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Song KH. Antibiotics for multidrug-resistant gram-positive bacteria. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.8.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Antimicrobial resistance is a major global threat to public health and is associated with increased morbidity and mortality. A few therapeutic options for the treatment of multidrug resistant (MDR) gram-positive bacteria, such as methicillin resistant Staphylococcus aureus, MDR Streptococcus pneumoniae, vancomycin resistant Enterococci, are available.Current Concepts: As a result of comprehensive efforts, a dozen novel antibiotics have been developed and approved for the treatment of MDR gram-positive bacteria in the United States and Europe over the past 15 years. However, only a few antibiotics have been introduced in the Republic of Korea. The purpose of this review is to evaluate the antibiotics that act against MDR gram-positive bacteria as a primary therapeutic option. Particularly, this review focuses on novel antibiotics, including ceftaroline, ceftobiprole, telavancin, dalbavancin, oritavancin, tedizolid, delafloxacin, omadacycline, and lefamulin.Discussion and Conclusion: Novel antibiotics against MDR gram-positive bacteria have not yet been sufficiently studied in various clinical settings, and therefore, the approved indications are limited. However, these antibiotics are expected to play a major role in the treatment of MDR gram-positive bacteria owing to their advantages, including broad anti-bacterial spectrum, rapid bactericidal effect, minimal drug-drug interaction, a favorable safety profile, availability of both intravenous and oral formulations, convenient dosing scheme, and a single dose (or once a week) regimen owing to long half-life. It is crucial to introduce these novel antibiotics in the Republic of Korea for the treatment of patients suffering from MDR bacterial infections.
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Park B, Liu GY. Immune-Based Anti-Staphylococcal Therapeutic Approaches. Microorganisms 2021; 9:microorganisms9020328. [PMID: 33562054 PMCID: PMC7915210 DOI: 10.3390/microorganisms9020328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/20/2022] Open
Abstract
Widespread methicillin-resistant Staphylococcus aureus (S. aureus) infections within community and healthcare settings are responsible for accelerated development of antibiotic resistance. As the antibiotic pipeline began drying up, alternative strategies were sought for future treatment of S. aureus infections. Here, we review immune-based anti-staphylococcal strategies that, unlike conventional antibiotics, target non-essential gene products elaborated by the pathogen. These strategies stimulate narrow or broad host immune mechanisms that are critical for anti-staphylococcal defenses. Alternative approaches aim to disrupt bacterial virulence mechanisms that enhance pathogen survival or induce immunopathology. Although immune-based therapeutics are unlikely to replace antibiotics in patient treatment in the near term, they have the potential to significantly improve upon the performance of antibiotics for treatment of invasive staphylococcal diseases.
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Affiliation(s)
- Bonggoo Park
- Cedars Sinai Medical Center, Division of Pediatric Infectious Diseases and the Immunobiology Research Institute, Los Angeles, CA 90048, USA;
| | - George Y. Liu
- Department of Pediatrics, University of California San Diego, La Jolla, CA 92093, USA
- Correspondence:
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Jorgensen SCJ, Murray KP, Lagnf AM, Melvin S, Bhatia S, Shamim MD, Smith JR, Brade KD, Simon SP, Nagel J, Williams KS, Ortwine JK, Veve MP, Truong J, Huang DB, Davis SL, Rybak MJ. A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections. Infect Dis Ther 2020; 9:89-106. [PMID: 31983021 PMCID: PMC7054514 DOI: 10.1007/s40121-019-00278-1] [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: 11/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background We sought to determine the real-world incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI). Methods Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (≥ 72 h) for ABSSSI and ≥ one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria. Results In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929–11.499), no medical insurance (aOR 3.451, 95% CI 1.310–9.090), ICU residence (aOR 4.398, 