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Vittorakis E, Vica ML, Zervaki CO, Vittorakis E, Maraki S, Mavromanolaki VE, Schürger ME, Neculicioiu VS, Papadomanolaki E, Junie LM. A Comparative Analysis of MRSA: Epidemiology and Antibiotic Resistance in Greece and Romania. Int J Mol Sci 2024; 25:7535. [PMID: 39062778 PMCID: PMC11277345 DOI: 10.3390/ijms25147535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
This study provides a comparative analysis of 243 Methicillin-resistant Staphylococcus aureus (MRSA) isolated strains from Greece and Romania, focusing on their epidemiology and antibiotic resistance patterns. Laboratory procedures included phenotypic and automated identification methods, susceptibility testing, DNA isolation, and PCR for detecting antibiotic resistance genes (MecA, SCCmec). Our study results show significant regional differences. In both regions, males have higher MRSA infection rates than females, but the percentages vary. Greece has a higher incidence of MRSA in younger age groups compared to Romania. The majority of MRSA infections occur in inpatient settings in both countries, highlighting the necessity for enhanced infection control measures. Antibiotic resistance profiles reveal higher resistance to several antibiotics in Greece compared to Romania. A molecular analysis shows a widespread distribution of antibiotic resistance genes among MRSA isolates in Greece. These results highlight the necessity for accomplished preventive strategies and optimized treatment protocols.
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Affiliation(s)
- Eftychios Vittorakis
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania (L.M.J.)
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.L.V.)
- Agios Georgios General Hospital of Chania, 73100 Crete, Greece
| | - Mihaela Laura Vica
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.L.V.)
| | | | | | - Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 70013 Crete, Greece; (S.M.); (V.E.M.)
| | - Viktoria Eirini Mavromanolaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 70013 Crete, Greece; (S.M.); (V.E.M.)
| | - Michael Ewald Schürger
- Department of Cell and Molecular Biology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.L.V.)
| | - Vlad Sever Neculicioiu
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania (L.M.J.)
| | | | - Lia Monica Junie
- Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania (L.M.J.)
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Elsheredy A, El-Soudany I, Elsherbini E, Metwally D, Ghazal A. Effect of azithromycin and phenylalanine-arginine beta-naphthylamide on quorum sensing and virulence factors in clinical isolates of Pseudomonas aeruginosa. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:37-49. [PMID: 33889361 PMCID: PMC8043820 DOI: 10.18502/ijm.v13i1.5491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Pseudomonas aeruginosa is a problematic opportunistic pathogen causing several types of nosocomial infections with a high resistance rate to antibiotics. Production of many virulence factors in P. aeruginosa is regulated by quorum sensing (QS), a cell-to-cell communication mechanism. In this study, we aimed to assess and compare the inhibitory effect of azithromycin (AZM) and EPI-PAβN (efflux pump inhibitor-Phenylalanine-Arginine Beta-Naphthylamide) on QS system and QS-dependent virulence factors in P. aeruginosa clinical isolates. Materials and Methods A total of 50 P. aeruginosa isolates were obtained from different types of clinical specimens. Isolates were investigated for detection of QS system molecules by AHL cross-feeding bioassay and QS-dependent virulence factors; this was also confirmed by detection of QS genes (lasR, lasI, rhlR, and rhlI) using PCR assay. The inhibitory effect of sub-MIC AZM and EPI PAβN on these virulence factors was assessed. Results All the P. aeruginosa, producing QS signals C4HSL, failed to produce C4HSL in the presence of sub-MIC AZM, In the presence of EPI PAβN (20 μg/ml) only 14 isolates were affected, there was a significant reduction in QS-dependent virulence factors production (protease, biofilm, rhamnolipid and pyocyanin) in the presence of either 20 μg/ml EPI or sub-MIC of AZM with the inhibitory effect of AZM was more observed than PAβN. Conclusion Anti-QS agents like AZM and EPI (PAβN) are useful therapeutic options for P. aeruginosa due to its inhibitory effect on QS-dependent virulence factors production without selective pressure on bacteria growth, so resistance to these agents is less likely to develop.
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Affiliation(s)
- Amel Elsheredy
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ingy El-Soudany
- Department of Microbiology and Immunology, Faculty of Pharmacy and Drug Manufacturing, Pharos, University in Alexandria, Alexandria, Egypt
| | - Eglal Elsherbini
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Dalia Metwally
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Abeer Ghazal
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Turuvekere Vittala Murthy N, Agrahari V, Chauhan H. Polyphenols against infectious diseases: Controlled release nano-formulations. Eur J Pharm Biopharm 2021; 161:66-79. [PMID: 33588032 DOI: 10.1016/j.ejpb.2021.02.003] [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: 12/07/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
The emergence of multi-drug resistant (MDR) pathogens has become a global threat and a cause of significant morbidity and mortality around the world. Natural products have been used as a promising approach to counter the infectious diseases associated with these pathogens. The application of natural products and their derivatives especially polyphenolic compounds as antibacterial agents is an active area of research, and prior studies have successfully treated a variety of bacterial infections using these polyphenolic compounds. However, delivery of polyphenolic compounds has been challenging due to their physicochemical properties and often poor aqueous solubility. In this regard, nanotechnology-based novel drug delivery systems offer many advantages, including improving bioavailability and the controlled release of polyphenolic compounds. This review summarizes the pharmacological mechanism and use of nano-formulations in developing controlled release delivery systems of naturally occurring polyphenols in infectious diseases.
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Affiliation(s)
| | - Vibhuti Agrahari
- Department of Pharmaceutical Sciences, College of Pharmacy, Oklahoma University, Oklahoma City, OK 73117, United States
| | - Harsh Chauhan
- School of Pharmacy and Health Professionals, Creighton University, Omaha, NE 68178, United States.
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Yuan Y, Shi W, Li R, Lim DSW, Armugam A, Zhang Y. Rational Design of Gram-Specific Antimicrobial Imidazolium Tetramers To Combat MRSA. ACS Biomater Sci Eng 2020; 6:5563-5570. [PMID: 33320560 DOI: 10.1021/acsbiomaterials.0c01248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antimicrobial resistance poses an increasingly serious global health threat. Hence, new antimicrobials with low propensity toward inducing resistance in bacteria are being developed to combat this threat. In this work, a series of imidazolium tetramers have been synthesized by modulating the linkers between imidazoliums or the length of the end groups within the structures of oligomers in order to optimize the activity, selectivity, and biocompatibility of the compounds. These new materials possess high biocompatibility, Gram selectivity, and high efficacy against the selected bacterium as well as clinically isolated methicillin-resistant Staphylococcus aureus species without inducing drug resistance. Therefore, we believe that these compounds can potentially be used to mitigate resistance as highly effective disinfectants in healthcare products or as antimicrobial therapies specifically for Gram-positive bacterial infections.
