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Zhang W, Dong L, Men P, Jiang G, Wang F, Wang C, Cheng M, Huang H, Yu X. In vitro antimicrobial activity of doxycycline, minocycline, and tigecycline against Mycobacterium abscessus complex: A meta-analysis study. Diagn Microbiol Infect Dis 2024; 110:116435. [PMID: 39032320 DOI: 10.1016/j.diagmicrobio.2024.116435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/11/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Mycobacterium abscessus complex (MABC) infections are increasing worldwide. Furthermore, these infections have a low treatment success rate due to their resistance to many current antibiotics. This study aimed to determine the overall in vitro activity of the tetracyclines doxycycline (DOX), minocycline (MIN), and tigecycline (TGC) against MABC clinical isolates. PATIENTS AND METHODS A systematic review of PubMed/MEDLINE, Web of Science, and Embase was conducted up to August 28, 2023. Studies applying the drug susceptibility testing standards of the Clinical and Laboratory Standards Institute were considered. A random effects model was used to assess the total in vitro resistance rates of the MABC clinical isolates to DOX, MIN, and TGC. The I2 and Cochran's Q statistics were employed to evaluate the origins of heterogeneity. All analyses were conducted using CMA V.3 software. RESULTS Twenty-six publications (22, 12, and 11 studies on DOX, MIN, and TGC, respectively) were included. The pooled in vitro resistance rates of the MABC clinical isolates to DOX and MIN at the breakpoint of 8 μg/mL were 93.0 % (95 % CI, 89.2 %-95.5 %) and 87.2 % (95 % CI, 76.5 %-93.4 %), respectively. In the case of TGC, the breakpoints of 2, 4, and 8 μg/mL were associated with pooled resistance rates of 2.5 % (95 % CI, 0.5 %-11.6 %), 7.2 % (95 % CI, 4.0 %-12.5 %), and 16.8 % (95 % CI, 4.7 %-45.0 %), respectively. CONCLUSION Among the three examined tetracyclines, MABC exhibited extremely high resistance rates to DOX and MIN, thereby limiting their use in treating MABC infections. Conversely, MABC showed an increased susceptibility rate to TGC, highlighting TGC administration as a viable treatment option for patients with MABC infections.
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Affiliation(s)
- Weihe Zhang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Lingling Dong
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Peixuan Men
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
| | - Guanglu Jiang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Fen Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Congli Wang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Mengli Cheng
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Hairong Huang
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China
| | - Xia Yu
- National Clinical Laboratory on Tuberculosis, Beijing Key Laboratory for Drug-Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing 101149, China.
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2
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Yaghoubi S, Zekiy AO, Krutova M, Gholami M, Kouhsari E, Sholeh M, Ghafouri Z, Maleki F. Tigecycline antibacterial activity, clinical effectiveness, and mechanisms and epidemiology of resistance: narrative review. Eur J Clin Microbiol Infect Dis 2021; 41:1003-1022. [PMID: 33403565 PMCID: PMC7785128 DOI: 10.1007/s10096-020-04121-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
Tigecycline is unique glycylcycline class of semisynthetic antimicrobial agents developed for the treatment of polymicrobial infections caused by multidrug-resistant Gram-positive and Gram-negative pathogens. Tigecycline evades the main tetracycline resistance genetic mechanisms, such as tetracycline-specific efflux pump acquisition and ribosomal protection, via the addition of a glycyclamide moiety to the 9-position of minocycline. The use of the parenteral form of tigecycline is approved for complicated skin and skin structure infections (excluding diabetes foot infection), complicated intra-abdominal infections, and community-acquired bacterial pneumonia in adults. New evidence also suggests the effectiveness of tigecycline for the treatment of severe Clostridioides difficile infections. Tigecycline showed in vitro susceptibility to Coxiella spp., Rickettsia spp., and multidrug-resistant Neisseria gonnorrhoeae strains which indicate the possible use of tigecycline in the treatment of infections caused by these pathogens. Except for intrinsic, or often reported resistance in some Gram-negatives, tigecycline is effective against a wide range of multidrug-resistant nosocomial pathogens. Herein, we summarize the currently available data on tigecycline pharmacokinetics and pharmacodynamics, its mechanism of action, the epidemiology of tigecycline resistance, and its clinical effectiveness.
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Affiliation(s)
- Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Angelina Olegovna Zekiy
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Russian Federation, Trubetskaya st., 8-2, 119991, Moscow, Russia
| | - Marcela Krutova
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Mehrdad Gholami
- Department of Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, P.O. Box 6939177143, Gorgan- Sari Road, Golestan Province, Gorgan, Iran. .,Department of Laboratory Sciences, Faculty of Paramedicine, Golestan University of Medical Sciences, P.O. Box 6939177143, Gorgan- Sari Road, Golestan Province, Gorgan, Iran.
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghafouri
- Department of Biochemistry, Biophysics and Genetics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Farajolah Maleki
- Department of Laboratory Sciences, School of Allied Medical Sciences, Ilam University of Medical sciences, Ilam, Iran.