95% CI 1.676–11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158–7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037–1.260). Based on infection severity and comorbidities, 34.7% of patients were candidates for oral antibiotics at baseline and 39.3% had non-purulent cellulitis which could have been more appropriately treated with a beta-lactam. Patients with V-AKI had significantly longer hospital lengths of stay (9 vs. 6 days, p = 0.001), higher 30-day readmission rates (30.8 vs. 9.0%, p < 0.001) and increased all-cause 30-day mortality (5.1 vs. 0.3%, p = 0.024) Conclusions V-AKI occurred in approximately one in ten ABSSSI patients and may be largely prevented by preferential use of oral antibiotics whenever possible, using beta-lactams for non-purulent cellulitis and limiting durations of vancomycin therapy. Electronic supplementary material The online version of this article (10.1007/s40121-019-00278-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah C J Jorgensen
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Abdalhamid M Lagnf
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
| | - Sarah Melvin
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
| | - Sahil Bhatia
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
| | - Muhammad-Daniayl Shamim
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA
| | - Jordan R Smith
- Fred Wilson School of Pharmacy, High Point University, High Point, NC, USA.,Cone Health, Greensboro, NC, USA
| | | | | | | | | | | | - Michael P Veve
- College of Pharmacy, University of Tennessee Health Sciences Center, Knoxville, TN, USA.,University of Tennessee Medical Center, Knoxville, TN, USA
| | | | - David B Huang
- Motif BioSciences, Princeton, NJ, USA.,Rutgers New Jersey Medical School, Trenton, NJ, USA
| | - Susan L Davis
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA.,Henry Ford Health-System, Detroit, MI, USA
| | - Michael J Rybak
- Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI, USA. .,Detroit Medical Center, Detroit, MI, USA. .,School of Medicine, Wayne State University, Detroit, MI, USA.
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4
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Trinh TD, Jorgensen SCJ, Zasowski EJ, Claeys KC, Lagnf AM, Estrada SJ, Delaportes DJ, Huang V, Klinker KP, Kaye KS, Davis SL, Rybak MJ. Multicenter Study of the Real-World Use of Ceftaroline versus Vancomycin for Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother 2019; 63:e01007-19. [PMID: 31405859 PMCID: PMC6811452 DOI: 10.1128/aac.01007-19] [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: 05/15/2019] [Accepted: 08/07/2019] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to determine if real-world ceftaroline treatment in adults hospitalized for acute bacterial skin and skin structure infections (ABSSSI) is associated with decreased infection-related length of stay (LOSinf) compared to that with vancomycin. This was a retrospective, multicenter, cohort study from 2012 to 2017. Cox proportional hazard regression, propensity score matching, and inverse probability of treatment weighting (IPTW) were used to determine the independent effect of treatment group on LOSinf The patients were adults hospitalized with ABSSSI and treated with ceftaroline or vancomycin for ≥72 h within 120 h of diagnosis at four academic medical centers and two community hospitals in Arizona, Florida, Michigan, and West Virginia. A total of 724 patients were included (325 ceftaroline treated and 399 vancomycin treated). In general, ceftaroline-treated patients had characteristics consistent with a higher risk of poor outcomes. The unadjusted median LOSinf values were 5 (interquartile range [IQR], 3 to 7) days and 6 (IQR, 4 to 8) days in the vancomycin and ceftaroline groups, respectively (hazard ratio [HR], 0.866; 95% confidence interval [CI], 0.747 to 1.002). The Cox proportional hazard model (adjusted HR [aHR], 0.891; 95% CI, 0.748 to 1.060), propensity score-matched (aHR, 0.955; 95% CI, 0.786 to 1.159), and IPTW (aHR, 0.918; 95% CI, 0.793 to 1.063) analyses demonstrated no significant difference in LOSinf between groups. Patients treated with ceftaroline were significantly more likely to meet criteria for discharge readiness at day 3 in unadjusted and adjusted analyses. Although discharge readiness at day 3 was higher in ceftaroline-treated patients, LOSinf values were similar between treatment groups. Clinical and nonclinical factors were associated with LOSinf.