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Affiliation(s)
- Yuan Yuan
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos #04-01, Singapore 138669, Singapore
| | - Weiwei Shi
- 2nd Hospital of Dalian Medical University, Dalian 116023, China
| | - Ruihua Li
- 2nd Hospital of Dalian Medical University, Dalian 116023, China
| | - Diane S W Lim
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos #04-01, Singapore 138669, Singapore
| | - Arunmozhiarasi Armugam
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos #04-01, Singapore 138669, Singapore
| | - Yugen Zhang
- Institute of Bioengineering and Nanotechnology, 31 Biopolis Way, The Nanos #04-01, Singapore 138669, Singapore
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Techaoei S, Jirayuthcharoenkul C, Jarmkom K, Dumrongphuttidecha T, Khobjai W. Chemical evaluation and antibacterial activity of novel bioactive compounds from endophytic fungi in Nelumbo nucifera. Saudi J Biol Sci 2020; 27:2883-2889. [PMID: 33100843 PMCID: PMC7569113 DOI: 10.1016/j.sjbs.2020.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
The objective of this study was to characterize an endophytic fungi producing-bioactive compound from the aquatic plant, Nelumbo nucifera. All parts of such plant were cleaned with surface sterilization technique and cultured on potato dextrose agar to isolate endophytic fungi. The identification was characterized by morphological and molecular technique. Fungal isolates were screened to discover antimicrobial activities by disc diffusion method against Methicillin-resistant Staphylococcus aureus DMST20651 (MRSA). MIC and MBC for those crude fungal extracts were determined. Finally, the chemical profile of crude extract was determined by gas chromatography and mass spectrometry. Six endophytic fungi were isolated from the surface-satirized parts of N. nucifera. Based on disc diffusion assay, the highest antibacterial activity against MRSA was isolate ST9.1 identified as Aspergillus cejpii. Results demonstrated that the ethyl acetate extraction had more active fractions with MIC of 2.5 mg/ml and MBC concentration of 50.0 mg/ml. The crude extracts were developed to identify the chemical constituents by gas chromatography and mass spectrometry. The major component of crude extract of endophytic fungi was 5-(1H-Indol-3-yl)-4,5-dihydro-[1,2,4]triazin-3-ylamine (C11H11N5). Thus, the plant could be used in the treatment of infectious diseases caused by bacterial pathogen.
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Affiliation(s)
- Surachai Techaoei
- Thai Traditional Medicine College, Rajamangala University of Technology Thanyaburi 12130 Thailand.,Innovation of Plants Extraction and Biological Activity for Pharmaceutical Products, Food Supplement and Medical Drugs, Thai Traditional Medicine College, Rajamangala University of Technology Thanyaburi 12130 Thailand
| | | | - Khemjira Jarmkom
- Thai Traditional Medicine College, Rajamangala University of Technology Thanyaburi 12130 Thailand.,Innovation of Plants Extraction and Biological Activity for Pharmaceutical Products, Food Supplement and Medical Drugs, Thai Traditional Medicine College, Rajamangala University of Technology Thanyaburi 12130 Thailand
| | - Thisakorn Dumrongphuttidecha
- Thai Traditional Medicine College, Rajamangala University of Technology Thanyaburi 12130 Thailand.,Innovation of Plants Extraction and Biological Activity for Pharmaceutical Products, Food Supplement and Medical Drugs, Thai Traditional Medicine College, Rajamangala University of Technology Thanyaburi 12130 Thailand
| | - Warachate Khobjai
- Department of Clinical Chemistry, Faculty of Medical Technology, Nation University No. 444 Vajiravuth Damnern Road, Prabat Sub-district, Mueang District, Lampang 52000, Thailand
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Kim EY, Kumar SD, Bang JK, Shin SY. Mechanisms of antimicrobial and antiendotoxin activities of a triazine‐based amphipathic polymer. Biotechnol Bioeng 2020; 117:3508-3521. [DOI: 10.1002/bit.27499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Eun Young Kim
- Department of Biomedical Science, Graduate School Chosun University Gwangju Republic of Korea
| | - S. Dinesh Kumar
- Department of Biomedical Science, Graduate School Chosun University Gwangju Republic of Korea
| | - Jeong Kyu Bang
- Division of Magnetic Resonance Korea Basic Science Institute (KBSI) Ochang Republic of Korea
| | - Song Yub Shin
- Department of Biomedical Science, Graduate School Chosun University Gwangju Republic of Korea
- Department of Cellular & Molecular Medicine, School of Medicine Chosun University Gwangju Republic of Korea
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Current options for the treatment of infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. Clin Microbiol Infect 2019; 25:932-942. [PMID: 30986558 DOI: 10.1016/j.cmi.2019.03.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are a frequent cause of invasive infections worldwide. Carbapenems are nowadays the most used drugs to treat these infections. However, due to the increasing rates of resistance to these antimicrobials, carbapenem-sparing alternatives are being investigated. OBJECTIVES AND SOURCES The aim of this narrative literature review is to summarize the published information on the currently available antibiotics for the treatment of ESBL-E infections, providing specific information on three subgroups of patients: Group 1, patients with severe infections or infections from high-risk sources or in severely immunocompromised patients; Group 2, patients with non-severe infections from intermediate-risk source; and Group 3, patients with non-severe urinary tract infection. CONTENT AND IMPLICATIONS For patients in Group 1, the current data would support the use of carbapenems. For milder infections, however, particularly urinary tract infections, other non-carbapenem antibiotics can be considered in selected cases, including beta-lactam/beta-lactam inhibitor combinations, cephamycins, temocillin and aminoglycosides. While specific studies should be performed in these situations, individualized decisions may be taken in order to avoid overuse of carbapenems.
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Riga EK, Gillies E, Lienkamp K. Self-Regenerating Antimicrobial Polymer Surfaces via Multilayer-Design - Sequential and Triggered Layer Shedding under Physiological Conditions. ADVANCED MATERIALS INTERFACES 2019; 6:1802049. [PMID: 34405081 PMCID: PMC7611505 DOI: 10.1002/admi.201802049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Indexed: 05/05/2023]
Abstract
Regeneration of materials properties through surface regeneration could extend the lifetime of devices and is still an emerging field of research. (Self-)regenerating antimicrobial polymer surfaces could help to fight biofilm formation and related bacterial infections. In this paper, four different polymer multilayer designs for the regeneration of antimicrobial surfaces by layer shedding are presented. The multilayer architectures consist of 100-200 nm thick, discrete polymer layers. They are made from poly(guanidinium oxanorbornene) networks as the antimicrobial component, and different interlayers made from degradable poly(adipic anhydrides), depolymerizable poly(ethyl glyoxylate), or water-soluble poly(acrylamide). Layer shedding is designed to occur after hydrolysis, dissolution or depolymerization under simulated physiological conditions. The multilayer fabrication and disassembly is monitored by fluorescence microscopy, ellipsometry FT-IR spectroscopy and atomic force microscopy. By testing the antimicrobial activity of the restored surfaces, their functional integrity after layer shedding is confirmed.
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Affiliation(s)
- Esther Karolin Riga
- Department of Microsystems Engineering (IMTEK) and Freiburg Center for Interactive Materials and Bioinspired Technologies (FIT), Albert-Ludwigs-Universität, Freiburg, Georges-Köhler-Allee 105, 79110 Freiburg, Germany
| | - Elizabeth Gillies
- Department of Chemistry and Department of Chemical and Biochemical Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5B7, Canada
| | - Karen Lienkamp
- Department of Microsystems Engineering (IMTEK) and Freiburg Center for Interactive Materials and Bioinspired Technologies (FIT), Albert-Ludwigs-Universität, Freiburg, Georges-Köhler-Allee 105, 79110 Freiburg, Germany
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Teklu DS, Negeri AA, Legese MH, Bedada TL, Woldemariam HK, Tullu KD. Extended-spectrum beta-lactamase production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control 2019; 8:39. [PMID: 30815254 PMCID: PMC6377715 DOI: 10.1186/s13756-019-0488-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/03/2019] [Indexed: 11/25/2022] Open
Abstract
Background The global emergence and spread of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae have been threatening the ability to treat an infection. Hence, this study aimed to determine the prevalence of ESBL-producing and multi-drug resistance (MDR) Enterobacteriaceae (ESBLs-E) from different clinical specimens in Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted from January 1 to May 30, 2017. A total of 426 Enterobacteriaceae isolates were identified from clinical specimens. The isolates were collected from four laboratories. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Muller Hinton agar (MHA). All Enterobacteriaceae were screened for ESBLs production using cefotaxime and ceftazidime as per CLSI guideline. Each ESBL screening positive Enterobacteriaceae were confirmed by a combination disk test (CDT). Data were entered and analyzed by using SPSS version-20. Result The most frequent Enterobacteriaceae were E. coli 228 (53.5%) and K. pneumoniae 103 (24.1%). The magnitude of ESBLs-E was 57.7% (246/426). The highest frequencies of ESBLs-E were observed in blood specimesns (84.4%) and the highest ESBLs production was observed in K. pneumoniae (85.4%). The highest resistance level was seen to sulfamethoxazole-trimethoprim (77.0%), amoxicillin with clavulanic acid (71.6%), cefotaxime (62.2%), cefepime (60.3%) and ceftazidime (60.8%). The overall magnitude of multi-drug resistance (MDR) level was 68.3%. Of ESBLs-E, 96.3% of them were MDR (P < 0.001). Conclusion There was a high prevalence of ESBLs-E and MDR isolate in Addis Ababa. Most of ESBLs-E was isolated primarily in blood and urine. The highest ESBLs production was observed among K. pneumoniae. Hence, strong infection control strategies must be implemented in hospital settings of the country.