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Abstract
INTRODUCTION The emergence of multidrug-resistant (MDR) infections has been extensively observed worldwide and has become a priority issue over past decade. Tigecycline , a broad spectrum antibiotic covering against many MDR organisms, has been widely used. However, recent meta-analysis studies have raised a concern for its efficacy and safety. Reviewing tigecycline safety data would enhance the appropriate use of this medication. AREAS COVERED This article reviews the safety profile of tigecycline, including its side effects and drug interactions. EXPERT OPINION The increased mortality associated with tigecycline is not yet well understood. Based on current evidence, alternative options must be prioritized over tigecycline if available. When tigecycline use is warranted, vigilant observation to identify any breakthrough infections and careful monitoring of progression of the original infection are highly recommended. Considering a second agent (either for synergism or enhancing coverage) may be required.
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Affiliation(s)
- Quanhathai Kaewpoowat
- University of Texas Health Science Center at Houston, Division of Infectious Diseases , 6431 Fannin Street, MSB 2.112, Houston, TX 77030 , USA +1 713 500 6733 ; +1 713 500 5495 ;
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4
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Abstract
Glycopeptide antimicrobials have been a component of our therapeutic armamentarium for nearly 50 years. Although vancomycin, and more recently teicoplanin, have performed yeoman service over the years, the specter of bacterial resistance among Gram-positive aerobes has created doubts concerning how long they will continue to be useful antimicrobial agents. In an attempt to prolong the utility of the glycopeptides, efforts are underway to create new derivatives with improved pharmacologic and pharmacokinetic properties. One example of an improved glycopeptide from the pharmacokinetic perspective is dalbavancin (BI397)--a teicoplanin analog currently undergoing human testing. Elimination of this compound from the body occurs extremely slowly, with terminal disposition half-lifes of up to 200 h in healthy volunteers, thus allowing once-weekly dosing. Although not generally considered to be a potential alternative for the treatment of infections due to glycopeptide-resistant Gram-positive pathogens, dalbavancin may still be considered an advance on existing agents based on its patient-convenient once-weekly dosing regimen.
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Affiliation(s)
- David R P Guay
- University of Minnesota, College of Pharmacy, Weaver-Densford Hall 7-115C, 308 Harvard Street SE, Minneapolis, MN 55455, USA.
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5
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Karaoui LR, EL-Lababidi R, Chahine EB. Oritavancin: An investigational lipoglycopeptide antibiotic. Am J Health Syst Pharm 2013; 70:23-33. [PMID: 23261897 DOI: 10.2146/ajhp110572] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lamis R. Karaoui
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Rania EL-Lababidi
- Clinical Pharmacy Services, Department of Pharmacy, Florida Hospital Orlando, Orlando, FL
| | - Elias B. Chahine
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL
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6
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Gautam A, Vyas R, Tewari R. Peptidoglycan biosynthesis machinery: a rich source of drug targets. Crit Rev Biotechnol 2010; 31:295-336. [PMID: 21091161 DOI: 10.3109/07388551.2010.525498] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The range of antibiotic therapy for the control of bacterial infections is becoming increasingly limited because of the rapid rise in multidrug resistance in clinical bacterial isolates. A few diseases, such as tuberculosis, which were once thought to be under control, have re-emerged as serious health threats. These problems have resulted in intensified research to look for new inhibitors for bacterial pathogens. Of late, the peptidoglycan (PG) layer, the most important component of the bacterial cell wall has been the subject of drug targeting because, first, it is essential for the survivability of eubacteria and secondly, it is absent in humans. The last decade has seen tremendous inputs in deciphering the 3-D structures of the PG biosynthetic enzymes. Many inhibitors against these enzymes have been developed using virtual and high throughput screening techniques. This review discusses the mechanistic and structural properties of the PG biosynthetic enzymes and inhibitors developed in the last decade.