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Affiliation(s)
- T D Trinh
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Medication Outcomes Center, Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, California, USA
| | - S C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - E J Zasowski
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Clinical Sciences, College of Pharmacy, Touro University California, Vallejo, California, USA
| | - K C Claeys
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Practice, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - A M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - S J Estrada
- Department of Pharmacy, Lee Health, Fort Myers, Florida, USA
- T2 Biosystems Inc., Lexington, Massachusetts, USA
| | - D J Delaportes
- Infectious Diseases Division, Mon Health, Morgantown, West Virginia, USA
| | - V Huang
- Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, Glendale, Arizona, USA
| | - K P Klinker
- College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - K S Kaye
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - S L Davis
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - M J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Detroit Medical Center, Detroit, Michigan, USA
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Aguirre TAS, Teijeiro-Osorio D, Rosa M, Coulter IS, Alonso MJ, Brayden DJ. Current status of selected oral peptide technologies in advanced preclinical development and in clinical trials. Adv Drug Deliv Rev 2016; 106:223-241. [PMID: 26921819 DOI: 10.1016/j.addr.2016.02.004] [Citation(s) in RCA: 211] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 01/12/2023]
Abstract
The development of oral dosage forms that allows absorption of therapeutic peptides to the systemic circulation is one of the greatest challenges for the pharmaceutical industry. Currently, a number of technologies including either mixtures of penetration enhancers or protease inhibitors and/or nanotechnology-based products are under clinical development. Typically, these formulations are presented in the form of enteric-coated tablets or capsules. Systems undergoing preclinical investigation include further advances in nanotechnology, including intestinal microneedle patches, as well as their combination with regional delivery to the colon. This review critically examines four selected promising oral peptide technologies at preclinical stage and the twelve that have progressed to clinical trials, as indicated in www.clinicaltrials.gov. We examined these technologies under the criteria of peptide selection, formulation design, system components and excipients, intestinal mechanism of action, efficacy in man, and safety issues. The conclusion is that most of the technologies in clinical trials are incremental rather than paradigm-shifting and that even the more clinically advanced oral peptide drugs examples of oral bioavailability appear to yield oral bioavailability values of only 1-2% and are, therefore, only currently suitable for a limited range of peptides.
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Affiliation(s)
- T A S Aguirre
- Centro de Ciências Exatas e Tecnologia, Universidade de Caxias do Sul (UCS), Caxias do Sul, Brazil
| | - D Teijeiro-Osorio
- CIMUS Research Institute, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M Rosa
- Sigmoid Pharma, Dublin City University, Invent Centre, Dublin 9, Ireland
| | - I S Coulter
- Sigmoid Pharma, Dublin City University, Invent Centre, Dublin 9, Ireland
| | - M J Alonso
- CIMUS Research Institute, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - D J Brayden
- UCD School of Veterinary Medicine and UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.
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Phillips CJ, Wells NA, Martinello M, Smith S, Woodman RJ, Gordon DL. Optimizing the detection of methicillin-resistant Staphylococcus aureus with elevated vancomycin minimum inhibitory concentrations within the susceptible range. Infect Drug Resist 2016; 9:87-92. [PMID: 27330319 PMCID: PMC4898034 DOI: 10.2147/idr.s107961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Determination of vancomycin minimum inhibitory concentration (MIC) can influence the agent used to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We studied diagnostic accuracy using E-test and VITEK® 2 against a gold standard broth microdilution (BMD) methodology, the correlation between methods, and associations between vancomycin MIC and MRSA phenotype from clinical isolates. Methods MRSA isolates were obtained from April 2012 to December 2013. Vancomycin MIC values were determined prospectively on all isolates by gradient diffusion E-test and automated VITEK® 2. The Clinical and Laboratory Standards Institute reference BMD method was performed retrospectively on thawed frozen isolates. Diagnostic accuracy for detecting less susceptible strains was calculated at each MIC cutoff point for E-Test and VITEK® 2 using BMD ≥1 µg/mL as a standard. The correlation between methods was assessed using Spearman’s rho (ρ). The association between MRSA phenotype and MIC for the three methods was assessed using Fisher’s exact test. Results Of 148 MRSA isolates, all except one (E-test =3 µg/mL) were susceptible to vancomycin (MIC of ≤2 µg/mL) irrespective of methodology. MICs were ≥1.0 µg/mL for 9.5% of BMD, 50.0% for VITEK® 2, and 27.7% for E-test. Spearman’s ρ showed weak correlations between methods: 0.29 E-test vs VITEK® 2 (P=0.003), 0.27 E-test vs BMD (P=0.001), and 0.31 VITEK® 2 vs BMD (P=0.002). The optimal cutoff points for detecting BMD-defined less susceptible strains were ≥1.0 µg/mL for E-test and VITEK® 2. E-test sensitivity at this cutoff point was 0.85 and specificity 0.29, while VITEK® 2 sensitivity and specificity were 0.62 and 0.51, respectively. Multiresistant MRSA strains tended to have higher MIC values compared to nonmultiresistant MRSA or epidemic MRSA 15 phenotypes by E-test (Fisher’s exact P<0.001) and VITEK® 2 (Fisher’s exact P<0.001). Conclusion Overall diagnostic accuracy and correlations between MIC methods used in routine diagnostic laboratories and the gold standard BMD showed limited overall agreement. This study helps optimize guidance on the effective use of vancomycin.
