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Gomes SN, Biscaia IFB, Lopes DS, Mengarda M, Murakami FS, Oliveira PR, Bernardi LS. Cocrystals Enhance Biopharmaceutical and Antimicrobial Properties of Norfloxacin. Pharmaceutics 2023; 15:2211. [PMID: 37765180 PMCID: PMC10536922 DOI: 10.3390/pharmaceutics15092211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
A solvate cocrystal of the antimicrobial norfloxacin (NFX) was formed by using isonicotinamide (INA) as a coformer with the solvent evaporation technique. The cocrystal formation was confirmed by performing solid-state characterization techniques. We evaluated the dissolution under supersaturated conditions and also the solubility at the vertex of triphasic domain of cocrystal and NFX in both water and Fasted-State Simulated Intestinal Fluid (FaSSIF). The antimicrobial activity was evaluated using the microdilution technique. The cocrystal showed 1.8 times higher dissolution than NFX in water at 60 min and 1.3 times higher in FaSSIF at 180 min in the kinetic study. The cocrystal also had an increase in solubility of 8.38 times in water and 6.41 times in FaSSIF. The biopharmaceutical properties of NFX with cocrystallization improved antimicrobial action, as shown in the results of minimum inhibitory concentration (MIC) and inhibitory concentrations of 50% (IC50%) and 90% (IC90%). This paper presents, for the first time, a more in-depth analysis of the cocrystal of NFX-INA concerning its dissolution, solubility, and antimicrobial activity. In all these criteria, the cocrystal obtained better results compared to the pure drug.
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Affiliation(s)
- Samantha Nascimento Gomes
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Estadual do Centro-Oeste (UNICENTRO), Guarapuava 85040-080, Brazil; (S.N.G.); (I.F.B.B.); (D.S.L.); (L.S.B.)
| | - Isabela Fanelli Barreto Biscaia
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Estadual do Centro-Oeste (UNICENTRO), Guarapuava 85040-080, Brazil; (S.N.G.); (I.F.B.B.); (D.S.L.); (L.S.B.)
| | - Diana Schon Lopes
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Estadual do Centro-Oeste (UNICENTRO), Guarapuava 85040-080, Brazil; (S.N.G.); (I.F.B.B.); (D.S.L.); (L.S.B.)
| | - Mariana Mengarda
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Federal do Paraná (UFPR), Curitiba 80210-170, Brazil (F.S.M.)
| | - Fábio Seigi Murakami
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Federal do Paraná (UFPR), Curitiba 80210-170, Brazil (F.S.M.)
| | - Paulo Renato Oliveira
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Estadual do Centro-Oeste (UNICENTRO), Guarapuava 85040-080, Brazil; (S.N.G.); (I.F.B.B.); (D.S.L.); (L.S.B.)
| | - Larissa Sakis Bernardi
- Graduate Program in Pharmaceutical Sciences, Department of Pharmacy, Universidade Estadual do Centro-Oeste (UNICENTRO), Guarapuava 85040-080, Brazil; (S.N.G.); (I.F.B.B.); (D.S.L.); (L.S.B.)
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2
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Wenzler E, Maximos M, Asempa TE, Biehle L, Schuetz AN, Hirsch EB. Antimicrobial susceptibility testing: An updated primer for clinicians in the era of antimicrobial resistance: Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2023; 43:264-278. [PMID: 36825480 DOI: 10.1002/phar.2781] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/15/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
Antimicrobial susceptibility testing (AST) is a critical function of the clinical microbiology laboratory and is essential for optimizing care of patients with infectious diseases, monitoring antimicrobial resistance (AMR) trends, and informing public health initiatives. Several methods are available for performing AST including broth microdilution, agar dilution, and disk diffusion. Technological advances such as the development of commercial automated susceptibility testing platforms and the advent of rapid diagnostic tests have improved the rapidity, robustness, and clinical application of AST. Numerous accrediting and regulatory agencies are involved in the process of AST and setting and revising breakpoints, including the U.S. Food and Drug Administration and the Clinical and Laboratory Standards Institute. Challenges to optimizing AST include the emergence of new resistance mechanisms, the development of new antimicrobial agents, and generation of new data requiring updates and revisions to established methods and breakpoints. Together, the challenges in AST methods and their interpretation create important opportunities for well-informed clinicians to improve patient outcomes and provide value to antimicrobial stewardship programs, especially in the setting of rapidly changing and increasing AMR. Addressing AST challenges will involve continued development of new technologies along with collaboration between clinicians and the laboratory to facilitate optimal antimicrobial use, combat the increasing burden of AMR, and inform the development of novel antimicrobials. This updated primer serves to reinforce important principles of AST, and to provide guidance on their implementation and optimization.