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Affiliation(s)
- Ankur Gautam
- Department of Biotechnology, Panjab University, Chandigarh, India
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Zhanel GG, Calic D, Schweizer F, Zelenitsky S, Adam H, Lagacé-Wiens PR, Rubinstein E, Gin AS, Hoban DJ, Karlowsky JA. New Lipoglycopeptides. Drugs 2010; 70:859-86. [DOI: 10.2165/11534440-000000000-00000] [Citation(s) in RCA: 234] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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9
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Aksoy D, Unal S. New antimicrobial agents for the treatment of Gram-positive bacterial infections. Clin Microbiol Infect 2008; 14:411-20. [DOI: 10.1111/j.1469-0691.2007.01933.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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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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11
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Kuti JL, Dowzicky M, Nicolau DP. Pharmacodynamic Performance of Tigecycline versus Common Intravenous Antibiotics for the Empiric Treatment of Complicated Skin and Skin Structure Infections. Surg Infect (Larchmt) 2008; 9:57-66. [DOI: 10.1089/sur.2007.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Joseph L. Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
| | | | - David P. Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut
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12
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Burchard GD, Einsele H, Hebart H, Heinz WJ, Herrmann M, Hörauf A, Mertens T, von Müller L, Zimmerli W. Antimikrobielle Therapie. KLINISCHE INFEKTIOLOGIE 2008. [PMCID: PMC7158361 DOI: 10.1016/b978-343721741-8.50008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Reid GE, Grim SA, Aldeza CA, Janda WM, Clark NM. Rapid development of Acinetobacter baumannii resistance to tigecycline. Pharmacotherapy 2007; 27:1198-201. [PMID: 17655518 DOI: 10.1592/phco.27.8.1198] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 53-year-old woman experienced a multidrug-resistant (MDR) Acinetobacter baumannii urinary tract infection 5 months after undergoing kidney and liver transplantation. The tigecycline minimum inhibitory concentration (MIC) for her A. baumannii isolate was 1.5 microg/ml; the patient received 2 weeks of therapy with intravenous tigecycline as a 100-mg loading dose followed by 50 mg every 12 hours, with no lapses in treatment and with resolution of the infection. Three weeks later, MDR A. baumannii was isolated from her sputum in the setting of clinical evidence of pneumonia, and tigecycline was restarted; the tigecycline MIC for the A. baumannii isolate was 2 microg/ml. At approximately the same time, the patient was found to have a paraspinal abscess and spinal osteomyelitis. Cultures of the abscess fluid grew A. baumannii with a tigecycline MIC of 24 microg/ml. A follow-up sputum culture again yielded A. baumannii, but with a tigecycline MIC of 24 microg/ml. Urine culture at that time also grew A. baumannii with a tigecycline MIC of 24 microg/ml. Clinicians should be aware that tigecycline MICs for A. baumannii isolates may increase during therapy with tigecycline after only brief exposure to the drug. Patients receiving tigecycline for Acinetobacter should be monitored for the development of clinical resistance, and isolates should be monitored for evidence of microbiologic resistance.
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Affiliation(s)
- Gail E Reid
- Department of Medicine, Section of Infectious Diseases, University of Illinois at Chicago, Chicago, Illinois, USA
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14
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Stein GE. New drugs to treat skin and soft tissue infections. Curr Infect Dis Rep 2007; 9:408-14. [PMID: 17880852 DOI: 10.1007/s11908-007-0063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Due to increasing antimicrobial resistance, a pressing need exists for new antibiotics to treat skin and soft tissue infections. Several newer agents such as tigecycline, daptomycin, and linezolid have been important additions for the treatment of multidrug-resistant pathogens. New drugs in development such as dalbavancin and ceftobiprole will further enhance our ability to treat mixed infections and improve patient compliance. These promising new antimicrobials will likely grow in importance as resistant bacterial strains increase in community-acquired infections.
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Affiliation(s)
- Gary E Stein
- Department of Medicine, Michigan State University, B320 Life Sciences, East Lansing, MI 48824, USA.
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15
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Eagye KJ, Kuti JL, Dowzicky M, Nicolau DP. Empiric therapy for secondary peritonitis: a pharmacodynamic analysis of cefepime, ceftazidime, ceftriaxone, imipenem, levofloxacin, piperacillin/tazobactam, and tigecycline using Monte Carlo simulation. Clin Ther 2007; 29:889-899. [PMID: 17697907 DOI: 10.1016/j.clinthera.2007.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Inappropriate antibiotic therapy (ie, the selection of an empiric agent without activity against the responsible pathogen) of secondary peritonitis may result in poor patient outcomes. The selection of an appropriate agent can be challenging because of the emerging resistance of target organisms to commonly prescribed antibiotics. OBJECTIVE The aim of this study was to perform a pharmacodynamic analysis, using recent global surveillance data, of commonly prescribed antibiotic agents and a newer agent, tigecycline, indicated in 2005 for the treatment of complicated intra-abdominal infections, to determine their probability for achieving microbiologic success against aerobic bacteria associated with secondary peritonitis. METHODS A 2-compartment model was constructed using pharmacokinetic data from critically ill patients and global surveillance data on MIC distributions for microorganisms encountered in secondary peritonitis. A Monte Carlo simulation of the modeled data was performed to determine drug-appropriate pharmacodynamic end points, including free-drug time above the MIC, steady-state concentration above the MIC, and AUC/MIC ratios. A cumulative fraction of response (CFR) against aerobic bacteria involved in secondary peritonitis was calculated for cefepime, ceftazidime, ceftriaxone, imipenem, levofloxacin, pip eracillin/tazobactam, and tigecycline. A CFR > or =90% was considered microbiologic success. The following treatment regimens, administered as 30-minute N infusions, were examined: cefepime 1 and 2 g q12h, ceftazidime 1 and 2 g q8h, ceftriaxone 1 and 2 g q24h, imipenem 500 mg q6h, levofloxacin 750 mg q24h, pip eracillin/tazobactam 3.375 g q6h, and tigecycline 50 mg q12h, after a loading dose of 100 mg. RESULTS A CFR > or =90% against nonenterococcal bacteria was predicted for imipenem 500 mg q6h (96.8%), cefepime 2 and 1 g q12h (95.3% and 92.4%, respectively), ceftazidime 2 g q8h (94.2%), and piperacillin/tazobactam 3.375 g q6h (91.2%). A CFR of 84.5% was predicted for tigecycline 50 mg q12h. Ceftriaxone and levofloxacin were predicted to have a CFR <80%. When enterococci were included in the model, the predicted CFRs for imipenem, piperacillin/tazobactam, and tigecycline were 93.4%, 88.4%, and 86.7%, respectively. CONCLUSIONS : MIC distribution and pathogen prevalence strongly influence the likelihood of microbiological success in secondary peritonitis; therefore, decisions regarding empiric therapy should consider local epidemiology. Using current global data, the following regimens are adequate choices if Enterococcus is not targeted: Combination therapy (with metronidazole) using cefepime 1 g or 2 g q12h, or ceftazidime 2 g q8h; or monotherapy with imipenem 500 mg q6h or piperacillin-tazobactam 3.375 g q6h. When Enterococcus is included in the epidemiologic mix, imipenem, piperacillin/tazobactam, and tigecycline all appear to be viable monotherapeutic choices.