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Affiliation(s)
- Cameron J Phillips
- SA Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia; Department of Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, SA, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Nicholas A Wells
- SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Marianne Martinello
- SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Simon Smith
- SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - David L Gordon
- Department of Microbiology and Infectious Diseases, School of Medicine, Flinders University, Adelaide, SA, Australia; SA Pathology, Microbiology and Infectious Diseases, Flinders Medical Centre, Bedford Park, SA, Australia
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7
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Davis JS, Sud A, O'Sullivan MVN, Robinson JO, Ferguson PE, Foo H, van Hal SJ, Ralph AP, Howden BP, Binks PM, Kirby A, Tong SYC. Combination of Vancomycin and β-Lactam Therapy for Methicillin-ResistantStaphylococcus aureusBacteremia: A Pilot Multicenter Randomized Controlled Trial. Clin Infect Dis 2015; 62:173-180. [DOI: 10.1093/cid/civ808] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/28/2015] [Indexed: 01/12/2023] Open
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8
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DiNubile MJ. Trials and Tribulations of Noninferiority: Caveat Emptor. Clin Infect Dis 2015; 60:1290-1. [DOI: 10.1093/cid/civ022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hegde SS, Janc JW. Efficacy of telavancin, a lipoglycopeptide antibiotic, in experimental models of Gram-positive infection. Expert Rev Anti Infect Ther 2014; 12:1463-75. [DOI: 10.1586/14787210.2014.979789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schirmer PL, Deresinski SC. Ceftobiprole: a new cephalosporin for the treatment of skin and skin structure infections. Expert Rev Anti Infect Ther 2014; 7:777-91. [DOI: 10.1586/eri.09.54] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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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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12
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Deresinski S. Methicillin-Resistant Staphylococcus aureus and Vancomycin: Minimum Inhibitory Concentration Matters. Clin Infect Dis 2012; 54:772-4. [DOI: 10.1093/cid/cir932] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Stan Deresinski
- Department of Medicine, Division of Infectious Disease and Geographic Medicine, Stanford University School of Medicine, California
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Synergistic activity of ceftobiprole and vancomycin in a rat model of infective endocarditis caused by methicillin-resistant and glycopeptide-intermediate Staphylococcus aureus. Antimicrob Agents Chemother 2012; 56:1476-84. [PMID: 22232278 DOI: 10.1128/aac.06057-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The therapeutic activity of ceftobiprole medocaril, the prodrug of ceftobiprole, was compared to that of vancomycin, daptomycin, and the combination of a subtherapeutic dose of ceftobiprole and vancomycin in a rat model of infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) (ATCC 43300) or glycopeptide-intermediate Staphylococcus aureus (GISA) (NRS4 and HIP 5836) strains. The minimum bactericidal concentrations of ceftobiprole, vancomycin, and daptomycin at bacterial cell densities similar to those encountered in the cardiac vegetation in the rat endocarditis model were 2, >64, and 8 μg/ml, respectively, for MRSA ATCC 43300 