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Affiliation(s)
- Dejenie Shiferaw Teklu
- Department of Clinical Bacteriology and Mycology National Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abebe Aseffa Negeri
- Department of Clinical Bacteriology and Mycology National Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Melese Hailu Legese
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Legesse Bedada
- Department of Public Health Microbiology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Hiwot Ketema Woldemariam
- Department of Virology, Ethiopian Public Health Institute, P. O. Box, 1242 Addis Ababa, Ethiopia
| | - Kassu Desta Tullu
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Almeida JR, Palacios ALV, Patiño RSP, Mendes B, Teixeira CAS, Gomes P, da Silva SL. Harnessing snake venom phospholipases A 2 to novel approaches for overcoming antibiotic resistance. Drug Dev Res 2018; 80:68-85. [PMID: 30255943 DOI: 10.1002/ddr.21456] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
The emergence of antibiotic resistance drives an essential race against time to reveal new molecular structures capable of addressing this alarming global health problem. Snake venoms are natural catalogs of multifunctional toxins and privileged frameworks, which serve as potential templates for the inspiration of novel treatment strategies for combating antibiotic resistant bacteria. Phospholipases A2 (PLA2 s) are one of the main classes of antibacterial biomolecules, with recognized therapeutic value, found in these valuable secretions. Recently, a number of biomimetic oligopeptides based on small fragments of primary structure from PLA2 toxins has emerged as a meaningful opportunity to overcome multidrug-resistant clinical isolates. Thus, this review will highlight the biochemical and structural properties of antibacterial PLA2 s and peptides thereof, as well as their possible molecular mechanisms of action and key roles in development of effective therapeutic strategies. Chemical strategies possibly useful to convert antibacterial peptides from PLA2 s to efficient drugs will be equally addressed.
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Affiliation(s)
| | | | | | - Bruno Mendes
- Departamento de Biologia Animal, Instituto de Biologia, Universidade de Campinas (UNICAMP), Campinas, Brazil
| | - Cátia A S Teixeira
- LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Porto, Portugal
| | - Paula Gomes
- LAQV/REQUIMTE, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, Porto, Portugal
| | - Saulo L da Silva
- Facultad de Ciencias Química, Universidad de Cuenca - Cuenca/Azuay - Ecuador
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Bai PY, Qin SS, Chu WC, Yang Y, Cui DY, Hua YG, Yang QQ, Zhang E. Synthesis and antibacterial bioactivities of cationic deacetyl linezolid amphiphiles. Eur J Med Chem 2018; 155:925-945. [DOI: 10.1016/j.ejmech.2018.06.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/10/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
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Treatment of Infections Caused by Extended-Spectrum-Beta-Lactamase-, AmpC-, and Carbapenemase-Producing Enterobacteriaceae. Clin Microbiol Rev 2018; 31:31/2/e00079-17. [PMID: 29444952 DOI: 10.1128/cmr.00079-17] [Citation(s) in RCA: 421] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Therapy of invasive infections due to multidrug-resistant Enterobacteriaceae (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole. These drugs might be considered in some specific situations. AmpC producers are resistant to cephamycins, but cefepime is an option. In the case of carbapenemase-producing Enterobacteriaceae (CPE), only some "second-line" drugs, such as polymyxins, tigecycline, aminoglycosides, and fosfomycin, may be active; double carbapenems can also be considered in specific situations. Combination therapy is associated with better outcomes for high-risk patients, such as those in septic shock or with pneumonia. Ceftazidime-avibactam was recently approved and is active against KPC and OXA-48 producers; the available experience is scarce but promising, although development of resistance is a concern. New drugs active against some CPE isolates are in different stages of development, including meropenem-vaborbactam, imipenem-relebactam, plazomicin, cefiderocol, eravacycline, and aztreonam-avibactam. Overall, therapy of MDR-E infection must be individualized according to the susceptibility profile, type, and severity of infection and the features of the patient.
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Abstract
Many bacterial infections can be treated with the use of antibiotics. These medications continue to reduce morbidity and mortality; unfortunately, their use has brought about drug-resistant pathogens that produce difficult-to-treat infections, which require more extreme treatments. New antibiotics are needed to combat this ever-evolving resistance pathogenesis.
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Affiliation(s)
- Ryan Kidd
- St. Louis College of Pharmacy, MO, USA
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14
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Zhang E, Bai PY, Cui DY, Chu WC, Hua YG, Liu Q, Yin HY, Zhang YJ, Qin S, Liu HM. Synthesis and bioactivities study of new antibacterial peptide mimics: The dialkyl cationic amphiphiles. Eur J Med Chem 2017; 143:1489-1509. [PMID: 29126736 DOI: 10.1016/j.ejmech.2017.10.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/15/2017] [Indexed: 12/11/2022]
Abstract
The emergence of infectious diseases caused by pathogenic bacteria is widespread. Therefore, it is urgently required to enhance the development of novel antimicrobial agents with high antibacterial activity and low cytotoxicity. A series of novel dialkyl cationic amphiphiles bearing two identical length lipophilic alkyl chains and one non-peptidic amide bond were synthesized and tested for antimicrobial activities against both Gram-positive and Gram-negative bacteria. Particular compounds synthesized showed excellent antibacterial activity toward drug-sensitive bacteria such as S. aureus, E. faecalis, E. coli and S. enterica, and clinical isolates of drug-resistant species such as methicillin-resistant S. aureus (MRSA), KPC-producing and NDM-1-producing carbapenem-resistant Enterobacteriaceae (CRE). For example, the MIC values of the best compound 4g ranged from 0.5 to 2 μg/mL against all these strains. Moreover, these small molecules acted rapidly as bactericidal agents, and functioned primarily by permeabilization and depolarization of bacterial membranes. Importantly, these compounds were difficult to induce bacterial resistance and can potentially combat drug-resistant bacteria. Thus, these compounds can be developed into a new class of antibacterial peptide mimics against Gram-positive and Gram-negative bacteria, including drug-resistant bacterial strains.
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Affiliation(s)
- En Zhang
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China; Collaborative Innovation Center of New Drug Research and Safety Evaluation, Henan Province, Zhengzhou 450001, PR China.
| | - Peng-Yan Bai
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - De-Yun Cui
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - Wen-Chao Chu
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - Yong-Gang Hua
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - Qin Liu
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - Hai-Yang Yin
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - Yong-Jie Zhang
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China
| | - Shangshang Qin
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China; Collaborative Innovation Center of New Drug Research and Safety Evaluation, Henan Province, Zhengzhou 450001, PR China.
| | - Hong-Min Liu
- School of Pharmaceutical Sciences, Institute of Drug Discovery and Development, Key Laboratory of Advanced Pharmaceutical Technology, Ministry of Education of China, Zhengzhou University, Zhengzhou 450001, PR China; Collaborative Innovation Center of New Drug Research and Safety Evaluation, Henan Province, Zhengzhou 450001, PR China.