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Affiliation(s)
- Kathryn J Eagye
- Center for Anti-In fective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - Joseph L Kuti
- Center for Anti-In fective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | | | - David P Nicolau
- Center for Anti-In fective Research and Development, Hartford Hospital, Hartford, Connecticut, USA; Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut, USA.
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16
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Cercenado E. Tigecycline: a new antimicrobial agent against multiresistant bacteria. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.3.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Drew RH. Emerging Options for Treatment of Invasive, Multidrug-ResistantStaphylococcus aureusInfections. Pharmacotherapy 2007; 27:227-49. [PMID: 17253914 DOI: 10.1592/phco.27.2.227] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Limited established treatment options exist for the treatment of serious, invasive infections caused by multidrug-resistant Staphylococcus aureus, most notably nosocomially acquired methicillin-resistant S. aureus (MRSA). Although vancomycin represents the gold standard for therapy of such invasive infections, reports of increasing in vitro resistance to vancomycin, combined with reports of clinical failures (with this and other antistaphylococcal agents), underscore the need for alternative therapies. Older agents with favorable in vitro activity available in both oral and intravenous dose forms include trimethoprim-sulfamethoxazole and clindamycin. Limited clinical data exist to support their routine use as initial therapy in the treatment of invasive disease. However, these and other options (e.g., tetracyclines) are being reexplored in the setting of increasing concern over MRSA acquired in the community setting. Newer treatment options for MRSA include linezolid, quinupristin-dalfopristin, daptomycin, and tigecycline. With the exception of linezolid, these newer agents require intravenous administration. Combination therapy may be considered in select invasive diseases refractory to standard monotherapies. These diseases include infections such as endocarditis, meningitis, and prosthetic device infections. Additional alternatives to vancomycin are under clinical investigation. Those in later stages of development include oritavancin, dalbavancin, telavancin, and ceftobiprole.
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Affiliation(s)
- Richard H Drew
- Duke University School of Medicine, Durham, North Carolina, USA.
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Affiliation(s)
- Matthias Turina
- Department of Surgery, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, Kentucky
| | - William G. Cheadle
- Department of Surgery, University of Louisville School of Medicine, University of Louisville Hospital, Louisville, Kentucky
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Bradley JS. New antibiotics for Gram-positive infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 582:151-65. [PMID: 16802626 DOI: 10.1007/0-387-33026-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- John S Bradley
- Division of Infectious Diseases, Children's Hospital, San Diego, CA 92123, USA
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20
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Halliday J, McKeveney D, Muldoon C, Rajaratnam P, Meutermans W. Targeting the forgotten transglycosylases. Biochem Pharmacol 2006; 71:957-67. [PMID: 16298347 DOI: 10.1016/j.bcp.2005.10.030] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Revised: 10/06/2005] [Accepted: 10/11/2005] [Indexed: 11/30/2022]
Abstract
Forty years ago, moenomycin was reported as a representative of a novel natural product class with strong antibacterial activity against Gram-positive organisms. Moenomycin was developed as an antimicrobial growth promoter in animal feeds. Mechanistically, moenomycin acts via inhibition of the transglycosylation process at the final stage of the peptidoglycan biosynthesis, in particular through binding directly to the transglycosylase enzymes, thereby preventing polymerisation of lipid II into linear peptidoglycan. Despite moenomycin's success, no developments of direct transglycosylase enzyme inhibitors were reported for over 30 years, probably due to the complexities and uncertainties surrounding the transglycosylation process, in particular the number of enzymes involved in the process and their specific roles. The development of better research tools and an improved understanding of the transglycosylation process, together with the increasing threat presented by multidrug-resistant bacteria, have led to a resurfacing of interest in targeting the forgotten transglycosylases. In addition, several new generation glycopeptides in clinical development inhibit the transglycosylation process, adding further value to the approach. In this paper, we summarise some of the developments in the area of transglycosylase inhibitors over the last 10 years.
