in patients with hematologic or solid organ malignancies. Methods: This is a retrospective study of 61 episodes of GNB bacteremia occurring in 56 patients with malignancy admitted to the Oncology Units in King Khalid University Hospital, Riyadh. Kingdom of Saudi Arabia during the period from January 2013 to October 2015. Data were retrieved from the computerized database of the microbiology laboratory and the patient’s medical records. Results: Hematological malignancies accounted for 30 (54%) and solid tumors accounted for 26 (46%). The most common hematological malignancies were leukemia 23 (77%), followed by lymphoma 6 (20%). Among solid tumors, colorectal cancer 9 (34.6) and breast cancer 6 (23%) were the most common. The most predominant pathogen was Escherichia coli (E. coli) (29.5%) followed by Acinetobacter baumannii (A. baumannii) (18%). The extended-spectrum beta-lactamases producers rate of E. coli and Klebsiella pneumonia was (34.6%). Imipenem resistance among Pseudomonas aeruginosa/A. baumannii was high (52.4%). The multi-resistant organisms rate was (43.5%). Risk factors associated with the bacteremia were ICU admission (32.1%), post-surgery (23.2%), and placement of central line (21.4%). The overall 30-day mortality rate of the studied population was high (32.1%). Conclusion: In light of the high resistant rate among the GNB isolated from malignancy patients from our institution, careful selection of antimicrobial treatment based on antimicrobial susceptibility testing is recommended.
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Affiliation(s)
- Fawzia E Al-Otaibi
- Department of Microbiology, King Saud University, King Khalid Hospital, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Wang XJ, Chan A. Optimizing Symptoms and Management of Febrile Neutropenia among Cancer Patients: Current Status and Future Directions. Curr Oncol Rep 2017; 19:20. [PMID: 28271398 DOI: 10.1007/s11912-017-0578-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Febrile neutropenia (FN) is a common and serious complication among cancer patients undergoing myelosuppressive chemotherapy. FN should be treated as a medical emergency because it can lead to life-threatening complications if appropriate treatment is not initiated immediately. This study provides a critical review on the current management of FN and identifies possible directions to optimize FN management.
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Affiliation(s)
- Xiao Jun Wang
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, 169610, Singapore.
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El-Najjar N, Jantsch J, Gessner A. The use of liquid chromatography-tandem mass spectrometry for therapeutic drug monitoring of antibiotics in cancer patients. ACTA ACUST UNITED AC 2017; 55:1246-1261. [DOI: 10.1515/cclm-2016-0700] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/28/2016] [Indexed: 12/24/2022]
Abstract
AbstractCancer remains a leading cause of mortality and morbidity worldwide. In addition to organ failure, the most frequent reasons for admission of cancer patients to intensive care units (ICU) are: infections and sepsis. As critically ill, the complexity of the health situation of cancer patients renders the standard antimicrobial regimen more complex and even inadequate which results in increased mortality rates. This is due to pathophysiological changes in the volume of distribution, increased clearance, as well as to organ dysfunction. While in the former cases a decrease in drug efficacy is observed, the hallmark of the latter one is overdosing leading to increased toxicity at the expense of efficacy. Furthermore, an additional risk factor is the potential drug-drug interaction between antibiotics and antineoplastic agents. Therefore, therapeutic drug monitoring (TDM) is a necessity to improve the clinical outcome of antimicrobial therapy in cancer patients. To be applied in routine analysis the method used for TDM should be cheap, fast and highly accurate/sensitive. Furthermore, as ICU patients are treated with a cocktail of antibiotics the method has to cover the simultaneous analysis of antibiotics used as a first/second line of treatment. The aim of the current review is to briefly survey the pitfalls in the current antimicrobial therapy and the central role of TDM in dose adjustment and drug-drug interaction’s evaluation. A major section is dedicated to summarize the currently published analytical methods and to shed light on the difficulties and potential problems that can be encountered during method development.
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Alp S, Akova M. Antibacterial Resistance in Patients with Hematopoietic Stem Cell Transplantation. Mediterr J Hematol Infect Dis 2017; 9:e2017002. [PMID: 28101308 PMCID: PMC5224809 DOI: 10.4084/mjhid.2017.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Recipients of hematopoietic stem cell transplantation (HSCT) are at substantial risk of bacterial, fungal, viral, and parasitic infections depending on the time elapsed since transplantation, presence of graft-versus-host disease (GVHD), and the degree of immunosuppression. Infectious complications in HSCT recipients are associated with high morbidity and mortality. Bacterial infections constitute the major cause of infectious complications, especially in the early post-transplant period. The emergence of antibacterial resistance complicates the management of bacterial infections in this patient group. Multidrug-resistant bacterial infections in this group of patients have attracted considerable interest and may lead to significant morbidity and mortality. Empirical antibacterial therapy in patients with HSCT and febrile neutropenia has a critical role for survival and should be based on local epidemiology. This review attempts to provide an overview of risk factors and epidemiology of emerging resistant bacterial infections and their management in HSCT recipients.