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15
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Freudenthal O, Quilès F, Francius G. Discrepancies between Cyclic and Linear Antimicrobial Peptide Actions on the Spectrochemical and Nanomechanical Fingerprints of a Young Biofilm. ACS OMEGA 2017; 2:5861-5872. [PMID: 30023754 PMCID: PMC6044769 DOI: 10.1021/acsomega.7b00644] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/30/2017] [Indexed: 06/08/2023]
Abstract
Antimicrobial peptides (AMPs) are currently known for their potential as an alternative to conventional antibiotics and new weapons against drug-resistant bacteria and biofilms. In the present work, the mechanism of action of a cyclic (colistin) and a linear (catestatin) AMP on a young E. coli biofilm was deciphered from the molecular to the cellular scale. To this end, infrared spectroscopy (attenuated total reflection-Fourier transform infrared) assisted by chemometric analysis was combined with fluorescence and atomic force microscopies to address the very different behaviors of both AMPs. Indeed, the colistin dramatically damaged the bacterial cell wall and the metabolism even though its action was not homogeneous over the whole bacterial population and repopulation can be observed after peptide removal. Conversely, catestatin did not lead to major damages in the bacterial morphology but its action was homogeneous over the whole bacterial population and the cells were unable to regrow after the peptide treatment. Our results strongly suggested that contrary to the cyclic molecule, the linear one is able to cause irreversible damages in the bacterial membrane concomitantly to a strong impact on the bacterial metabolism.
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Affiliation(s)
- Oona Freudenthal
- Université
de Lorraine, Laboratoire de Chimie Physique et Microbiologie pour
l’Environnement, LCPME,
UMR 7564, Villers-lès-Nancy, F-54600, France
- CNRS,
Laboratoire de Chimie Physique et Microbiologie pour l’Environnement,
LCPME, UMR 7564, Villers-lès-Nancy, F-54600, France
| | - Fabienne Quilès
- Université
de Lorraine, Laboratoire de Chimie Physique et Microbiologie pour
l’Environnement, LCPME,
UMR 7564, Villers-lès-Nancy, F-54600, France
- CNRS,
Laboratoire de Chimie Physique et Microbiologie pour l’Environnement,
LCPME, UMR 7564, Villers-lès-Nancy, F-54600, France
| | - Grégory Francius
- Université
de Lorraine, Laboratoire de Chimie Physique et Microbiologie pour
l’Environnement, LCPME,
UMR 7564, Villers-lès-Nancy, F-54600, France
- CNRS,
Laboratoire de Chimie Physique et Microbiologie pour l’Environnement,
LCPME, UMR 7564, Villers-lès-Nancy, F-54600, France
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16
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Thapa P, Bhandari D, Shrestha D, Parajuli H, Chaudhary P, Amatya J, Amatya R. A hospital based surveillance of metallo-beta-lactamase producing gram negative bacteria in Nepal by imipenem-EDTA disk method. BMC Res Notes 2017; 10:322. [PMID: 28743282 PMCID: PMC5526278 DOI: 10.1186/s13104-017-2640-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A rising threat of the rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gram-negative pathogens is a matter of public health concern worldwide. Hence, for a low income nation like Nepal, surveillance data on MBL producing clinical isolates via a cost effective technique is necessary to prevent their dissemination as well as formulation and regulation of antimicrobial stewardship policy. METHODS The prospective study was conducted at Nepal Medical College, Kathmandu from May to October, 2014 to assess the prevalence of MBL production among ceftazidime-resistant Gram-negative rods (GNRs) isolates. The samples were processed according to standard microbiological procedure following the Manual of clinical Microbiology. Isolated GNRs were subjected to susceptibility testing against the selected panel of antibiotics by Kirby- Bauer disc diffusion method and interpretation made in conformity with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Ceftazidime-resistant isolates were subjected to the detection of MBL production by imipenem-EDTA combined disc (CD) method. RESULTS Among the Gram-negative isolates, 5.80% (21/362) were found to be MBL positive with Acinetobacter spp. showing the highest prevalence i.e. 85.71% (18/21), followed by P. aeruginosa i.e. 14.29% (3/21). None of the other cefazidime resistant gram negative bacteria tested were found to be positive for MBL production with all the positive isolates determined to be Multidrug resistant (MDR) strains. CONCLUSION This study demonstrated a higher rate of resistance among P. aeruginosa and Acinetobacter spp. to a wide variety of antibiotic categories with an additional burden of MBL production within them, warranting a need for strict surveillance and rapid detection of MBL production among the GNRs.
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Affiliation(s)
- Pratigya Thapa
- Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal.
| | - Dinesh Bhandari
- Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal.,Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Dhiraj Shrestha
- Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal
| | - Hiramani Parajuli
- Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal
| | - Prakash Chaudhary
- Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal
| | - Jyoti Amatya
- Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal
| | - Ritu Amatya
- Department of Microbiology, Nepal Medical College and Teaching Hospital, Kathmandu University, Dhulikhel, Nepal
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Zeng J, Zhang L, Gao M, Wu J, Wu H, Chen J, Chen X, Tang W. Tigecycline treatment in an infant with extensively drug-resistant Acinetobacter baumannii bacteremia. Int J Infect Dis 2017; 61:23-26. [PMID: 28572073 DOI: 10.1016/j.ijid.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 11/27/2022] Open
Abstract
The successful use of tigecycline in a 12-month old liver transplant recipient with extensively drug-resistant Acinetobacter baumannii bacteremia is presented. Tigecycline serum concentrations were monitored to help improve antibiotic efficacy and minimize side effects. A literature review identified 11 additional pediatric cases of A. baumannii infection treated with tigecycline since 2011. Tigecycline treatment should be considered in children with extensively drug-resistant bacterial infections.
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Affiliation(s)
- Jiawei Zeng
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Lidan Zhang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Min Gao
- Department of Pharmacy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Jingjing Wu
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Haiyan Wu
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jie Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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18
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Nisin gold nanoparticles assemble as potent antimicrobial agent against Enterococcus faecalis and Staphylococcus aureus clinical isolates. J Drug Deliv Sci Technol 2017. [DOI: 10.1016/j.jddst.2016.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
BACKGROUND AND OBJECTIVE Searching for a new antimicrobial agent is a significant challenge because of increasing resistance of microbes to antibiotics. Because plants are an inexpensive source of rich metabolic substances that are highly efficient, this study was designed to evaluate the antimicrobial activity of Sarcocolla gum resin extracted from Astragalus sarcocolla root and its phytochemicals. To the best of the author's knowledge, the antimicrobial activity of Sarcocolla gum resin has not previously been reported. MATERIALS AND METHODS The antimicrobial activity of Sarcocolla gum resin was evaluated using a well diffusion assay. The effect of water and ethanol extracts in various concentrations (20, 40 and 60%) against the growth of pathogenic bacteria and yeast were tested. RESULTS The results showed that the lower concentration (20%) of water and ethanol extracts had no inhibitory effect on any of the tested microbes except Staphylococcus aureus (S. aureus) ATCC 29213. However, an antimicrobial effect of water and ethanol extracts was observed on most tested microbes at higher concentrations (40 and 60%). The S. aureus ATCC 29213 was resistant to all ethanol extract concentrations. In contrast, S. aureus ATCC 29213 was inhibited by water extracts at all concentrations tested. Minimum inhibitory concentrations (MIC) were estimated using a 2-fold dilution method and MIC values were between 12.5-25 μg mL-1. Phytochemical screening was performed using standard procedures that showed the presence of sterols, terpenoids, flavonoids, alkaloids, saponins and tannins. CONCLUSION This study showed that Sarcocolla gum resin extract possesses high antimicrobial activity that depends on the solvent type, the concentration of plant extract and the microbe type. These results provide a new source of antimicrobial that may be useful in the manufacture of antibiotics.