and 4, >64, and 8 μg/ml, respectively, for the GISA strain. Ceftobiprole medocaril administered in doses of 100 mg/kg of body weight given intravenously (i.v.) twice a day (BID) every 8 h (q8h) (equivalent to a human therapeutic dose of ceftobiprole [500 mg given three times a day [TID]) was the most effective monotherapy, eradicating nearly 5 log(10) CFU/g MRSA or 6 log(10) CFU/g GISA organisms from the cardiac vegetation and had the highest incidence of sterile vegetation compared to the other monotherapies in the endocarditis model. In in vitro time-kill studies, synergistic effects were observed with ceftobiprole and vancomycin on MRSA and GISA strains, and in vivo synergy was noted with combinations of subtherapeutic doses of these agents for the same strains. Additionally, sterile vegetations were achieved in 33 and 60%, respectively, of the animals infected with MRSA ATCC 43300 or GISA NRS4 receiving ceftobiprole-vancomycin combination therapy. In summary, ceftobiprole was efficacious both as monotherapy and in combination with vancomycin in treating MRSA and GISA infections in a rat infective endocarditis model and warrants further evaluation.
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Pharmacodynamics of TD-1792, a novel glycopeptide-cephalosporin heterodimer antibiotic used against Gram-positive bacteria, in a neutropenic murine thigh model. Antimicrob Agents Chemother 2011; 56:1578-83. [PMID: 22155835 DOI: 10.1128/aac.05382-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TD-1792 is a novel glycopeptide-cephalosporin heterodimer investigational antibiotic that displays potent bactericidal effects against clinically relevant Gram-positive organisms in vitro. The present studies evaluated the in vivo pharmacokinetics (PK) and pharmacodynamics (PD) of TD-1792 in the neutropenic murine thigh infection animal model. TD-1792, dosed subcutaneously (SC), produced dose-dependent reduction in the thigh bacterial burden of several organisms, including methicillin-susceptible and -resistant strains of Staphylococcus aureus and Staphylococcus epidermidis (MSSA, MRSA, MSSE, MRSE, respectively), penicillin-susceptible strains of Streptococcus pneumoniae (PSSP), Streptococcus pyogenes, and vancomycin-intermediate-susceptible Staphylococcus aureus (VISA). In single-dose efficacy studies, the 1-log(10) CFU kill effective dose (ED(1-log kill)) estimates for TD-1792 ranged from 0.049 to 2.55 mg/kg of body weight administered SC, and the bacterial burden was reduced by up to 3 log(10) CFU/g from pretreatment values. Against S. aureus ATCC 33591 (MRSA), the total 24-h log(10) stasis dose (ED(stasis)) and ED(1-logkill) doses for TD-1792 were 0.53 and 1.11 mg/kg/24 h, respectively, compared to 23.4 and 54.6 mg/kg/24 h for vancomycin, indicating that TD-1762 is 44- to 49-fold more potent than vancomycin. PK-PD analysis of data from single-dose and dose-fractionation studies for MRSA (ATCC 33591) demonstrated that the total-drug 24-h area under the concentration-time curve-to-MIC ratio (AUC/MIC ratio) was the best predictor of efficacy (r(2) = 0.826) compared to total-drug maximum plasma concentration of drug-to-MIC ratio (Cmax/MIC ratio; r(2) = 0.715) and percent time that the total-drug plasma drug concentration remains above the MIC (%Time>MIC; r(2) = 0.749). The magnitudes of the total-drug AUC/MIC ratios associated with net bacterial stasis, a 1-log(10) CFU reduction from baseline and near maximal effect, were 21.1, 37.2, and 51.8, respectively. PK-PD targets based on such data represent useful inputs for analyses to support dose selection decisions for clinical studies of patients.