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Affiliation(s)
- Sehnaz Alp
- Associate Professor, Hacettepe University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Murat Akova
- Professor, Hacettepe University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey
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40
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Abstract
PURPOSE OF REVIEW Neutropenic fever is the most common infective complication in patients receiving cytotoxic chemotherapy, and may result in severe sepsis, septic shock and mortality. Advancements in approaches to empiric antimicrobial therapy and prophylaxis have resulted in improved outcomes. Mortality may, however, still be as high as 50% in high-risk cancer populations. The objective of this review is to summarize factors associated with reduced mortality in patients with neutropenic fever, highlighting components of clinical care with potential for inclusion in quality improvement programs. RECENT FINDINGS Risks for mortality are multifactorial, and include patient, disease and treatment-related factors. Historically, guidelines for management of neutropenic fever have focused upon antimicrobial therapy. There is, however, a recognized need for early identification of sepsis to enable timely administration of antibiotic therapy and for this to be integrated with a whole of systems approach within healthcare facilities. Use of Systemic Inflammatory Response Syndrome criteria is beneficial, but validation is required in neutropenic fever populations. SUMMARY In the context of emerging and increasing infections because of antimicrobial-resistant bacteria in patients with neutropenic fever, quality improvement initiatives to reduce mortality must encompass antimicrobial stewardship, early detection of sepsis, and use of valid tools for clinical assessment. C-reactive protein and procalcitonin hold potential for inclusion into clinical pathways for management of neutropenic fever.
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Jasovský D, Littmann J, Zorzet A, Cars O. Antimicrobial resistance-a threat to the world's sustainable development. Ups J Med Sci 2016; 121:159-64. [PMID: 27416324 PMCID: PMC4967260 DOI: 10.1080/03009734.2016.1195900] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/26/2016] [Indexed: 01/21/2023] Open
Abstract
This commentary examines how specific sustainable development goals (SDGs) are affected by antimicrobial resistance and suggests how the issue can be better integrated into international policy processes. Moving beyond the importance of effective antibiotics for the treatment of acute infections and health care generally, we discuss how antimicrobial resistance also impacts on environmental, social, and economic targets in the SDG framework. The paper stresses the need for greater international collaboration and accountability distribution, and suggests steps towards a broader engagement of countries and United Nations agencies to foster global intersectoral action on antimicrobial resistance.
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Affiliation(s)
| | | | | | - Otto Cars
- ReAct Europe, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Abstract
Little information is currently available regarding bloodstream infection (BSI) in patients with solid tumors who, for a variety of reasons, are particularly predisposed to develop this condition. In this review we focus on the incidence, epidemiology, clinical features, etiology, antimicrobial resistance, and outcomes of BSI of adult cancer patients with solid tumors. Most episodes of BSI occur in non-neutropenic patients, in whom the site of primary or metastatic tumor often serves as the portal of entry. The urinary tract and the abdomen are the most frequent sources of infection, and cholangitis is the most common recurrent source of BSI. Gram-negative bacilli are becoming the leading cause of BSI in patients with solid tumors, and the rate of multidrug resistance is increasingly being recognized. The case-fatality rate in patients with solid tumors and BSI is high, especially among those with comorbidities, advanced neoplasms, corticosteroid therapy, and shock at presentation.
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Affiliation(s)
- Carlota Gudiol
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,b REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III , Madrid , Spain.,c Institut Català d'Oncologia , Barcelona , Spain
| | - José María Aguado
- b REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III , Madrid , Spain.,d Unit of Infectious Diseases, Instituto de Investigación Hospital, Complutense University , Madrid , Spain
| | - Jordi Carratalà
- a Department of Infectious Diseases , Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona , Barcelona , Spain.,b REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III , Madrid , Spain
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Nouér SA, Nucci M, Anaissie E. Tackling antibiotic resistance in febrile neutropenia: current challenges with and recommendations for managing infections with resistant Gram-negative organisms. Expert Rev Hematol 2015; 8:647-58. [DOI: 10.1586/17474086.2015.1060576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Lee JY, Lee BH, Lee JY. Gambogic Acid Disrupts Toll-like Receptor4 Activation by Blocking Lipopolysaccharides Binding to Myeloid Differentiation Factor 2. Toxicol Res 2015; 31:11-6. [PMID: 25874028 PMCID: PMC4395650 DOI: 10.5487/tr.2015.31.1.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 01/13/2023] Open
Abstract
Our body's immune system has defense mechanisms against pathogens such as viruses and bacteria. Immune responses are primarily initiated by the activation of toll-like receptors (TLRs). In particular, TLR4 is well-characterized and is known to be activated by gram-negative bacteria and tissue damage signals. TLR4 requires myeloid differentiation factor 2 (MD2) as a co-receptor to recognize its ligand, lipopolysaccharides (LPS), which is an extracellular membrane component of gram-negative bacteria. Gambogic acid is a xanthonoid isolated from brownish or orange resin extracted from Garcinia hanburyi. Its primary effect is tumor suppression. Since inflammatory responses are related to the development of cancer, we hypothesized that gambogic acid may regulate TLR4 activation. Our results demonstrated that gambogic acid decreased the expression of pro-inflammatory cytokines (TNF-α, IL-6, IL-12, and IL-1β) in both mRNA and protein levels in bone marrow-derived primary macrophages after stimulation with LPS. Gambogic acid did not inhibit the activation of Interferon regulatory factor 3 (IRF3) induced by TBK1 overexpression in a luciferase reporter gene assay using IFN-β-PRD III-I-luc. An in vitro kinase assay using recombinant TBK1 revealed that gambogic acid did not directly inhibit TBK1 kinase activity, and instead suppressed the binding of LPS to MD2, as determined by an in vitro binding assay and confocal microscopy analysis. Together, our results demonstrate that gambogic acid disrupts LPS interaction with the TLR4/MD2 complex, the novel mechanism by which it suppresses TLR4 activation.