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Affiliation(s)
- Judy Halliday
- Alchemia Limited, 3 Hi-Tech Court, Eight Mile Plains, Brisbane Technology Park, Qld 4113, Australia
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21
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Squires RA, Postier RG. Tigecycline for the treatment of infections due to resistant Gram-positive organisms. Expert Opin Investig Drugs 2006; 15:155-62. [PMID: 16433594 DOI: 10.1517/13543784.15.2.155] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tigecycline is a novel compound in the antimicrobial class known as the glycylcyclines. In vitro studies have shown it to have activity against the vast majority of Gram-positive pathogens, including multi-drug resistant Staphylococcus aureus and vancomycin-resistant enterococci. Tigecycline has also shown excellent in vitro activity against a broad range of Gram-negative enteric organisms including strains resistant to other antimicrobials as well as anaerobes. Tigecycline is not affected by the ribosomal protection and efflux mechanisms transmitted by the known tetracycline resistance genes. Tigecycline represents an exciting new class of glycylcycline antimicrobial agents for the treatment of multi-drug resistant Gram-positive bacteria. Although its broad spectrum of activity, which also includes Gram-negative enterics, makes it a candidate for empiric therapy for intra-abdominal infections, its spectrum against multi-drug resistant Gram-positive organisms makes it a very attractive choice for empiric treatment of Gram-positive infections in patients at risk for resistant strains. The two pivotal Phase II clinical trials involving complicated skin and soft tissue infections and intra-abdominal infections have shown the drug to be safe and effective.
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Affiliation(s)
- Ronald A Squires
- University of Oklahoma Health Sciences Center, Department of Surgery, Oklahoma City, Oklahoma, USA
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Hsueh PR, Chen WH, Teng LJ, Luh KT. Nosocomial infections due to methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci at a university hospital in Taiwan from 1991 to 2003: resistance trends, antibiotic usage and in vitro activities of newer antimicrobial agents. Int J Antimicrob Agents 2005; 26:43-9. [PMID: 15975769 PMCID: PMC7126964 DOI: 10.1016/j.ijantimicag.2005.04.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 04/06/2005] [Indexed: 11/10/2022]
Abstract
A rapid increase of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection (from 39% in 1991 to 75% in 2003) and vancomycin-resistant enterococci (VRE) (from 1.2% in 1996 to 6.1% in 2003) at a university hospital in Taiwan was found. The noticeable rise of MRSA and VRE was significantly correlated with the increased consumption of glycopeptides, β-lactam–β-lactamase inhibitor combinations, extended-spectrum cephalosporins, carbapenems and fluoroquinolones (Pearson's correlation coefficient, P < 0.05). Minimum inhibitory concentrations (MICs) of 100 non-duplicate blood isolates of MRSA (in 2003) and of 25 non-duplicate isolates of vancomycin-resistant Enterococcus faecalis and 172 vancomycin-resistant Enterococcus faecium (in 1996–2003) causing nosocomial infection recovered from various clinical specimens of patients treated at the hospital to nine antimicrobial agents were determined by the agar dilution method. All of these isolates were susceptible to linezolid and were inhibited by 0.5 mg/L of tigecycline, and all MRSA isolates were inhibited by daptomycin 1 mg/L, including two isolates of MRSA with heteroresistance to vancomycin. Daptomycin had two-fold better activity against vancomycin-resistant E. faecalis (MIC90, 2 mg/L) than against vancomycin-resistant E. faecium (MIC90, 4 mg/L). Decreased susceptibilities of vancomycin-resistant E. faecium and MRSA to quinupristin/dalfopristin (non-susceptibility 25% and 8%, respectively) were found. Telithromycin had poor activity against the isolates tested (MIC90, 8 mg/L). Linezolid, daptomycin and tigecycline may represent therapeutic options for infections caused by these resistant Gram-positive organisms.