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Abi-Haidar Y, Gupta K, Strymish J, Williams SA, Itani KM. Factors Associated with Post-Operative Conversion to Methicillin-ResistantStaphylococcus AureusPositivity or Infection in Initially MRSA-Negative Patients. Surg Infect (Larchmt) 2011; 12:435-42. [DOI: 10.1089/sur.2011.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Youmna Abi-Haidar
- Department of Surgery, Management Research at the Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Kalpana Gupta
- Department of Medicine, Management Research at the Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Judith Strymish
- Department of Medicine, Management Research at the Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sandra A. Williams
- Center for Organization, Leadership, Management Research at the Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - Kamal M.F. Itani
- Department of Surgery, Management Research at the Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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16
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Morosini MI, Cantón R. [Tolerance and heteroresistance in Gram-positive microorganisms]. Med Clin (Barc) 2011; 135 Suppl 3:16-22. [PMID: 21477700 DOI: 10.1016/s0025-7753(10)70036-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
During the last few years, insufficient efficacy of currently recommended antimicrobial agents has been observed, mainly in the case of glycopeptides, during the treatment of infections due to methicillin-resistant Staphylococcus aureus, even if these isolates show MIC values within the susceptible range. The phenomena associated with this observation are tolerance (a genetic event in which a bactericidal antibiotic fails to kill a bacterial population), persistence (a non-inherited and transient phenotypic phenomenon in which a bacterial subpopulation -0.1%-10%- survive lethal antimicrobial concentrations irrespective of the mechanisms of action) and heteroresistance (an epigenetic event in which less susceptible isogenic subpopulations are recovered when the entire population is challenged with concentrations exceeding MIC values). New antimicrobials, including daptomycin, are less affected by these phenomena and should be considered as the treatment of choice when these events are demonstrated or suspected.
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Affiliation(s)
- María Isabel Morosini
- Servicio de Microbiología y CIBER de Investigación en Salud Pública, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Universitario Ramón y Cajal, Madrid, España
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Logman JFS, Stephens J, Heeg B, Haider S, Cappelleri J, Nathwani D, Tice A, van Hout BA. Comparative effectiveness of antibiotics for the treatment of MRSA complicated skin and soft tissue infections. Curr Med Res Opin 2010; 26:1565-78. [PMID: 20429820 DOI: 10.1185/03007995.2010.481251] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE With a growing number of studies and comparators in MRSA skin infections, a unified framework for comparing treatments is needed for health technology assessment (HTA). The objective was to systematically assess the success rates of common antimicrobial agents for the treatment of complicated skin and soft tissue infections (cSSTIs) caused by MRSA. METHODS MEDLINE, EMBASE, and Cochrane databases were searched to identify published clinical trials in which dalbavancin, daptomycin, linezolid, telavancin, teicoplanin, tigecycline, and vancomycin were used to treat cSSTIs. Pooled efficacy estimates were generated from clinical and microbiological determinations of success for the MRSA-subgroups in cSSTI clinical trials using a Bayesian meta-analytic approach. Success rates for each antibiotic were reported with 95% Bayesian confidence intervals (called credible intervals [CrI]). In sensitivity analyses the impact of different model parameters and article quality were investigated. RESULTS Out of 36 identified studies, 14 studies on six antibiotics with 28 treatment arms (n = 1840) were included in the analysis. No MRSA data in cSSTI were found for teicoplanin. The pooled success rate and CrI(95%) for each agent was: vancomycin (74.7%; CrI(95%): 64.1%-83.5%), dalbavancin (87.7%; CrI(95%): 74.6%-95.4%), linezolid (84.4%; CrI(95%): 76.6%-90.6%), telavancin (83.5%; CrI(95%): 73.6%-90.8%), daptomycin (78.1%; CrI(95%): 54.6%-93.2%) and tigecycline (70.4%; CrI(95%): 48.0%-87.6%). Comparisons between antibiotics suggested differences versus vancomycin for linezolid (+9.7%; CrI(95%): 4.4%-15.8%), dalbavancin (+13.1%; CrI(95%): 1.0%-23.8%), and telavancin (+8.8%; CrI(95%): 1.5-16.7%). The finding of lower vancomycin efficacy in MRSA cSSTI did not change in sensitivity analyses. CONCLUSION The results of this meta-analysis suggest higher success rates for linezolid and the new glycopeptides (dalbavancin and telavancin) in MRSA-confirmed cSSTIs. The uncertainty margins reflect the study limitations including number of cases and indirect nature of the comparisons. This example of Bayesian meta-analysis for MRSA cSSTI provides a potential framework for comparisons that is useful for HTA and formulary decision-making.