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Affiliation(s)
- Jin Young Lee
- Integrated Research Institute of Pharmaceutical Sciences, College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
| | - Byung Ho Lee
- Pharmacology Research Center, Korea Research Institute of Chemical Technology, Daejeon, Korea
| | - Joo Young Lee
- Integrated Research Institute of Pharmaceutical Sciences, College of Pharmacy, The Catholic University of Korea, Bucheon, Korea
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Moghnieh R, Estaitieh N, Mugharbil A, Jisr T, Abdallah DI, Ziade F, Sinno L, Ibrahim A. Third generation cephalosporin resistant Enterobacteriaceae and multidrug resistant gram-negative bacteria causing bacteremia in febrile neutropenia adult cancer patients in Lebanon, broad spectrum antibiotics use as a major risk factor, and correlation with poor prognosis. Front Cell Infect Microbiol 2015; 5:11. [PMID: 25729741 PMCID: PMC4325930 DOI: 10.3389/fcimb.2015.00011] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/17/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Bacteremia remains a major cause of life-threatening complications in patients receiving anticancer chemotherapy. The spectrum and susceptibility profiles of causative microorganisms differ with time and place. Data from Lebanon are scarce. We aim at evaluating the epidemiology of bacteremia in cancer patients in a university hospital in Lebanon, emphasizing antibiotic resistance and risk factors of multi-drug resistant organism (MDRO)-associated bacteremia. MATERIALS AND METHODS This is a retrospective study of 75 episodes of bacteremia occurring in febrile neutropenic patients admitted to the hematology-oncology unit at Makassed General Hospital, Lebanon, from October 2009-January 2012. It corresponds to epidemiological data on bacteremia episodes in febrile neutropenic cancer patients including antimicrobial resistance and identification of risk factors associated with third generation cephalosporin resistance (3GCR) and MDRO-associated bacteremia. RESULTS Out of 75 bacteremias, 42.7% were gram-positive (GP), and 57.3% were gram-negative (GN). GP bacteremias were mostly due to methicillin-resistant coagulase negative staphylococci (28% of total bacteremias and 66% of GP bacteremias). Among the GN bacteremias, Escherichia coli (22.7% of total, 39.5% of GN organisms) and Klebsiella pneumoniae(13.3% of total, 23.3% of GN organisms) were the most important causative agents. GN bacteremia due to 3GC sensitive (3GCS) bacteria represented 28% of total bacteremias, while 29% were due to 3GCR bacteria and 9% were due to carbapenem-resistant organisms. There was a significant correlation between bacteremia with MDRO and subsequent intubation, sepsis and mortality. Among potential risk factors, only broad spectrum antibiotic intake >4 days before bacteremia was found to be statistically significant for acquisition of 3GCR bacteria. Using carbapenems or piperacillin/tazobactam>4 days before bacteremia was significantly associated with the emergence of MDRO (p < 0.05). CONCLUSION Our findings have major implications for the management of febrile neutropenia, especially in breakthrough bacteremia and fever when patients are already on broadspectrum antibiotics. Emergence of resistance to 3GCs and, to a lesser extent, to carbapenems in GN isolates has to be considered seriously in our local guidelines for empiric treatment of febrile neutropenia, especially given that their occurrence was proven to be associated with poorer outcomes.
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Affiliation(s)
- Rima Moghnieh
- Department of Internal Medicine, Makassed General Hospital Beirut, Lebanon
| | - Nour Estaitieh
- Department of Internal Medicine, Makassed General Hospital Beirut, Lebanon
| | - Anas Mugharbil
- Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital Beirut, Lebanon
| | | | - Fouad Ziade
- Faculty of Public Health, Lebanese University Beirut, Lebanon
| | - Loubna Sinno
- Research Coordinator, Makassed General Hospital Beirut, Lebanon
| | - Ahmad Ibrahim
- Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital Beirut, Lebanon
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