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Affiliation(s)
- Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
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23
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Lee SY, Kuti JL, Nicolau DP. Antimicrobial Management of Complicated Skin and Skin Structure Infections in the Era of Emerging Resistance. Surg Infect (Larchmt) 2005; 6:283-95. [PMID: 16201938 DOI: 10.1089/sur.2005.6.283] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Complicated skin and skin structure infections (cSSSIs) are among the most common infections treated in the hospital setting. The mainstays of treatment continue to be antimicrobial therapy combined with appropriate surgical intervention. Due to increasing resistance among pathogens commonly implicated in cSSSIs, the objectives of this review were to describe the potential pathogens causing skin infections, the implications of resistance to currently used drug therapy, and the role of new antibiotics with activity for pathogens causing cSSSIs. METHODS Relevant information from the primary literature and review articles were identified through a MEDLINE search of the medical literature (1980 to the present) using the terms abscess, wound infection, skin and skin structure infection, antibiotics, resistance, quinupristin- dalfopristin, linezolid, daptomycin, tigecycline, oritavancin, and dalbavancin. Meeting posters and slides were identified from the Interscience Conference of Antimicrobial Agents and Chemotherapy (1998-2004) for supplemental data. RESULTS The most commonly implicated pathogens in cSSSIs include gram-positive bacteria, specifically Staphylococcus aureus. Gram-negative and mixed organisms are additionally encountered in serious cSSSI. Antimicrobial resistance among both gram-positive and gramnegative bacteria has increased significantly during the last decade, with methicillin resistance among S. aureus approaching 60% in hospitals and becoming more frequent in the community as well. As a result, resistance is the driving factor for treatment failure and rising costs for infection management. Few antimicrobial agents are available currently to treat resistant bacteria in cSSSIs; vancomycin is currently the drug of choice against resistant grampositive cocci; however, resistance to this agent has appeared in enterococci and S. aureus. Several new antibiotics such as linezolid and daptomycin are now available for the management of cSSSIs. Other agents such as tigecycline are under investigation and should be available soon to increase treatment options for cSSSIs caused by resistant bacteria. CONCLUSIONS Although the resistance of cSSSI pathogens is problematic, new antibiotics with broad-spectrum activity against resistant gram-positive and gram-negative bacteria are promising for the management of severe cSSSIs.
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Affiliation(s)
- Su Young Lee
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA
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24
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Turina M, Cheadle WG. Clinical Challenges and Unmet Needs in the Management of Complicated Skin and Skin Structure, and Soft Tissue Infections. Surg Infect (Larchmt) 2005. [DOI: 10.1089/sur.2005.6.2s-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Napolitano LM. Emerging Issues in the Diagnosis and Management of Infections Caused by Multi-Drug-Resistant, Gram-Positive Cocci. Surg Infect (Larchmt) 2005. [DOI: 10.1089/sur.2005.6.s2-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Turina M, Cheadle WG. Clinical Challenges and Unmet Needs in the Management of Complicated Skin and Skin Structure, and Soft Tissue Infections. Surg Infect (Larchmt) 2005. [DOI: 10.1089/sur.2005.6.s2-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthias Turina
- From the Veterans Affairs Medical Center, Louisville, and the Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292
| | - William G. Cheadle
- From the Veterans Affairs Medical Center, Louisville, and the Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292
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DeRyke CA, Maglio D, Nicolau DP. Defining the need for new antimicrobials: clinical and economic implications of resistance in the hospitalised patient. Expert Opin Pharmacother 2005; 6:873-89. [PMID: 15952918 DOI: 10.1517/14656566.6.6.873] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resistance among pathogens causing the most common infections encountered in hospitalised patients is increasing. Due to this resistance, the clinical efficacy of current antimicrobial agents is decreasing against many pathogens, including Streptococcus pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Pseudomonas aeruginosa, extended-spectrum beta-lactamases, and AmpC beta-lactamase-producing organisms. Studies assessing the impact of these resistance mechanisms on clinical outcomes have been performed; however, studies determining the economic impact of resistance have been limited. Strategies to retain the clinical efficacy of currently available agents include the initiation of antimicrobials with efficacy against the suspected pathogen(s) based on data obtained from local antibiograms, the use of combination therapy, and pharmacodynamic optimisation. Once a broad-spectrum regimen has been initiated, de-escalation to narrow, targeted antimicrobial therapy based on susceptibility data is warranted. Despite these efforts, new antimicrobials with novel mechanisms of action are eagerly anticipated to extend the current armamentarium against the growing population of multi-drug-resistant pathogens.
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Affiliation(s)
- C Andrew DeRyke
- Center for Anti-infective Research and Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
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29
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Sun HK, Ong CT, Umer A, Harper D, Troy S, Nightingale CH, Nicolau DP. Pharmacokinetic profile of tigecycline in serum and skin blister fluid of healthy subjects after multiple intravenous administrations. Antimicrob Agents Chemother 2005; 49:1629-32. [PMID: 15793157 PMCID: PMC1068611 DOI: 10.1128/aac.49.4.1629-1632.2005] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The pharmacokinetics of tigecycline, when given as a 100-mg loading dose followed by 50 mg every 12 h, were determined in serum and blister fluid. The peak tigecycline concentration and half-life in serum were greater than those in blister fluid. Tigecycline penetrates into blister fluid well, with a mean penetration rate of 74%.