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Affiliation(s)
- Eric Wenzler
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mira Maximos
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Tomefa E Asempa
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - Lauren Biehle
- School of Pharmacy, University of Wyoming, Laramie, Wyoming, USA
| | - Audrey N Schuetz
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Elizabeth B Hirsch
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA
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3
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Pacocha N, Zapotoczna M, Makuch K, Bogusławski J, Garstecki P. You will know by its tail: a method for quantification of heterogeneity of bacterial populations using single-cell MIC profiling. LAB ON A CHIP 2022; 22:4317-4326. [PMID: 36222371 DOI: 10.1039/d2lc00234e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Severe non-healing infections are often caused by multiple pathogens or by genetic variants of the same pathogen exhibiting different levels of antibiotic resistance. For example, polymicrobial diabetic foot infections double the risk of amputation compared to monomicrobial infections. Although these infections lead to increased morbidity and mortality, standard antimicrobial susceptibility methods are designed for homogenous samples and are impaired in quantifying heteroresistance. Here, we propose a droplet-based label-free method for quantifying the antibiotic response of the entire population at the single-cell level. We used Pseudomonas aeruginosa and Staphylococcus aureus samples to confirm that the shape of the profile informs about the coexistence of diverse bacterial subpopulations, their sizes, and antibiotic heteroresistance. These profiles could therefore indicate the outcome of antibiotic treatment in terms of the size of remaining subpopulations. Moreover, we studied phenotypic variants of a S. aureus strain to confirm that the profile can be used to identify tolerant subpopulations, such as small colony variants, associated with increased risks for the development of persisting infections. Therefore, the profile is a versatile instrument for quantifying the size of each bacterial subpopulation within a specimen as well as their individual and joined heteroresistance.
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Affiliation(s)
- Natalia Pacocha
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland.
| | - Marta Zapotoczna
- Department of Molecular Microbiology, Institute of Microbiology, Faculty of Biology, Biological and Chemical Research Centre, University of Warsaw, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Karol Makuch
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland.
| | - Jakub Bogusławski
- International Centre for Translational Eye Research, Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
- Department of Physical Chemistry of Biological Systems, Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
- Laser & Fiber Electronics Group, Faculty of Electronics, Wrocław University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Piotr Garstecki
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland.
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Combination of Whole Genome Sequencing and Metagenomics for Microbiological Diagnostics. Int J Mol Sci 2022; 23:ijms23179834. [PMID: 36077231 PMCID: PMC9456280 DOI: 10.3390/ijms23179834] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/21/2022] Open
Abstract
Whole genome sequencing (WGS) provides the highest resolution for genome-based species identification and can provide insight into the antimicrobial resistance and virulence potential of a single microbiological isolate during the diagnostic process. In contrast, metagenomic sequencing allows the analysis of DNA segments from multiple microorganisms within a community, either using an amplicon- or shotgun-based approach. However, WGS and shotgun metagenomic data are rarely combined, although such an approach may generate additive or synergistic information, critical for, e.g., patient management, infection control, and pathogen surveillance. To produce a combined workflow with actionable outputs, we need to understand the pre-to-post analytical process of both technologies. This will require specific databases storing interlinked sequencing and metadata, and also involves customized bioinformatic analytical pipelines. This review article will provide an overview of the critical steps and potential clinical application of combining WGS and metagenomics together for microbiological diagnosis.
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Xiong Y, Han Y, Zhao Z, Gao W, Ma Y, Jiang S, Wang M, Zhang Q, Zhou Y, Chen Y. Impact of Carbapenem Heteroresistance Among Multidrug-Resistant ESBL/AmpC-Producing Klebsiella pneumoniae Clinical Isolates on Antibiotic Treatment in Experimentally Infected Mice. Infect Drug Resist 2022; 14:5639-5650. [PMID: 34992390 PMCID: PMC8711563 DOI: 10.2147/idr.s340652] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/08/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose Antibiotic resistance is a growing health crisis that is further complicated by treatment failures caused by bacteria that exhibit heterogeneous susceptibility to antibiotics. The aim of this study was to describe imipenem (IPM)-heteroresistant strains among multidrug-resistant (MDR) ESBL/AmpC-producing Klebsiella pneumoniae clinical isolates, investigate their molecular phenotypic characteristics, and elucidate the outcome of antibiotic treatment in mice infected with the heteroresistant isolates. Materials and Methods Antimicrobial susceptibility of K. pneumoniae isolates was determined by the disk diffusion and E-test methods. Heteroresistance to IPM was confirmed by population analysis profile (PAP) assays. PCR and sequencing were employed to detect MDR determinants. Molecular differences between the susceptible and resistant subpopulations were evaluated by sequencing and quantitative real-time reverse transcription PCR (qRT-PCR) analysis. The effect of the carbapenem-heteroresistant strains on antibiotic treatment was assessed using a mouse model of peritonitis with heteroresistant K. pneumoniae and subsequent treatment with IPM. Results In total, 37 MDR ESBL/AmpC-producing clinical isolates of K. pneumoniae were identified between September 2018 and December 2019. These strains were notably resistant to conventional antimicrobials other than carbapenems. Among the isolates, three strains exhibited heteroresistance to IPM and carried several ESBL and/or AmpC genes. Mice infected with a lethal dose of any of the three heteroresistant isolates were unable to survive in the presence of IPM treatment, as the percentage of the IPM-resistant subpopulation of each strain was increased in the peritoneum of these mice at 24 h after infection. The resistant subpopulation of the strains presented pulsed-field gel electrophoresis (PFGE) profiles that were identical to those of the susceptible subpopulation, but ompK36 porin showed a reduction in gene expression (0.09- to 0.50-fold) in the resistant subpopulation. Conclusion Carbapenem-heteroresistant strains were present among the MDR K. pneumoniae isolates producing ESBL/AmpC β-lactamases, and these heteroresistant strains failed IPM therapy in experimentally infected mice.