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20
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Soliman FM, Fathy MM, Salama MM, Saber FR. Comparative study of the volatile oil content and antimicrobial activity of Psidium guajava L. and Psidium cattleianum Sabine leaves. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.bfopcu.2016.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Self-assembled cationic amphiphiles as antimicrobial peptides mimics: Role of hydrophobicity, linkage type, and assembly state. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2016; 13:343-352. [PMID: 27520722 DOI: 10.1016/j.nano.2016.07.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 01/05/2023]
Abstract
Inspired by high promise using naturally occurring antimicrobial peptides (AMPs) to treat infections caused by antimicrobial-resistant bacteria, cationic amphiphiles (CAms) were strategically designed as synthetic mimics to overcome associated limitations, including high manufacture cost and low metabolic stability. CAms with facially amphiphilic conformation were expected to demonstrate membrane-lytic properties and thus reduce tendency of resistance development. By systematically tuning the hydrophobicity, CAms with optimized compositions exhibited potent broad-spectrum antimicrobial activity (with minimum inhibitory concentrations in low μg/mL range) as well as negligible hemolytic activity. Electron microscope images revealed the morphological and ultrastructure changes of bacterial membranes induced by CAm treatment and validated their membrane-disrupting mechanism. Additionally, an all-atom molecular dynamics simulation was employed to understand the CAm-membrane interaction on molecular level. This study shows that these CAms can serve as viable scaffolds for designing next generation of AMP mimics as antimicrobial alternatives to combat drug-resistant pathogens.
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22
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Christena LR, Mangalagowri V, Pradheeba P, Ahmed KBA, Shalini BIS, Vidyalakshmi M, Anbazhagan V, Sai subramanian N. Copper nanoparticles as an efflux pump inhibitor to tackle drug resistant bacteria. RSC Adv 2015. [DOI: 10.1039/c4ra15382k] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Casein capped copper nanoparticles at sub inhibitory concentrations function as an efflux pump inhibitor and restores susceptibility to antibiotics in drug resistant bacteria.
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Affiliation(s)
| | | | | | | | | | - Mohan Vidyalakshmi
- School of Chemical and Biotechnology
- SASTRA University
- Thanjavur-613401
- India
| | | | - Nagarajan Sai subramanian
- School of Chemical and Biotechnology
- SASTRA University
- Thanjavur-613401
- India
- Center for Research on Infectious Diseases (CRID)
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23
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Fair RJ, Tor Y. Antibiotics and bacterial resistance in the 21st century. PERSPECTIVES IN MEDICINAL CHEMISTRY 2014; 6:25-64. [PMID: 25232278 PMCID: PMC4159373 DOI: 10.4137/pmc.s14459] [Citation(s) in RCA: 866] [Impact Index Per Article: 86.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/24/2014] [Accepted: 06/24/2014] [Indexed: 12/11/2022]
Abstract
Dangerous, antibiotic resistant bacteria have been observed with increasing frequency over the past several decades. In this review the factors that have been linked to this phenomenon are addressed. Profiles of bacterial species that are deemed to be particularly concerning at the present time are illustrated. Factors including economic impact, intrinsic and acquired drug resistance, morbidity and mortality rates, and means of infection are taken into account. Synchronously with the waxing of bacterial resistance there has been waning antibiotic development. The approaches that scientists are employing in the pursuit of new antibacterial agents are briefly described. The standings of established antibiotic classes as well as potentially emerging classes are assessed with an emphasis on molecules that have been clinically approved or are in advanced stages of development. Historical perspectives, mechanisms of action and resistance, spectrum of activity, and preeminent members of each class are discussed.
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Affiliation(s)
- Richard J Fair
- Department for Biomolecular Systems, Max Planck Institute of Colloids and Interfaces, Berlin, Germany
| | - Yitzhak Tor
- Department of Chemistry and Biochemistry, University of California, San Diego, La Jolla, CA, USA
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24
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Zhanel GG, Trapp S, Gin AS, DeCorby M, Lagacé-Wiens PRS, Rubinstein E, Hoban DJ, Karlowsky JA. Dalbavancin and telavancin: novel lipoglycopeptides for the treatment of Gram-positive infections. Expert Rev Anti Infect Ther 2014; 6:67-81. [DOI: 10.1586/14787210.6.1.67] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Rodríguez-Baño J, Pascual A. Clinical significance of extended-spectrum β-lactamases. Expert Rev Anti Infect Ther 2014; 6:671-83. [DOI: 10.1586/14787210.6.5.671] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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26
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Zavascki AP, Carvalhaes CG, Picão RC, Gales AC. Multidrug-resistantPseudomonas aeruginosaandAcinetobacter baumannii: resistance mechanisms and implications for therapy. Expert Rev Anti Infect Ther 2014; 8:71-93. [DOI: 10.1586/eri.09.108] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cunha BA. Once-Daily Tigecycline Therapy of Multidrug-Resistant and Non-Multidrug-Resistant Gram-Negative Bacteremias. J Chemother 2013; 19:232-3. [PMID: 17434836 DOI: 10.1179/joc.2007.19.2.232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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28
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Schitter G, Wrodnigg TM. Update on carbohydrate-containing antibacterial agents. Expert Opin Drug Discov 2013; 4:315-56. [PMID: 23489128 DOI: 10.1517/17460440902778725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Since the first known use of antibiotics > 2,500 years ago, a research field with immense importance for the welfare of mankind has been developed. After a decrease in interest in this topic by the end of the 20th century the occurrence of (poly-)resistant strains of bacteria induced a revival of antibiotics research. Health systems have been seeking viable and reliable solutions to this dangerous and expansive threat. OBJECTIVE This review will focus on carbohydrate-containing antibiotics and will give an outline of recently published novel isolated, semisynthetic as well as synthetic structures, their mechanism of action, if known, and the strategies for the design of compounds with potential by improved antibacterial properties. METHODS The literature between 2000 and 2008 was screened with main focus on recent examples of novel structures and strategies for the lead finding of exclusively antibacterial agents. RESULTS/CONCLUSION With the explanation of the role of the carbohydrate moieties in the respective antibacterial agents together with better synthetic strategies in carbohydrate chemistry as well as improvements in assay development for high throughput screening methods, carbohydrate-containing antibiotics can be used for the finding of potential drug leads that contribute to the fight against infections and diseases caused by (resistant) bacterial pathogens.