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Affiliation(s)
- Heather K Sun
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA
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30
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Yin LY, Lazzarini L, Li F, Stevens CM, Calhoun JH. Comparative evaluation of tigecycline and vancomycin, with and without rifampicin, in the treatment of methicillin-resistant Staphylococcus aureus experimental osteomyelitis in a rabbit model. J Antimicrob Chemother 2005; 55:995-1002. [PMID: 15857944 DOI: 10.1093/jac/dki109] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Staphylococcus aureus is the most common organism isolated in osteomyelitis. Methicillin-resistant S. aureus (MRSA) infections are particularly difficult to treat. We evaluated the efficacy of tigecycline and vancomycin with and without rifampicin in a rabbit model of MRSA osteomyelitis. METHODS A 28 day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily), with and without oral rifampicin (40 mg/kg twice daily); or subcutaneous administration of vancomycin (30 mg/kg twice daily), with and without oral rifampicin (40 mg/kg twice daily) were compared. Osteomyelitis was induced with an intramedullary injection of 10(6) colony-forming units of MRSA. Infected rabbits were randomly divided into six groups: tigecycline, tigecycline with oral rifampicin, vancomycin, vancomycin with oral rifampicin, and no treatment control and tigecycline bone penetration groups. Treatment began 2 weeks after infection. After 4 weeks of therapy, the rabbits were left untreated for 2 weeks. Rabbits were then euthanized, and the tibias were harvested. The bones were cultured, and bacterial counts of MRSA were performed. RESULTS Rabbits that received tigecycline and oral rifampicin therapy (n=14) showed a 100% infection clearance. Rabbits treated with tigecycline (n=10) showed a 90% clearance. Rabbits treated with vancomycin and oral rifampicin (n=10) also showed a 90% clearance. Rabbits treated with vancomycin (n=11) showed an 81.8% clearance. Untreated controls (n=15) demonstrated only a 26% clearance. For the tigecycline bone penetration group, the bone concentrations of tigecycline in the infected tibia were significantly higher than the non-infected ones. CONCLUSIONS Tigecycline may be an effective alternative to vancomycin in the treatment of MRSA osteomyelitis.
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Affiliation(s)
- Li-Yan Yin
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA
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Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become a serious nosocomial pathogen, and more recent reports in the scientific literature underscore the potential issues with emerging community-MRSA. MRSA is reported to be involved in > 50% of hospital S. aureus infections, more in the intensive care unit (ICU) than the non-ICU, and increases in multi-drug resistant MRSA and increasingly virulent MRSA have been reported. Together with its broad-based beta-lactam resistance, MRSA often possesses a multi-drug resistance genotype, including cephalosporins, aminoglycosides, fluoroquinolones, and macrolide resistances. MRSA has now emerged as the predominant nosocomial Gram-positive pathogen, and it has a high rate of morbidity and mortality. Action must be taken to contain and eradicate MRSA through a combination of infection control, the development of novel anti-MRSA agents, development of vaccines and other non-traditional approaches of intervention.
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Affiliation(s)
- John F Barrett
- Merck Research Laboratories, 126 E. Lincoln Avenue, Rahway, NJ 07065, USA.
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Koch S, Hufnagel M, Huebner J. Treatment and prevention of enterococcal infections--alternative and experimental approaches. Expert Opin Biol Ther 2005; 4:1519-31. [PMID: 15335318 DOI: 10.1517/14712598.4.9.1519] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Enterococci are one of the leading types of organisms isolated from infections of hospitalised patients and the third most common cause of nosocomial bloodstream infections. They contribute significantly to patient mortality and morbidity, as well as healthcare costs. The emergence of resistance against virtually all clinically available antibiotics and the ability to transfer these resistance determinants to other pathogens demonstrates the urgency for an improved understanding of enterococcal virulence mechanisms, and the development of alternative treatment and prevention options. This article reviews new antimicrobials, vaccine targets, bacteriophage therapy, as well as treatments targeting virulence factors and biofilm, for their potential to treat and/or prevent enterococcal infections. Although clinical isolates often cause serious infections, so-called 'non-pathogenic' strains are used as therapeutics in the form of probiotics. Understanding the differences between true pathogens and beneficial commensals may help to evaluate future treatment and prophylactic options.
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Affiliation(s)
- Stefanie Koch
- Department of Medicine, Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115, USA
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Abstract
Tigecycline, is a novel broad-spectrum glycylcycline antibiotic, which has activity against a broad range of Gram-positive, Gram-negative, atypical, anaerobic and antibiotic-resistant bacteria. This includes activity against MRSA, VRE and penicillin resistant Streptococcus pneumoniae. Whilst exhibiting antibacterial activities typical of earlier tetracyclines, it has more potent activity against tetracycline-resistant organisms. Although a bacteriostatic compound in vitro, its effectiveness in clinical trials suggests that traditional laboratory thinking about using bacteriostatic drugs in serious infections needs to be revised. Unlike existing tetracyclines, tigecycline is only available as an intravenous preparation, is administered twice daily although its long half life and post-antibiotic effect may make once daily dosing possible, appears to have good tissue penetration (e.g. skin) and requires no adjustment in the presence of renal or hepatic diseases. It is efficacious in complicated skin and soft tissue infections and in intra-abdominal infections. In three trials, it was well tolerated despite increased frequency of nausea and vomiting. In the light of these early clinical data and the likelihood that this agent will become available for clinical use within the next 12-24 months, this review aims to summarise the key clinical data and potential formulary considerations for the future use of this agent, subject to further clinical trials and publication of clinical human data.