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Affiliation(s)
- Yilin Xiong
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
| | - Yuqiao Han
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
| | - Zinan Zhao
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
| | - Wenting Gao
- Institute of Genome Engineered Animal Models for Human Disease, Dalian Medical University, Dalian, People's Republic of China
| | - Yong Ma
- Institute of Genome Engineered Animal Models for Human Disease, Dalian Medical University, Dalian, People's Republic of China
| | - Shiyu Jiang
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
| | - Mengyao Wang
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
| | - Qingqing Zhang
- Laboratory of Pathogenic Biology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
| | - Yun Zhou
- Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Yang Chen
- Department of Biotechnology, College of Basic Medical Sciences, Dalian Medical University, Dalian, People's Republic of China
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The Genotype-to-Phenotype Dilemma: How Should Laboratories Approach Discordant Susceptibility Results? J Clin Microbiol 2021; 59:JCM.00138-20. [PMID: 33441396 DOI: 10.1128/jcm.00138-20] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traditional culture-based methods for identification and antimicrobial susceptibility testing (AST) of bacteria take 2 to 3 days on average. Syndromic molecular diagnostic panels have revolutionized clinical microbiology laboratories as they can simultaneously identify an organism and detect some of the most significant antimicrobial resistance (AMR) genes directly from positive blood culture broth or from various specimen types (e.g., whole blood, cerebrospinal fluid, and respiratory specimens). The presence or absence of an AMR marker associated with a particular organism can be used to predict the phenotypic AST results to more rapidly guide therapy. Numerous studies have shown that genotypic susceptibility predictions by syndromic panels can improve patient outcomes. However, an important limitation of AMR marker detection to predict phenotype is the potential discrepancies that may arise upon performing phenotypic AST of the recovered organism in culture. The focus of this minireview is to address how clinical laboratories should interpret rapid molecular results from commercial platforms in relation to phenotypic AST. Stepwise approaches and solutions are provided to resolve discordant results between genotypic and phenotypic susceptibility results.
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Chen FE, Kaushik A, Hsieh K, Chang E, Chen L, Zhang P, Wang TH. Toward Decentralizing Antibiotic Susceptibility Testing via Ready-to-Use Microwell Array and Resazurin-Aided Colorimetric Readout. Anal Chem 2021; 93:1260-1265. [PMID: 33372757 DOI: 10.1021/acs.analchem.0c04095] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In the face of the global threat from drug-resistant superbugs, there remains an unmet need for simple and accessible diagnostic tools that can perform important antibiotic susceptibility testing against pathogenic bacteria and guide antibiotic treatments outside of centralized clinical laboratories. As a potential solution to this important problem, we report herein the development of a microwell array-based resazurin-aided colorimetric antibiotic susceptibility test (marcAST). At the core of marcAST is a ready-to-use microwell array device that is preassembled with custom titers of various antibiotics and splits bacterial samples upon a simple syringe injection step to initiate AST against all antibiotics. We also employ resazurin, which changes from blue to pink in the presence of growing bacteria, to accelerate and enable colorimetric readout in our AST. Even with its simplicity, marcAST can accurately measure the minimum inhibitory concentrations of reference bacterial strains against common antibiotics and categorize the antibiotic susceptibilities of clinically isolated bacteria. With more characterization and refinement, we envision that marcAST can become a potentially useful tool for performing AST without trained personnel, laborious procedures, or bulky instruments, thereby decentralizing this important test for combating drug-resistant superbugs.
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Affiliation(s)
- Fan-En Chen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Aniruddha Kaushik
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Kuangwen Hsieh
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Emily Chang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Liben Chen
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Pengfei Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Tza-Huei Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States.,Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States.,Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, Maryland 21218, United States
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8
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Wang R, Erickson D. Paper-Based Semi-quantitative Antimicrobial Susceptibility Testing. ACS OMEGA 2021; 6:1410-1414. [PMID: 33490800 PMCID: PMC7818583 DOI: 10.1021/acsomega.0c05060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/18/2020] [Indexed: 05/02/2023]
Abstract
Antimicrobial resistance is increasingly recognized as a major threat to global health. To combat this emerging threat, accessible antimicrobial susceptibility testing should be prioritized as a key component of stewardship efforts. In this work, we developed a user-friendly paper-based test that provides visual readout of bacterial antibiotic susceptibility in a semiquantitative format. We leveraged on-chip paper microfluidics to enable multiplexed testing of multiple antibiotic dilutions with a single sample addition step, replicating the functionality of traditional broth-dilution-based susceptibility testing in a simplified format. Our paper-based test offers several advantages including low sample volume requirement and lack of need for humidity control during incubation, an innovation that addresses a key limitation of conventional paper-microfluidic devices. Using several clinically relevant bacterial organisms and antimicrobial agents, we demonstrate that our colorimetric readout approach provides a strong predictor of susceptibility category.
