Antibiotic resistance: where do ketolides fit?

Antimicrobial edible apple films inactivate antibiotic resistant and susceptible Campylobacter jejuni strains on chicken breast

Campylobacter jejuni is the leading cause of bacterial diarrheal illness worldwide. Many strains are now becoming multidrug resistant. Apple-based edible films containing carvacrol and cinnamaldehyde were evaluated for bactericidal activity against antibiotic resistant and susceptible C. jejuni strains on chicken. Retail chicken breast samples inoculated with D28a and H2a (resistant strains) and A24a (a sensitive strain) were wrapped in apple films containing cinnamaldehyde or carvacrol at 0.5%, 1.5%, and 3% concentrations, and then incubated at 4 or 23 °C for 72 h. Immediately after wrapping and at 72 h, samples were plated for enumeration of viable C. jejuni. The antimicrobial films exhibited dose- and temperature-dependent bactericidal activity against all strains. Films with ≥1.5% cinnamaldehyde reduced populations of all strains to below detection at 23 °C at 72 h. At 4 °C with cinnamaldehyde, reductions were variable for all strains, ranging from 0.2 to 2.5 logs and 1.8 to 6.0 logs at 1.5% and 3.0%, respectively. Films with 3% carvacrol reduced populations of A24a and H2a to below detection, and D28a by 2.4 logs at 23 °C and 72 h. A 0.5-log reduction was observed for both A24a and D28a, and 0.9 logs for H2a at 4 °C at 3% carvacrol. Reductions ranged from 1.1 to 1.9 logs and 0.4 to 1.2 logs with 1.5% and 0.5% carvacrol at 23 °C, respectively. The films with cinnamaldehyde were more effective than carvacrol films. Reductions at 23 °C were greater than those at 4 °C. Our results showed that antimicrobial apple films have the potential to reduce C. jejuni on chicken and therefore, the risk of campylobacteriosis. Possible mechanisms of antimicrobial effects are discussed.

PRACTICAL APPLICATION

  Apple antimicrobial films could potentially be used in retail food packaging to reduce C. jejuni commonly present on food.

Reverse engineering antibiotic sensitivity in a multidrug-resistant Pseudomonas aeruginosa isolate

Antibiotic resistance is a pervasive and growing clinical problem. We describe an evaluation of a reverse engineering approach for identifying cellular mechanisms and genes that could be manipulated to increase antibiotic sensitivity in a resistant Pseudomonas aeruginosa isolate. We began by chemically mutating a broadly resistant isolate of P. aeruginosa and screening for mutants with increased sensitivity to the aminoglycoside amikacin, followed by performing whole-genome transcriptional profiling of the mutant and wild-type strains to characterize the global changes occurring as a result of the mutations. We then performed a series of assays to characterize the mechanisms involved in the increased sensitivity of the mutant strains. We report four primary results: (i) mutations that increase sensitivity occur at a high frequency (10(-2)) relative to the frequency of those that increase resistance (10(-5) to 10(-10)) and occur at a frequency 10(4) higher than the frequency of a single point mutation; (ii) transcriptional profiles were altered in sensitive mutants, resulting in overall expression patterns more similar to those of the sensitive laboratory strain PAO1 than those of the parental resistant strain; (iii) genes found from transcriptional profiling had the more dramatic changes in expression-encoded functions related to cellular membrane permeability and aminoglycoside modification, both of which are known aminoglycoside resistance mechanisms; and finally, (iv) even though we did not identify the specific sites of mutation, several different follow-up MIC assays suggested that the mutations responsible for increased sensitivity differed between sensitive mutants.