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Affiliation(s)
- Dilip Nathwani
- Infection and Immunodeficiency Unit (Ward 42), East Block, Ninewells Hospital and Medical School, Tayside University Hospitals, Dundee DD1 9SY, UK.
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Barrett JF. MRSA: status and prospects for therapy? An evaluation of key papers on the topic of MRSA and antibiotic resistance. Expert Opin Ther Targets 2005; 8:515-9. [PMID: 15584858 DOI: 10.1517/14728222.8.6.515] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a serious nosocomial pathogen, and a related community-sourced MRSA is emerging. MRSA has evolved to become the major S. aureus phenotype in the hospital, emerging from just 30 to over 60% of the S. aureus population over the past 15 years. Together with its beta-lactam resistance, MRSA possesses multi-drug resistance genotype, including quinolones, macrolides and sulfonamides. MRSA has now emerged as the predominant nosocomial Gram-positive pathogen, and it has a high rate of mortality. Action must be taken to contain and eradicate MRSA through a combination of infection control and the development of novel anti-MRSA agents and vaccines.
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Affiliation(s)
- John F Barrett
- Merck Research Laboratories, 126 E. Lincoln Avenue, Rahway, NJ 07650, USA.
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35
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Charles PGP, Grayson ML. The dearth of new antibiotic development: why we should be worried and what we can do about it. Med J Aust 2005; 181:549-53. [PMID: 15540967 DOI: 10.5694/j.1326-5377.2004.tb06444.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2004] [Accepted: 09/22/2004] [Indexed: 11/17/2022]
Abstract
The emergence and spread of multidrug-resistant pathogens has increased substantially over the past 20 years. Over the same period, the development of new antibiotics has decreased alarmingly, with many pharmaceutical companies pulling out of antibiotic research in favour of developing "lifestyle" drugs. Reasons given for withdrawing from antibiotic development include poor "net present value" status of antibiotics, changes in regulations requiring larger drug trials and prolonged post-marketing surveillance, clinical preference for narrow-spectrum rather than broad-spectrum agents, and high new-drug purchase costs. Major improvements in infection control in Australia are needed to prevent further spread of resistant clones, buying some time to develop urgently needed new antibiotic agents. Perpetuating a culture of "pharma bashing" will simply lead to more pharmaceutical companies withdrawing from the market. A change in the health and research culture is needed to improve cooperation between public, academic and private sectors.
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Deresinski S. Methicillin-Resistant Staphylococcus aureus: An Evolutionary, Epidemiologic, and Therapeutic Odyssey. Clin Infect Dis 2005; 40:562-73. [PMID: 15712079 DOI: 10.1086/427701] [Citation(s) in RCA: 272] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 11/10/2004] [Indexed: 11/03/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus, first identified just over 4 decades ago, has undergone rapid evolutionary changes and epidemiologic expansion. It has spread beyond the confines of health care facilities, emerging anew in the community, where it is rapidly becoming a dominant pathogen. This has led to an important change in the choice of antibiotics in the management of community-acquired infections and has also led to the development of novel antimicrobials.
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Affiliation(s)
- Stan Deresinski
- Division of Infectious Disease and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.
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38
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Abstract
PURPOSE OF REVIEW This article reviews recent publications regarding new antimicrobial drugs for the treatment of vancomycin-resistant enterococci. RECENT FINDINGS Newer drugs against vancomycin-resistant enterococci are now available or will soon be available. Quinupristin-dalfopristin, a streptogramin, and linezolid, an oxazolidinone, are effective and safe but only bacteriostatic against enterococi. Bacterial isolates resistant to either antibiotic have been described. Daptomycin, a lipopeptide antimicrobial, has good in-vitro bactericidal activity against enterococci, but very limited clinical data exist regarding the treatment of serious enterococcal infection with this compound. Ramoplanin, the first glycolipodepsipeptide antimicrobial in clinical trials, is not systemically absorbed after oral administration, and is being evaluated for the prevention of bloodstream infection in patients colonized with vancomycin-resistant enterococci. Oritavancin and dalbavancin (both glycopeptides) and tigecycline (a monocycline derivative) are being evaluated in phase II and III trials and are not yet commercially available. SUMMARY Treatment of vancomycin-resistant enterococci continues to be problematical although these new drugs offer some hope. The rational use of antibiotics, strict guidelines for the use of new compounds, and adherence to infection control practices continue to be essential components of the management of vancomycin-resistant enterococci colonization and infection.
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Affiliation(s)
- Carlos Torres-Viera
- Yale New Haven Hospital and Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut 06504, USA.
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