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Affiliation(s)
- Ruisheng Wang
- Meinig
School of Biomedical Engineering, Cornell
University, Ithaca, New York 14853, United States
| | - David Erickson
- Sibley
School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
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9
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Development, characterization and photobiological activity of nanoemulsion containing zinc phthalocyanine for oral infections treatment. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2020; 211:112010. [PMID: 32890891 DOI: 10.1016/j.jphotobiol.2020.112010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/20/2020] [Accepted: 08/22/2020] [Indexed: 12/15/2022]
Abstract
Nanotechnology, when applied to PDT's, allows the encapsulation of ZnPc in nanocarriers, producing thus nanoemulsions that permit the use of ZnPc as photosensitizers. The Enterococcus faecalis and methicillin-resistant Staphylococcus aureus (MRSA) are microorganisms present in biofilms which can cause resistant endodontic infections. The objective of this work is the development and characterization of clove essential oil nanoemulsions containing ZnPc. The formulations were developed according to factorial experimental planning and characterized by the determination of the mean drop size, Polydispersity Index (PdI), content, organoleptic characteristics, stability, morphology, cytotoxicity in the dark and evaluation of the photobiological activity. The experimental planning was able to indicate the maximum amount of ZnPc that could be encapsulated in the nanoemulsion while maintaining droplet size <50 nm and PdI < 0.2. The surface plots for the response variables indicated a robust region for the combination of Pluronic® F-127 and clove oil factors. The result of this study was the choice of the nanoemulsion containing ZnPc solution at 5%, clove oil at 5%, Pluronic® F-127 at 10% and will be codified as ZnPc-NE. The nanoemulsion presented a mean diameter of 30.52 nm, PDI < 0.2 and a concentration of 17.5 μg/mL, as well as stability at room temperature for 180 days. TEM showed that the drops are spherical with nanometric size, which corroborates the results of dynamic light scattering. Concerning the photobiological activity, the ZnPc-NE exhibited MIC 1.09 μg/mL for Enterococcus faecalis and 0.065 μg/mL for MRSA (Methicillin-resistant Staphylococcus aureus). ZnPc-NE showed higher photobiological activity than free ZnPc. Besides, cytotoxicity studies showed that blank-NE (nanoemulsions without PS) showed good antimicrobial activity. Thus, clove oil nanoemulsion is an excellent nanocarrier to promote the photobiological activity of the ZnPc against pathogenic microorganisms.
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De Angelis G, Posteraro B, Menchinelli G, Liotti FM, Spanu T, Sanguinetti M. Antimicrobial susceptibility testing of pathogens isolated from blood culture: a performance comparison of Accelerate Pheno™ and VITEK® 2 systems with the broth microdilution method. J Antimicrob Chemother 2020; 74:i24-i31. [PMID: 30690539 PMCID: PMC6382034 DOI: 10.1093/jac/dky532] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objectives To compare the performance of the Accelerate Pheno™ system with that of the conventional phenotypic VITEK® 2 system for rapid antimicrobial susceptibility testing (AST) of bacterial pathogens from positive blood culture (PBC) samples, based on the reference broth microdilution (BMD) method. Methods Prospectively collected PBCs that represented patient-unique bloodstream infection episodes were included. For PBC samples showing monomicrobial growth (n = 86), AST was performed using both Accelerate Pheno™ and VITEK® 2 systems directly from PBC broth. Colony isolates derived from subculture of PBC broth were then used for BMD testing. AST results were interpreted according to 2017 EUCAST breakpoints. Results The overall categorical agreement between Accelerate Pheno™ system and BMD was 92.7% (467/504) for Gram-negative organisms and 99.0% (95/96) for Gram-positive organisms, with rates for very major errors of 3.6% (6/166), major errors 2.2% (9/416) and minor errors 3.8% (23/600). The overall categorical agreement between the VITEK® 2 system and BMD was 91.7% (463/505) for Gram-negative organisms and 99.0% (97/98) for Gram-positive organisms, with rates of very major errors of 2.4% (4/169), major errors 1.0% (4/416) and minor errors 5.8% (35/603). Importantly, unlike the VITEK® 2 system, no false-susceptible results occurred with two colistin-resistant organism-growing PBCs tested using the Accelerate Pheno™ system. Conclusions Based on these findings, the Accelerate Pheno™ system can be a valid alternative for the rapid AST of Gram-negative and Gram-positive bacteria in bloodstream infections.
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Affiliation(s)
- Giulia De Angelis
- Istituto di Microbiologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Posteraro
- Istituto di Patologia Speciale Medica e Semeiotica Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Menchinelli
- Istituto di Microbiologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flora Marzia Liotti
- Istituto di Microbiologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa Spanu
- Istituto di Microbiologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Istituto di Microbiologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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A fidget spinner for the point-of-care diagnosis of urinary tract infection. Nat Biomed Eng 2020; 4:591-600. [DOI: 10.1038/s41551-020-0557-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/14/2020] [Indexed: 12/20/2022]
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12
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Miljković N, Godman B, van Overbeeke E, Kovačević M, Tsiakitzis K, Apatsidou A, Nikopoulou A, Yubero CG, Portillo Horcajada L, Stemer G, Kuruc-Poje D, De Rijdt T, Bochenek T, Huys I, Miljković B. Risks in Antibiotic Substitution Following Medicine Shortage: A Health-Care Failure Mode and Effect Analysis of Six European Hospitals. Front Med (Lausanne) 2020; 7:157. [PMID: 32478082 PMCID: PMC7235345 DOI: 10.3389/fmed.2020.00157] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction: Medicine shortages result in great risk for the continuity of patient care especially for antimicrobial treatment, potentially enhancing resistance rates and having a higher economic impact. This study aims to identify, describe, assess, and assign risk priority levels to potential failures following substitution of antimicrobial treatment due to shortages among European hospitals. Furthermore, the study investigated the impact of corrective actions on risk reduction so as to provide guidance and improve future patient care. Methods: Health-care failure mode and effect analysis (HFMEA) was applied to hospitals in Austria (H-AT), Belgium (H-BE), Croatia (H-CR), Greece (H-GR), Spain (H-SP), and Serbia (H-SR). Multidisciplinary teams identified processes, failure modes, causes, and corrective actions related to antibiotic substitution following medicine shortages. Characteristics of study hospitals as well as severity, probability, and hazard scores (HSs) of failure modes/causes were analyzed using Microsoft Office Excel 2010 and IBM SPSS Statistics® via descriptive and inferential statistics. Results: Through HFMEA, 74 failure modes were identified, with 53 of these scoring 8 or above on the basis of assigned severity and probability for a failure. Severity of failure modes differed before and after corrective actions in H-CR, H-GR, and H-SR (p < 0.005). Their probability differed in all study hospitals (p < 0.005) when compared before and after corrective actions aimed to be implemented. The highest number of failure-mode causes was detected in H-CR (46) and the lowest in H-SP (16). Corrective actions can address failure modes and lower HSs; therein, all teams proposed the following: structuring communication among stakeholders, introducing electronic prescribing, strengthening pharmacists' involvement, and increasing effectiveness of the ward stock assessment. These proposed actions led to HS reductions up to 83%. Conclusion: There is a lack of structure in addressing risks associated with antibiotic substitution following shortages. Furthermore, lack of communication, data scarcity on availability of antibiotics, non-supportive information technology (IT) systems, and lack of internal substitution protocols hinder quick assessment of alternatives addressing patient needs. Nevertheless, the study shows that health-care professionals manage to secure optimal antimicrobial treatment for patients using available IT and human resources.