Managing acute lower respiratory tract infections in an era of antibacterial resistance

Respiratory tract infections account for more than 116 million office visits and an estimated 3 million visits to hospital EDs annually. Patients presenting at EDs with symptoms suggestive of lower respiratory tract infections of suspected bacterial etiology are often severely ill, thus requiring a rapid presumptive diagnosis and empiric antimicrobial treatment. Traditionally, clinicians have relied on beta-lactam or macrolide antibiotics to manage community-acquired lower respiratory tract infections. However, the emerging resistance of Streptococcus pneumoniae to beta-lactams and/or macrolides may affect the clinical efficacy of these agents. Inappropriate use of antibiotics and use of agents with an overly broad spectrum of antimicrobial activity have contributed to the emergence of antibiotic resistance. When treating respiratory infections, clinicians need to prescribe antimicrobial agents only for those individuals with infections of suspected bacterial etiology; to select agents with a targeted spectrum of activity that ensures coverage against typical S pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis strains, including antibiotic-resistant strains and atypical pathogens; and to consider agents with specific chemical properties that limit the development of antimicrobial resistance and that achieve concentrations at sites of infection that exceed those required for bactericidal activity. Newer classes of antimicrobial agents, such as the oxazolidinones and ketolides, will likely play a significant role in this era of antimicrobial resistance.

A nationwide survey of physician office visits found that inappropriate antibiotic prescriptions were issued for bacterial respiratory tract infections in ambulatory patients

OBJECTIVE

Correlations between probabilities of resistance and the frequencies with which antibiotics were prescribed for treating bacterial respiratory infections were examined in a nationwide ambulatory population.

STUDY DESIGN AND SETTING

The data of a nationwide probability sample survey of visits to physician offices in the United States in 1999 were used to conduct this study of drug use. A clinical pharmacologist identified antibiotics prescribed during those visits using a large online database. The participating physicians diagnosed the bacterial respiratory infections. An infectious disease expert determined the probabilities of bacterial resistance from a nationwide antibiotic surveillance database.

RESULTS

Various bacterial respiratory infections were diagnosed during 6.5% of physician office visits in 1999. One or more antibiotics were prescribed during 51.0% of those visits. The probabilities of resistance to the most frequently prescribed antibiotics varied from 20% to 40% and showed a weak positive correlation with the frequencies of antibiotic prescriptions.

CONCLUSION

A significant number of inappropriate antibiotic prescriptions were issued for infections with a high probability of bacterial resistance to the prescribed antibiotics.

Current Management Issues Associated with Community-Acquired Pneumonia

Community-acquired pneumonia (CAP) is a significant cause of morbidity, mortality, and increased cost. Despite numerous managementguidelines, CAP continues to existas a challenge to the learned clinician. Due to a lack of sensitive diagnostic testing, causative pathogens are often not identified, making most therapy empiric. Increasing levels of bacterial resistance to available antimicrobials worldwide has been implicated in driving up the costs of treatment and adversely effecting clinical outcomes. Pharmacists can be part of the solution by encouraging appropriate antimicrobial selection based on resistance patterns in their communities and ensuring appropriate vaccines are employed to prevent CAP.

The emerging role of atypical pathogens in community-acquired pneumonia

Community-acquired pneumonia (CAP) constitutes a major cause of morbidity and mortality. Although Streptococcus pneumoniae remains the bacterium most commonly implicated in CAP, the atypical respiratory pathogens Mycoplasma pneumoniae, Legionella species, and Chlamydia pneumoniae are being isolated with increasing frequency Contrary to previous beliefs, these agents are capable of causing severe as well as mild-to-moderate illness. Moreover, they can affect all age groups. Indeed, atypical pathogens are implicated in up to 40% of CAP cases and commonly occur as copathogens in mixed-infection CAP, an etiology associated with particularly high mortality (up to 25%). Laboratory methods for detecting atypical pathogens are slow, and there is significant overlap between atypical and typical CAP manifestations. For these reasons, accurate prediction of etiology cannot be made purely on clinical or radiologic grounds. Consequently, empiric antimicrobial therapy for atypical pathogens (with agents such as macrolides, fluoroquinolones, in some cases tetracyclines, or the new ketolides) warrants careful consideration and now is recommended for the treatment of CAP.