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Generic vancomycin products fail in vivo despite being pharmaceutical equivalents of the innovator. Antimicrob Agents Chemother 2010; 54:3271-9. [PMID: 20547818 DOI: 10.1128/aac.01044-09] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Generic versions of intravenous antibiotics are not required to demonstrate therapeutic equivalence with the innovator because therapeutic equivalence is assumed from pharmaceutical equivalence. To test such assumptions, we studied three generic versions of vancomycin in simultaneous experiments with the innovator and determined the concentration and potency of the active pharmaceutical ingredient by microbiological assay, single-dose pharmacokinetics in infected mice, antibacterial effect by broth microdilution and time-kill curves (TKC), and pharmacodynamics against two wild-type strains of Staphylococcus aureus by using the neutropenic mouse thigh infection model. The main outcome measure was the comparison of magnitudes and patterns of in vivo efficacy between generic products and the innovator. Except for one product exhibiting slightly greater concentration, vancomycin generics were undistinguishable from the innovator based on concentration and potency, protein binding, in vitro antibacterial effect determined by minimal inhibitory or bactericidal concentrations and TKC, and serum pharmacokinetics. Despite such similarities, all generic products failed in vivo to kill S. aureus, while the innovator displayed the expected bactericidal efficacy: maximum antibacterial effect (Emax) (95% confidence interval [CI]) was 2.04 (1.89 to 2.19), 2.59 (2.21 to 2.98), and 3.48 (2.92 to 4.04) versus 5.65 (5.52 to 5.78) log10 CFU/g for three generics and the innovator product, respectively (P<0.0001, any comparison). Nonlinear regression analysis suggests that generic versions of vancomycin contain inhibitory and stimulatory principles within their formulations that cause agonistic-antagonistic actions responsible for in vivo failure. In conclusion, pharmaceutical equivalence does not imply therapeutic equivalence for vancomycin.
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Taieb F, Le Monnier A, Bille E, Lanternier F, Mechai F, Ribadeau-Dumas F, Maenulein E, Forge C, Corriol O, Nassif X, Lortholary O, Zahar JR. [Optimized clinical use of vancomycin, a prospective observational study in a Paris teaching hospital]. Med Mal Infect 2009; 40:273-8. [PMID: 19954910 DOI: 10.1016/j.medmal.2009.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 07/02/2009] [Accepted: 10/28/2009] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Vancomycin is still the cornerstone of antibiotic therapy for patients with suspected or proven invasive methicillin resistant Staphylococcus aureus infections. However, clinical and pharmacodynamic studies underline that appropriate doses depend on the infection site, the patient's weight, his renal function, and the bacterial susceptibility. OBJECTIVE AND METHOD In this prospective study made in a Paris teaching hospital, our two goals were to describe the modalities of infusion and serum concentration obtained during therapy, in our pediatrics and adults population. RESULTS In our hospital, vancomycin was administered every eight hours in 83 % (97/102) of the cases and the doses used were 30 mg/kg per day in 67 % of cases (68/102). Serum trough levels reached 15 mcg/ml and 20 mcg/ml in 36 % and 18 % of cases respectively. Moreover, despite adequate doses, trough levels of 15 mcg/ml were obtained in only 40 % of cases. CONCLUSION Vancomycin infusion use could be optimized, by defining optimal serum concentrations and monitoring made by a mobile team of infectious diseases specialists.