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Affiliation(s)
- Nenad Miljković
- Institute for Orthopaedic Surgery "Banjica", University of Belgrade, Belgrade, Serbia
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom.,Department of Public Health and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Milena Kovačević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Karyofyllis Tsiakitzis
- General Hospital of Thessaloniki "G. Papanikolaou", Hospital Pharmacy Department, Thessaloniki, Greece
| | - Athina Apatsidou
- General Hospital of Thessaloniki "G. Papanikolaou", Hospital Pharmacy Department, Thessaloniki, Greece
| | - Anna Nikopoulou
- General Hospital of Thessaloniki "G. Papanikolaou", Hospital Pharmacy Department, Thessaloniki, Greece
| | | | | | - Gunar Stemer
- Gunar Stemer, Medicines Information and Clinical Pharmacy Services, Vienna General Hospital, Vienna, Austria
| | - Darija Kuruc-Poje
- General Hospital "Dr. Tomislav Bardek", Hospital Pharmacy Department, Koprivnica, Croatia
| | - Thomas De Rijdt
- Pharmacy Department, University Hospitals Leuven, UZ Herestraat, Leuven, Belgium
| | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade, Belgrade, Serbia
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13
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Richter A, Feßler AT, Böttner A, Köper LM, Wallmann J, Schwarz S. Reasons for antimicrobial treatment failures and predictive value of in-vitro susceptibility testing in veterinary practice: An overview. Vet Microbiol 2020; 245:108694. [PMID: 32456814 DOI: 10.1016/j.vetmic.2020.108694] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/19/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
The choice of the most suitable antimicrobial agent for the treatment of an animal suffering from a bacterial infection is a complex issue. The results of bacteriological diagnostics and the in-vitro antimicrobial susceptibility testing (AST) provide guidance of potentially suitable antimicrobials. However, harmonized AST methods, veterinary-specific interpretive criteria and quality control ranges, which are essential to conduct AST in-vitro and to evaluate the corresponding results lege artis, are not available for all antimicrobial compounds, bacterial pathogens, animal species and sites of infection of veterinary relevance. Moreover, the clinical benefit of an antimicrobial agent (defined as its in vivo efficacy) is not exclusively dependent on the in-vitro susceptibility of the target pathogen. Apart from the right choice of an antibacterial drug with suitable pharmacokinetic properties and an appropriate pharmaceutical formulation, the success of treatment depends substantially on its adequate use. Even if this is ensured and in-vitro susceptibility confirmed, an insufficient improvement of clinical signs might be caused by biofilm-forming bacteria, persisters, or specific physicochemical conditions at the site of infection, such as pH value, oxygen partial pressure and perfusion rate. This review summarizes relevant aspects that have an impact on the predictive value of in-vitro AST and points out factors, potentially leading to an ineffective outcome of antibacterial treatment in veterinary practice. Knowing the reasons of inadequate beneficial effects can help to understand possible discrepancies between in-vitro susceptibility and in vivo efficacy and aid in undertaking strategies for an avoidance of treatment failures.
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Affiliation(s)
- Angelika Richter
- Institute of Pharmacology, Pharmacy and Toxicology, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany.
| | - Andrea T Feßler
- Institute of Microbiology and Epizootics, Centre of Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
| | | | | | - Jürgen Wallmann
- Federal Office of Consumer Protection and Food Safety, Berlin, Germany
| | - Stefan Schwarz
- Institute of Microbiology and Epizootics, Centre of Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, Berlin, Germany
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14
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Li M, Zhang C, Chen G, Nahar L, Sarker SD, Guo M. Headspace gas chromatographic method for antimicrobial screening: Minimum inhibitory concentration determination. J Pharm Biomed Anal 2020; 181:113122. [PMID: 31991320 DOI: 10.1016/j.jpba.2020.113122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022]
Abstract
The headspace gas chromatographic method has been widely used to detect volatile metabolites to reflect the growth state of microorganisms, however, it has never been used for the determination of the minimum inhibitory concentration in antibacterial drugs. This paper reports a new method for evaluating the antimicrobial activity of drugs by measuring the amount of CO2 produced by bacterial metabolism after treatment with drugs. According to the amount of CO2 produced by bacterial metabolism, a proper amount of bacterial liquid is selected and added to a drug-containing culture medium as compared with bacteria without drugs in parallel. The amount of CO2 produced by bacteria is measured by using a headspace gas chromatograph coupled with a thermal conductivity detector to measure the bacteriostasis rate and the minimum bacteriostasis concentration of the tested drug, so as to evaluate its antibacterial activity. The accuracy of this method was verified by comparison with the standard method (the OD method), which indicated that the precision was less than 3 % (expressed by relative standard deviation), the inhibition rate (R2 = 0.968) was consistent with the reference method above. This method is simple in operation and can avoid the error caused by the properties of the sample such as volatility, solubility and color in the determination of the minimum inhibitory concentration. It is suitable for the determination of antibacterial activity of drugs, especially natural drugs.