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Affiliation(s)
- Georg Schitter
- Technical University Graz, Institute of Organic Chemistry, Univ.-Doz. TMW, Dip.-Ing. GS, Glycogroup, A-8010 Graz, Austria +43 316 873 8744 ; +43 316 873 8740 ;
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Yoshida A, Akaiwa M, Asakawa T, Hamashima Y, Yokoshima S, Fukuyama T, Kan T. Total synthesis of (-)-lemonomycin. Chemistry 2012; 18:11192-5. [PMID: 22848018 DOI: 10.1002/chem.201202073] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Indexed: 11/10/2022]
Affiliation(s)
- Atsushi Yoshida
- School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, Japan
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30
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Chalón MC, Acuña L, Morero RD, Minahk CJ, Bellomio A. Membrane-active bacteriocins to control Salmonella in foods. Food Res Int 2012. [DOI: 10.1016/j.foodres.2011.08.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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31
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Giamarellou H. Multidrug-resistant Gram-negative bacteria: how to treat and for how long. Int J Antimicrob Agents 2010; 36 Suppl 2:S50-4. [PMID: 21129924 DOI: 10.1016/j.ijantimicag.2010.11.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The emergence of multidrug-resistant (MDR) Gram-negative bacilli creates a big problem for the treatment of nosocomial infections. As the pharmaceutical pipeline wanes, the only therapeutic options are two revived antibacterials (colistin and fosfomycin), a newer one (tigecycline) and an early-phase neoglycoside (ACHN-490). Polymyxins, known since 1947, are mostly represented by polymyxin E (colistin), which has recently gained a principal position in the management of the most difficult-to-treat MDR Gram-negative pathogens -Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. However, despite promising therapeutic results in 59-75% of cases, the reported studies share common drawbacks, i.e. the absence of a control group, their retrospective nature, variable dosing and duration of therapy, simultaneous administration of other antibiotics in >70% and a lack of resistance development monitoring. The necessity for well-designed prospective clinical trials is therefore urgent. Fosfomycin is active in vitro against MDR Enterobacteriaceae, including a high proportion of P. aeruginosa; however, clinical experience is lacking with the parenteral formulation in MDR infection and on the best combinations to prevent resistance development. Tigecycline, which is active against MDR Enterobacteriaceae and A. baumannii, has shown satisfactory clinical experience. However, dosage adjustment is required because of low blood levels. ACHN-490, which has promising in vitro activity against MDR K. pneumoniae, is still in early phase II trials in urinary tract infections. Meanwhile, the strict application of infection control measures is the cornerstone of nosocomial infection prevention, and antibiotic stewardship, exemplified by appropriate duration of therapy and de-escalation policies, should not be overlooked.
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32
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Dinleyici EC, Yargic ZA, Bor O, Kiremitci A, Durmaz G. Tigecycline treatment of multi-drug-resistant Corynebacterium jeikeium infection in a child with relapsing and refractory acute lymphoblastic leukemia. Pediatr Blood Cancer 2010; 55:349-51. [PMID: 20582969 DOI: 10.1002/pbc.22527] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Corynebacterium jeikeium has been recognized as an important cause of infection, particularly among neutropenic patients who have central venous catheter (CVC). Routine use of tigecycline in children is not yet approved. Here in we present a child with relapsed-refractory lymphoblastic leukemia who was successfully treated with tigecyline due to multi-drug-resistant C. jeikeium sepsis without removal of CVC. Our case highlights the use of tigecycline where there are no alternatives. Further studies regarding the efficacy and safety of tigecycline in pediatric patients are needed.
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Affiliation(s)
- Ener Cagri Dinleyici
- Faculty of Medicine, Department of Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey.
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33
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Corona A, Bertolini G, Lipman J, Wilson AP, Singer M. Antibiotic use and impact on outcome from bacteraemic critical illness: the BActeraemia Study in Intensive Care (BASIC). J Antimicrob Chemother 2010; 65:1276-85. [DOI: 10.1093/jac/dkq088] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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34
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Giamarellou H, Poulakou G. Multidrug-resistant Gram-negative infections: what are the treatment options? Drugs 2009; 69:1879-901. [PMID: 19747006 DOI: 10.2165/11315690-000000000-00000] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The emergence of multidrug-resistant (MDR) Gram-negative bacilli creates a challenge in the treatment of nosocomial infections. While the pharmaceutical pipeline is waning, two revived old antibacterials (colistin and fosfomycin), a newer one (tigecycline) and an 'improved' member of an existing class (doripenem) are the only therapeutic options left. The class of polymyxins, known since 1947 and represented mostly by polymyxin B and polymyxin E (colistin), has recently gained a principal role in the treatment of the most problematic MDR Gram-negative pathogens (such as Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae and Stenotrophomonas maltophilia). Future prospective studies are needed to answer important clinical questions, such as the possible benefit of combination with other antimicrobials versus monotherapy, the efficacy of colistin in neutropenic hosts and the role of inhaled colistin. As new pharmacokinetic data emerge, clarification of the pharmacokinetic/pharmacodynamic (PK/PD) profile of colistin as well as appropriate dosing seems urgent, while development of resistance must be carefully monitored. Fosfomycin tromethamine, a synthetic salt of fosfomycin discovered in 1969, has regained attention because of its in vitro activity against extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and MDR P. aeruginosa. Although in use for decades in oral and parenteral formulations for a variety of infections without significant toxicity, its clinical utility in MDR infections remains to be explored in future studies. Tigecycline, the first representative of the new class of glycylcyclines, holds promise in infections from MDR K. pneumoniae (K. pneumoniae carbapenemase [KPC]- and ESBL-producing strains) and Enterobacteriaceae with various mechanisms of resistance. The in vitro activity of tigecycline against A. baumannii makes it a tempting option, as it is currently the most active compound against MDR strains along with colistin. However, the usual minimum inhibitory concentration values of this pathogen are approximately 2 mg/L and compromise clinical outcomes based on PK/PD issues. Its advantageous penetration into various tissues is useful in infections of the skin and soft tissues as well as intra-abdominal infections (official indications), whereas low serum concentrations compromise its use in bloodstream infections. Therefore, prospective studies with dose escalation are urgently needed, as well as clarification of its role in nosocomial pneumonia, after poor results in the study of ventilator-associated pneumonia. Finally, doripenem, the recently licensed member of the carbapenems (without significant spectrum alterations from the ascendant members) seems to possess a lower potential for resistance selection and a more favourable pharmacokinetic profile when given as an extended infusion. The latter strategy could prove helpful in overcoming low level resistance of A. baumannii and P. aeruginosa strains.
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Affiliation(s)
- Helen Giamarellou
- 4th Department of Internal Medicine, Athens University School of Medicine, ATTIKON University Hospital of Athens, Athens, Greece.