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Affiliation(s)
- F Taieb
- Service de microbiologie - hygiène hospitalière, université Paris Descartes, CHU Necker-Enfants-Malades, AP-HP, France; Université Paris Descartes, CHU Necker-Enfants-Malades, AP-HP, équipe mobile d'infectiologie, France
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Uçkay I, Teterycz D, Ferry T, Harbarth S, Lübbeke A, Emonet S, Chilcott M, Hoffmeyer P, Bernard L. Poor utility of MRSA screening to predict staphylococcal species in orthopaedic implant infections. J Hosp Infect 2009; 73:89-91. [DOI: 10.1016/j.jhin.2009.06.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 06/23/2009] [Indexed: 11/29/2022]
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da Silva LVS, Zavascki AP, de Souza MV, Marcadenti A. Caution when reconsidering empiric antimicrobial therapy for methicillin-resistant Staphylococcus aureus skin and soft-tissue infections. Am J Surg 2008; 196:618-9. [DOI: 10.1016/j.amjsurg.2007.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 12/30/2007] [Indexed: 10/21/2022]
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Naschitz JE, Gagarin A, Schor RG. Spurious toxic vancomycin levels. Eur J Intern Med 2008; 19:e36-7. [PMID: 18848166 DOI: 10.1016/j.ejim.2008.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 01/20/2008] [Indexed: 11/21/2022]
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Ceftobiprole: breaking therapeutic dogmas of the β-lactam class. Diagn Microbiol Infect Dis 2008; 61:82-5. [DOI: 10.1016/j.diagmicrobio.2008.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 02/25/2008] [Indexed: 11/20/2022]
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Peppard WJ, Johnston CJ, Urmanski AM. Pharmacologic options for CNS infections caused by resistant Gram-positive organisms. Expert Rev Anti Infect Ther 2008; 6:83-99. [PMID: 18251666 DOI: 10.1586/14787210.6.1.83] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infectious disease continues to evolve, presenting new and challenging clinical situations for practitioners. Specific to device-related and neurosurgical-related CNS infections, Gram-positive organisms are of growing concern. Current Infection Disease Society of America guidelines for the treatment of CNS infections offer little direction after conventional therapy, consisting of vancomycin, has failed or the patient has demonstrated intolerance. A review of literature evaluating alternative therapies, specifically linezolid, quinupristin/dalfopristin, daptomycin and tigecycline, will be presented. Interpretations of these data are offered followed by a brief presentation of future therapies, including ortavancin, telavancin, dalbavancin, ceftobiprole and iclaprim, all of which possess potent Gram-positive activity.
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Affiliation(s)
- William J Peppard
- Clinical Pharmacist, Surgical Critical Care, Froedtert Hospital, 9200 West, Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Approaches to serious methicillin-resistant Staphylococcus aureus infections with decreased susceptibility to vancomycin: clinical significance and options for management. Curr Opin Infect Dis 2008; 20:568-73. [PMID: 17975405 DOI: 10.1097/qco.0b013e3282f1beb8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW This review addresses therapeutic approaches to Staphylococcus aureus infections with diminished susceptibility to vancomycin, focusing on recently published data in English language medical literature between June 2006 and July 2007. RECENT FINDINGS Knowledge regarding the potential limitations of vancomycin therapy for S. aureus infections continues to emerge. Recent changes include alteration of the Clinical Laboratory and Standards Institute vancomycin breakpoint for S. aureus and questions regarding the utility of the lower breakpoint of 2.0 mg/l. Interest continues in the accessory gene regulator (agr) locus and its impact on the activity of vancomycin. Newer options for drug therapy progress, with strengths and limitations becoming more apparent for each. SUMMARY Newer antimicrobial agents active against methicillin-resistant S. aureus such as daptomycin and linezolid continue to show value. Older antimicrobial agents may play an important therapeutic role and warrant further examination. Work is needed to evaluate current agents against methicillin-resistant S. aureus in the setting of elevated vancomycin minimum inhibitory concentrations or clinical failure. Antimicrobial selection for methicillin-resistant S. aureus infections with reduced susceptibility to vancomycin should be governed by disease severity, susceptibility patterns, knowledge of the limitations of current susceptibility testing, and strengths and weaknesses of the agents being considered.
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