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Affiliation(s)
- Menghui Li
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, 430074, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Chunyun Zhang
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, 430074, China; Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan, 430074, China; Innovation Academy for Drug Discovery and Development, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Guilin Chen
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, 430074, China; Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan, 430074, China; Innovation Academy for Drug Discovery and Development, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Lutfun Nahar
- Laboratory of Growth Regulators, Institute of Experimental Botany ASCR & Palacký University, Šlechtitelů 27, 78371, Olomouc, Czech Republic
| | - Satyajit D Sarker
- Centre for Natural Products Discovery, School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, James Parsons Building, Byrom Street, Liverpool, L3 3AF, United Kingdom
| | - Mingquan Guo
- CAS Key Laboratory of Plant Germplasm Enhancement and Specialty Agriculture, Wuhan Botanical Garden, Chinese Academy of Sciences, Wuhan, 430074, China; Sino-Africa Joint Research Center, Chinese Academy of Sciences, Wuhan, 430074, China; Innovation Academy for Drug Discovery and Development, Chinese Academy of Sciences, Shanghai, 201203, China.
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15
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Wang R, Vemulapati S, Westblade LF, Glesby MJ, Mehta S, Erickson D. cAST: Capillary-Based Platform for Real-Time Phenotypic Antimicrobial Susceptibility Testing. Anal Chem 2020; 92:2731-2738. [PMID: 31944675 DOI: 10.1021/acs.analchem.9b04991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antimicrobial resistance is recognized as one of the greatest emerging threats to public health. Antimicrobial resistant (AMR) microorganisms affect nearly 2 million people a year in the United States alone and place an estimated $20 billion burden on the healthcare system. The rise of AMR microorganisms can be attributed to a combination of overprescription of antimicrobials and a lack of accessible diagnostic methods. Delayed diagnosis is one of the primary reasons for empiric therapy, and diagnostic methods that enable rapid and accurate results are highly desirable to facilitate evidence-based treatment. This is particularly true for clinical situations at the point-of-care where access to state-of-the-art diagnostic equipment is scarce. Here, we present a capillary-based antimicrobial susceptibility testing platform (cAST), a unique approach that offers accelerated assessment of antimicrobial susceptibility in a low-cost and simple testing format. cAST delivers an expedited time-to-readout by means of optical assessment of bacteria incubated in a small capillary form factor along with a resazurin dye. cAST was designed using a combination of off-the-shelf and custom 3D-printed parts, making it extremely suitable for use in resource-limited settings. We demonstrate that growth of bacteria in cAST is approximately 25% faster than in a conventional microplate, further validate the diagnostic performance with clinical isolates, and show that cAST can deliver accurate antimicrobial susceptibility test results within 4-8 h.
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Affiliation(s)
- Ruisheng Wang
- Meinig School of Biomedical Engineering , Cornell University , Ithaca , New York 14853 , United States
| | - Sasank Vemulapati
- Sibley School of Mechanical and Aerospace Engineering , Cornell University , Ithaca , New York 14853 , United States
| | - Lars F Westblade
- Department of Pathology and Laboratory Medicine , Weill Cornell Medicine , New York , New York 10065 , United States.,Division of Infectious Diseases, Department of Medicine , Weill Cornell Medicine , New York , New York 10065 , United States
| | - Marshall J Glesby
- Division of Infectious Diseases, Department of Medicine , Weill Cornell Medicine , New York , New York 10065 , United States
| | - Saurabh Mehta
- Division of Nutritional Sciences , Cornell University , Ithaca , New York 14853 , United States
| | - David Erickson
- Meinig School of Biomedical Engineering , Cornell University , Ithaca , New York 14853 , United States.,Division of Nutritional Sciences , Cornell University , Ithaca , New York 14853 , United States
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16
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Potier JFN, Durham AE. Antimicrobial susceptibility of bacterial isolates from ambulatory practice and from a referral hospital. J Vet Intern Med 2020; 34:300-306. [PMID: 31849110 PMCID: PMC6979268 DOI: 10.1111/jvim.15685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Responsible use of antimicrobials in equine practice relies on knowledge of common bacterial isolates and their antimicrobial sensitivities. OBJECTIVES To assess the frequency of bacterial resistance to a combination of parenteral penicillin and gentamicin and to trimethoprim and sulfamethoxazole for PO use in a selection of clinical isolates, and subsequently to determine the prevalence of resistance to antimicrobials that might then be used as alternatives to first-line antimicrobials for the same isolates. METHODS Retrospective analysis of minimal inhibitory concentrations (MICs) of antimicrobials for 6354 bacterial isolates from 365 ambulatory practices and 519 isolates from a referral hospital. The MICs were used to indicate sensitivity or resistance to commonly used antimicrobials and the prevalences of resistance were compared between origin of the isolates, and among antimicrobial drugs. RESULTS Isolates from the referral hospital were significantly (P < .05) more likely to be resistant to the antimicrobials tested than those derived from ambulatory practice. Overall, 91% of the ambulatory isolates and 64% of the hospital isolates were sensitive to penicillin-gentamicin. For trimethoprim-sulfamethoxazole combination, 82% of the ambulatory practice isolates and 56% of the referral hospital isolates were sensitive. CONCLUSIONS AND CLINICAL IMPORTANCE Most isolates were sensitive to penicillin and gentamicin as well as trimethoprim-sulfamethoxazole. No predictable efficacious second choice antimicrobial was identified for those isolates resistant to the first-line antimicrobials. The likelihood of isolates being sensitive to second choice antimicrobials was variable but generally higher for ambulatory isolates compared to referral isolates. Bacterial identification and measurement of MIC are essential to make the appropriate antimicrobial choice.