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35
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Prazeres VFV, Tizón L, Otero JM, Guardado-Calvo P, Llamas-Saiz AL, van Raaij MJ, Castedo L, Lamb H, Hawkins AR, González-Bello C. Synthesis and Biological Evaluation of New Nanomolar Competitive Inhibitors of Helicobacter pylori Type II Dehydroquinase. Structural Details of the Role of the Aromatic Moieties with Essential Residues. J Med Chem 2009; 53:191-200. [DOI: 10.1021/jm9010466] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Verónica F. V. Prazeres
- Laboratorio de Química Orgánica (CSIC) y Departamento de Química Orgánica, Facultad de Química, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Lorena Tizón
- Laboratorio de Química Orgánica (CSIC) y Departamento de Química Orgánica, Facultad de Química, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - José M. Otero
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Pablo Guardado-Calvo
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Antonio L. Llamas-Saiz
- Unidad de Rayos X, Edificio CACTUS, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Mark J. van Raaij
- Departamento de Bioquímica y Biología Molecular, Facultad de Farmacia, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Instituto de Biología Molecular de Barcelona, Consejo Superior de Investigaciones Científicas (IBMB-CSIC), Parc Científic de Barcelona, Baldiri Reixach 10-12, E-08028 Barcelona, Spain
| | - Luis Castedo
- Laboratorio de Química Orgánica (CSIC) y Departamento de Química Orgánica, Facultad de Química, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Heather Lamb
- Institute of Cell and Molecular Biosciences, Medical School, University, Newcastle upon Tyne, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
| | - Alastair R. Hawkins
- Institute of Cell and Molecular Biosciences, Medical School, University, Newcastle upon Tyne, Catherine Cookson Building, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K
| | - Concepción González-Bello
- Laboratorio de Química Orgánica (CSIC) y Departamento de Química Orgánica, Facultad de Química, Universidad de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Clinical and molecular characteristics of nosocomial meticillin-resistant Staphylococcus aureus skin and soft tissue isolates from three Indian hospitals. J Hosp Infect 2009; 73:253-63. [DOI: 10.1016/j.jhin.2009.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 07/05/2009] [Indexed: 11/22/2022]
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Dhawan B, Gadepalli R, Kapil A. In vitro activity of daptomycin against Staphylococcus aureus and vancomycin-resistant Enterococcus faecium isolates associated with skin and soft tissue infections: first results from India. Diagn Microbiol Infect Dis 2009; 65:196-8. [DOI: 10.1016/j.diagmicrobio.2009.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/12/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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Colistin serum concentrations after intravenous administration in critically ill patients with serious multidrug-resistant, gram-negative bacilli infections: a prospective, open-label, uncontrolled study. Clin Ther 2009; 30:143-51. [PMID: 18343250 DOI: 10.1016/j.clinthera.2008.01.015] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND The emergence of multidrug-resistant nosocomial pathogens, such as Pseudomonas aeruginosa and Acinetobacter baumannii, has led to the revival of the systemic use of antimicrobial agent colistin in critically ill patients, but only limited data are available to define its pharmacokinetic profile in these patients. OBJECTIVE The aim of this study was to assess steady-state serum concentrations of colistin after i.v. administration of colistin methanesulfonate (CMS) in critically ill patients with stable kidney function. METHODS This prospective, open-label, uncontrolled study was conducted at 2 intensive care units in the Athens Trauma Hospital, KAT, Athens, Greece. Adult patients were nonconsecutively enrolled if they were critically ill and had stable kidney function (<0.5 mg/dL change in serum creatinine prior to and until the day of sample collection) and had been receiving CMS as part of a treatment regimen for sepsis irrespective of site of infection with multidrug-resistant, gram-negative bacilli. After i.v. administration of 225-mg CMS (with the exception of 1 patient who received 150 mg) every 8 or 12 hours for at least 2 days, blood samples were collected just before and at 10 minutes and 1, 2, 4, 6, and 8 hours after i.v. infusion (duration, 30 minutes) of the colistin dose on the sampling day. RESULTS Fourteen nonconsecutive patients were enrolled in the study (13 male, 1 female; mean [SD] age, 62.0 [19.2] years; mean [SD] estimated weight, 72.5 [8.5] kg; mean [SD] Acute Physiology And Chronic Health Evaluation II score on admission, 17.1 [6.0]). At steady state, mean (SD) colistin maximum and minimum concentrations were 2.93 (1.24) and 1.03 (0.44) mg/L, respectively, while mean (SD) apparent total body clearance, apparent volume of distribution, and t(1/2) were 13.6 (5.8) L/h, 139.9 (60.3) L, and 7.4 (1.7) hours, respectively. Colistin-related nephrotoxicity was not observed in the study patients. CONCLUSION CMS dosage regimens administered to these critically ill adult patients were associated with suboptimal Cmax/MIC ratios for many strains of gram-negative bacilli currently reported as sensitive (MIC, < or = 2 microg/mL).
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El Solh AA, Alhajhusain A. Update on the treatment of Pseudomonas aeruginosa pneumonia. J Antimicrob Chemother 2009; 64:229-238. [DOI: 10.1093/jac/dkp201] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Bocanegra-García V, Del Rayo Camacho-Corona M, Ramírez-Cabrera M, Rivera G, Garza-González E. The bioactivity of plant extracts against representative bacterial pathogens of the lower respiratory tract. BMC Res Notes 2009; 2:95. [PMID: 19486533 PMCID: PMC2702266 DOI: 10.1186/1756-0500-2-95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 06/01/2009] [Indexed: 11/23/2022] Open
Abstract
Background Lower respiratory tract infections are a major cause of illness and death. Such infections are common in intensive care units (ICU) and their lethality persists despite advances in diagnosis, treatment and prevention. In Mexico, some plants are used in traditional medicine to treat respiratory diseases or ailments such as cough, bronchitis, tuberculosis and other infections. Medical knowledge derived from traditional societies has motivated searches for new bioactive molecules derived from plants that show potent activity against bacterial pathogens. Therefore, the aim of this study was to evaluate the effect of hexanic, chloroformic (CLO), methanolic (MET) and aqueous extracts from various plants used in Mexican traditional medicine on various microorganisms associated with respiratory disease. Methods thirty-five extracts prepared from nine plants used in Mexican traditional medicine for the treatment of respiratory infections were evaluated against 15 control bacterial species and clinical isolates. Results Both chloroformic (CLO) and methanolic (MET) extracts of Larrea tridentata were active against Methicillin-resistant S. aureus, B. subtilis and L. monocytogenes. A MET extract of L. tridentata was also active against S. aureus, S. pneumoniae, S. maltophilia, E. faecalis and H. influenzae and the CLO extract was active against A. baumannii. An Aqueous extract of M. acumitata and a MET extract of N. officinale were active against S. pneumoniae. CLO and MET extracts of L. tridentata were active against clinical isolates of S. aureus, S. pneumoniae and E. faecalis. Conclusion Overall, our results support the potential use of L. tridentata as a source of antibacterial compounds.
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Affiliation(s)
- Virgilio Bocanegra-García
- Departamento de Biología Molecular y Bioingeniería, UAM Reynosa Aztlán, Universidad Autónoma de Tamaulipas, Reynosa, Mexico.
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Improvements in the prevention and management of infectious complications after hematopoietic stem cell transplantation. Cancer Treat Res 2009; 144:539-73. [PMID: 19779875 DOI: 10.1007/978-0-387-78580-6_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Activity of levofloxacin alone and in combination with a DnaK inhibitor against gram-negative rods, including levofloxacin-resistant strains. Antimicrob Agents Chemother 2008; 53:814-7. [PMID: 19015359 DOI: 10.1128/aac.01132-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Synergy time-kill testing of levofloxacin alone and in combination with CHP-105, a representative DnaK inhibitor, against 50 gram-negative rods demonstrated that 34 of the 50 strains tested showed significant synergy between levofloxacin and CHP-105 after 12 h and 24 h. Fourteen of these 34 organisms were quinolone resistant (levofloxacin MICs of > or =4 microg/ml).
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Giamarellou H, Antoniadou A, Kanellakopoulou K. Acinetobacter baumannii: a universal threat to public health? Int J Antimicrob Agents 2008; 32:106-19. [PMID: 18571905 DOI: 10.1016/j.ijantimicag.2008.02.013] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 02/07/2008] [Indexed: 01/28/2023]
Abstract
Acinetobacter spp. are non-fermentative, strictly aerobic, Gram-negative microorganisms with a confusing taxonomic history. The Acinetobacter baumannii-Acinetobacter calcoaceticus complex is the species most commonly isolated from clinical specimens. It is ubiquitous in nature and has been found as part of the normal skin, throat and rectal flora as well as in food and body lice. It colonises patients in Intensive Care Units and contaminates inanimate hospital surfaces and devices as well as wounds, including war injuries. Although a frequent coloniser, Acinetobacter can be the cause of severe and sometimes lethal infections, mostly of nosocomial origin, predominantly ventilator-associated pneumonia. Bacteraemic infections are rare but may evolve to septic shock. Acinetobacter also emerges as a cause of nosocomial outbreaks and is characterised by increasing antimicrobial multiresistance. Antibiotic use, especially carbapenems and third-generation cephalosporins, is recognised as the most important risk factor for multiresistance. Described resistance mechanisms include hydrolysis by beta-lactamases, alterations in outer membrane proteins and penicillin-binding proteins, and increased activity of efflux pumps. Today, Acinetobacter resistant to carbapenems, aminoglycosides and fluoroquinolones presents a challenge to the clinician. However, sulbactam, tigecycline and colistin represent the current therapeutic approaches, which are associated with satisfactory efficacy.