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17
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Mo M, Yang Y, Zhang F, Jing W, Iriya R, Popovich J, Wang S, Grys T, Haydel SE, Tao N. Rapid Antimicrobial Susceptibility Testing of Patient Urine Samples Using Large Volume Free-Solution Light Scattering Microscopy. Anal Chem 2019; 91:10164-10171. [PMID: 31251566 PMCID: PMC7003966 DOI: 10.1021/acs.analchem.9b02174] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The emergence of antibiotic resistance has prompted the development of rapid antimicrobial susceptibility testing (AST) technologies that will enable evidence-based treatment and promote antimicrobial stewardship. To date, many rapid AST methods have been developed, but few are able to be performed on clinical samples directly. Here we developed a large volume light scattering microscopy technique that tracks phenotypic features of single bacterial cells directly in clinical urine samples without sample enrichment or culturing. The technique demonstrated rapid (90 min) detection of Escherichia coli in 24 clinical urine samples with 100% sensitivity and 83% specificity and rapid (90 min) AST in 12 urine samples with 87.5% categorical agreement with two antibiotics, ampicillin and ciprofloxacin.
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Affiliation(s)
- Manni Mo
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
- School of Molecular Sciences, Arizona State University, Tempe, Arizona 85287, United States
| | - Yunze Yang
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
| | - Fenni Zhang
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
| | - Wenwen Jing
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
| | - Rafael Iriya
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona 85287, United States
| | - John Popovich
- Biodesign Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, Arizona 85287, United States
| | - Shaopeng Wang
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
| | - Thomas Grys
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona 85054, United States
| | - Shelley E. Haydel
- Biodesign Center for Immunotherapy, Vaccines and Virotherapy, Arizona State University, Tempe, Arizona 85287, United States
- School of Life Sciences, Arizona State University, Tempe, Arizona 85287, United States
| | - Nongjian Tao
- Biodesign Center for Biosensors and Bioelectronics, Arizona State University, Tempe, Arizona 85287, United States
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, Arizona 85287, United States
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18
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Lipworth S, Hough N, Buchanan R, Smith EG, Robinson E, Alexander E, Peto T, Crook D, Walker T. Improved Performance Predicting Clarithromycin Resistance in Mycobacterium abscessus on an Independent Data Set. Antimicrob Agents Chemother 2019; 63:e00400-19. [PMID: 31160290 PMCID: PMC6658746 DOI: 10.1128/aac.00400-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Samuel Lipworth
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Natasha Hough
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ruaridh Buchanan
- National Mycobacterium Reference Service-South, London, United Kingdom
| | - E Grace Smith
- Public Health England Regional Mycobacterial Reference Laboratory, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Esther Robinson
- Public Health England Regional Mycobacterial Reference Laboratory, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Eliza Alexander
- National Mycobacterium Reference Service-South, London, United Kingdom
| | - Tim Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Derrick Crook
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England, Oxford, United Kingdom
| | - Timothy Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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19
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Affiliation(s)
- Victor I. Band
- Emory Antibiotic Resistance Center, Emory University, Atlanta, Georgia, United States of America
- Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
| | - David S. Weiss
- Emory Antibiotic Resistance Center, Emory University, Atlanta, Georgia, United States of America
- Emory Vaccine Center, Emory University, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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20
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Veiga A, Toledo MDGT, Rossa LS, Mengarda M, Stofella NCF, Oliveira LJ, Gonçalves AG, Murakami FS. Colorimetric microdilution assay: Validation of a standard method for determination of MIC, IC 50%, and IC 90% of antimicrobial compounds. J Microbiol Methods 2019; 162:50-61. [PMID: 31078627 DOI: 10.1016/j.mimet.2019.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
Abstract
The emergence of multiresistant bacteria directly impacts on the search for new compounds with antimicrobial activity, and it is important the improvement of new techniques are able to determine the minimum inhibitory concentration (MIC) of antimicrobial compounds. The microdilution technique is widely used for saving culture media, reagents and compounds to be tested. However, the literature does not describe a colorimetric method capable of correlating absorbance with concentration of viable microorganisms (CFU mL-1). Therefore, the novelty of this work was the standardization and validation of a colorimetric and quantitative method capable of determining the MIC of several compounds with antimicrobial activity and the conversion of absorbance values to CFU mL-1. The conditions carried out for the method were: the use of 0.125% (w/v) 2,3,5-triphenyltetrazolium chloride (TTC) solution added after 22 h of incubation at 35 °C, followed by 2 more hours of incubation and subsequent reading in a spectrophotometer. The tested microorganisms were: Staphylococcus aureus (ATCC 6538), Escherichia coli (ATCC 8739), Pseudomonas aeruginosa (ATCC 9027) and Candida albicans (ATCC 10231). The method was validated and showed linearity (R2 > 0.95), precision (RSD <26%), accuracy (75% to 122%) and robustness (p > 0.05). The validated parameters ensured the harmonization of methodology to determine not only MIC as well as inhibitory concentrations of 50% (IC50%) and 90% (IC90%) of the antimicrobial compounds.