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Affiliation(s)
- Helen Giamarellou
- 4th Department of Internal Medicine, University General Hospital ATTIKON, 1 Rimini Street, Athens, Greece.
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Abstract
The emergence and spread of multidrug resistance in many pathogenic bacterial species is increasing at an alarming rate, especially with hospital-acquired infections in the critical care setting. Deaths associated with hospital-acquired infections have exceeded the number attributable to several of the top 10 leading causes of death reported in the United States. The emerging resistance limits the use of older antibiotics. Tigecycline is a new agent, and this article explores its role in the treatment of adults in the critical care setting.
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Affiliation(s)
- Praveen K Mullangi
- Department of Infectious Diseases, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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Abstract
Based on the worldwide prevalence of multidrug-resistant strains of Pseudomas aeruginosa and the fact that no newer antipseudomonal agents are available, this article aims to investigate therapeutic solutions for combating infections caused by P aeruginosa, including multidrug-resistant strains. The article focuses mainly on colistin, the re-emerging old antibiotic that possesses prominent antipseudomonal activity in vitro and on doripenem, a newer carbapenem that seems to be close to its global marketing. Regarding older antipseudomonal antibiotics that have been reviewed extensively, only newer aspects on their use are considered in this article.
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Poulakou G, Giamarellou H. Doripenem: an expected arrival in the treatment of infections caused by multidrug-resistant Gram-negative pathogens. Expert Opin Investig Drugs 2008; 17:749-71. [PMID: 18447600 DOI: 10.1517/13543784.17.5.749] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Potent new drugs against multidrug-resistant Gram-negative bacteria, namely Pseudomonas aeruginosa and Acinetobacter spp. and pan-drug-resistant Klebsiella pneumoniae, which constitute an increasing medical threat, are almost absent from the future pharmaceutical pipeline. OBJECTIVE This drug evaluation focuses on the position of doripenem, a novel forthcoming carbapenem. Mechanisms of resistance and new drugs with anti-Gram-negative activity are also briefly reviewed. METHODS Literature search was performed for new carbapenems, new antibiotics, doripenem, metallo-beta-lactamase inhibitors, multidrug-resistant pathogens, antipseudomonal antibiotics and multidrug-resistant epidemiology. RESULTS Doripenem possesses a broad spectrum of activity against Gram-negative bacteria, similar to that of meropenem, while retaining the spectrum of imipenem against Gram-positive pathogens. Against P. aeruginosa, doripenem exhibits rapid bactericidal activity with 2 - 4-fold lower MIC values, compared to meropenem. Exploitation of pharmacokinetic/pharmacodynamic applications could offer a treatment opportunity against strains exhibiting borderline resistance to doripenem. Stability against numerous beta-lactamases, low adverse event potential and more potent in vitro antibacterial activity against P. aeruginosa and A. baumanni compared to the existing carbapenems, are its principal features.
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Affiliation(s)
- Garyphallia Poulakou
- University General Hospital ATTIKON, National and Kapodistrian University, Athens Medical School, 124 62 Athens, Greece.
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Betrosian AP, Frantzeskaki F, Xanthaki A, Douzinas EE. Efficacy and safety of high-dose ampicillin/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia. J Infect 2008; 56:432-6. [PMID: 18501431 DOI: 10.1016/j.jinf.2008.04.002] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Revised: 04/08/2008] [Accepted: 04/09/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the safety and efficacy of ampicillin/sulbactam (Amp/Sulb) and colistin (COL) in the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP). METHODS A prospective cohort study in adult critically ill patients with VAP. Patients were randomly assigned to receive Amp/Sulb (9 g every 8h) or COL (3 MIU every 8h) intravenously. Dosage was adjusted according to creatinine clearance. RESULTS A total of 28 patients were enrolled (15 COL, 13 Amp/Sulb). Resolution of symptoms and signs occurred in 60% (9/15) of the COL group and 61.5% (9/13) of the Amp/Sulb group, improvement in 13.3% (2/15) vs. 15.3% (1/13) and failure in 26.6% (4/15) vs. 23% (3/13), respectively. The difference was not statistically significant. Bacteriologic success was achieved in 66.6% (10/15) vs. 61.5% (8/13) in the COL and Amp/Sulb groups, respectively (p<0.2). Mortality rates (14 days and 28 days) were 15.3% and 30% for the Amp/Sulb and 20% and 33% for the COL group, respectively. Adverse events were 39.6% (including 33% nephrotoxicity) for the COL group and 30.7% (15.3% nephrotoxicity) for the Amp/Sulb group (p=NS). CONCLUSION Colistin and high-dose ampicillin/sulbactam were comparably safe and effective treatments for critically ill patients with MDR A. baumannii VAP.
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Affiliation(s)
- Alex P Betrosian
- 3rd Department of Critical Care, Athens University, Evgenidion Hospital, Papadiamantopoulou 20, Athens, Greece.
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Wisell KT, Kahlmeter G, Giske CG. Trimethoprim and enterococci in urinary tract infections: new perspectives on an old issue. J Antimicrob Chemother 2008; 62:35-40. [DOI: 10.1093/jac/dkn147] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Galani I, Kontopidou F, Souli M, Rekatsina PD, Koratzanis E, Deliolanis J, Giamarellou H. Colistin susceptibility testing by Etest and disk diffusion methods. Int J Antimicrob Agents 2008; 31:434-9. [PMID: 18328674 DOI: 10.1016/j.ijantimicag.2008.01.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 01/04/2008] [Indexed: 11/28/2022]
Abstract
The accuracy of disk susceptibility methods for colistin against 778 bacterial pathogens was evaluated in comparison with Etest using interpretive criteria available from the Clinical and Laboratory Standards Institute (CLSI). Colistin exhibited excellent activity against Acinetobacter baumannii and Escherichia coli isolates (minimum inhibitory concentration for 90% of the organisms (MIC(90))=0.5 mg/L), whilst it was less active both against Enterobacter spp. and Klebsiella pneumoniae (MIC for 50% of the organisms (MIC(50))=0.5 mg/L, MIC(90)=16 mg/L). Colistin also showed good activity against Pseudomonas aeruginosa (MIC(90)=2 mg/L, MIC(50)=1 mg/L) but poor activity against Stenotrophomonas maltophilia (MIC(50)=8 mg/L, MIC(90)=128 mg/L). Only 0.8% of minor errors were observed between the studied methods for P. aeruginosa isolates when the CLSI criteria were applied. All A. baumannii isolates with a zone diameter < or =12 mm were resistant and those with a zone diameter > or =14 mm were susceptible according to MIC breakpoints established by the CLSI. Among nine isolates exhibiting a zone diameter of 13 mm, one was resistant to colistin (MIC=8 mg/L) and eight isolates were susceptible (MIC=0.5 mg/L). Applying a MIC breakpoint of < or =2 mg/L for susceptibility in Enterobacteriaceae, all isolates with a zone diameter > or =14 mm were susceptible, whilst all isolates with a zone diameter < or =11 mm were resistant. Among isolates with zone diameters of 12-13 mm, 59% were characterised as susceptible. Major errors were observed only in K. pneumoniae isolates at a rate of 0.8%. The poor agar diffusion characteristics of colistin limit the predictive accuracy of the disk diffusion test and consequently values of 12-13 mm should be confirmed with MIC determination by Etest or broth dilution method.
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Affiliation(s)
- Irene Galani
- Fourth Department of Internal Medicine, Molecular Biology Section, Athens University School of Medicine, Athens, Greece.
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