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Affiliation(s)
- Andressa Veiga
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Maria da Graça T Toledo
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Luciane S Rossa
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Mariana Mengarda
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Nayana C F Stofella
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Laiane J Oliveira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Alan G Gonçalves
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil
| | - Fábio S Murakami
- Universidade Federal do Paraná, Programa de Pós-Graduação em Ciências Farmacêuticas, Av. Pref. Lothário Meissner, 632 - Jardim Botânico, 80210-170 Curitiba, PR, Brazil.
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21
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Kang KN, Klein DR, Kazi MI, Guérin F, Cattoir V, Brodbelt JS, Boll JM. Colistin heteroresistance in Enterobacter cloacae is regulated by PhoPQ-dependent 4-amino-4-deoxy-l-arabinose addition to lipid A. Mol Microbiol 2019; 111:1604-1616. [PMID: 30873646 DOI: 10.1111/mmi.14240] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2019] [Indexed: 01/01/2023]
Abstract
The Enterobacter cloacae complex (ECC) consists of closely related bacteria commonly associated with the human microbiota. ECC are increasingly isolated from healthcare-associated infections, demonstrating that these Enterobacteriaceae are emerging nosocomial pathogens. ECC can rapidly acquire multidrug resistance to conventional antibiotics. Cationic antimicrobial peptides (CAMPs) have served as therapeutic alternatives because they target the highly conserved lipid A component of the Gram-negative outer membrane. Many Enterobacteriaceae fortify their outer membrane with cationic amine-containing moieties to prevent CAMP binding, which can lead to cell lysis. The PmrAB two-component system (TCS) directly activates 4-amino-4-deoxy-l-arabinose (l-Ara4N) biosynthesis to result in cationic amine moiety addition to lipid A in many Enterobacteriaceae such as E. coli and Salmonella. In contrast, PmrAB is dispensable for CAMP resistance in E. cloacae. Interestingly, some ECC clusters exhibit colistin heteroresistance, where a subpopulation of cells exhibit clinically significant resistance levels compared to the majority population. We demonstrate that E. cloacae lipid A is modified with l-Ara4N to induce CAMP heteroresistance and the regulatory mechanism is independent of the PmrABEcl TCS. Instead, PhoPEcl binds to the arnBEcl promoter to induce l-Ara4N biosynthesis and PmrAB-independent addition to the lipid A disaccharolipid. Therefore, PhoPQEcl contributes to regulation of CAMP heteroresistance in some ECC clusters.
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Affiliation(s)
- Katie N Kang
- Department of Biology, University of Texas at Arlington, Arlington, TX, USA
| | - Dustin R Klein
- Department of Chemistry, University of Texas at Austin, Austin, TX, USA
| | - Misha I Kazi
- Department of Biology, University of Texas at Arlington, Arlington, TX, USA
| | - François Guérin
- Department of Clinical Microbiology, Caen University Hospital, EA4655, University of Caen Normandie, Caen, France
| | - Vincent Cattoir
- Department of Clinical Microbiology and National Reference Center for Antimicrobial Resistance (Lab Enterococci), Rennes University Hospital Inserm Unit U1230, University of Rennes 1, Rennes, France
| | | | - Joseph M Boll
- Department of Biology, University of Texas at Arlington, Arlington, TX, USA
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22
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Pereckaite L, Tatarunas V, Giedraitiene A. Current antimicrobial susceptibility testing for beta-lactamase-producing Enterobacteriaceae in clinical settings. J Microbiol Methods 2018; 152:154-164. [PMID: 30063958 DOI: 10.1016/j.mimet.2018.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 11/17/2022]
Abstract
The worldwide prevalence of beta-lactamase-producing Enterobacteriaceae (BL-E) is increasing. Bacterial infections involving ESBLs can be more difficult to treat because of antibiotic resistance, as there are fewer effective antibiotics left to be used. Moreover, treatment failure is often observed. Thus, quick and accurate identification of β-lactamases is imperative to minimize it. This review article describes most commonly used phenotypic techniques and molecular methods for the detection of ESBLs, acquired AmpC β-lactamases, and carbapenemases produced by Enterobacteriaceae. Phenotypic detection tests remain useful and relevant in clinical laboratories while molecular diagnostic methods are less affordable, more technically demanding, and not standardized. Molecular methods could be used to speed up results of bacterial antibiotic resistance or to clarify the results of phenotypic β-lactamases confirmation tests.
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Affiliation(s)
- Laura Pereckaite
- Department of Laboratory Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vacis Tatarunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agne Giedraitiene
- Institute of Microbiology and Virology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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23
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Chastain DB, King ST, Stover KR. Rethinking urinary antibiotic breakpoints: analysis of urinary antibiotic concentrations to treat multidrug resistant organisms. BMC Res Notes 2018; 11:497. [PMID: 30029611 PMCID: PMC6053836 DOI: 10.1186/s13104-018-3599-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/12/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The present study analyzed whether renally eliminated antibiotics achieve sufficient urinary concentrations based on their pharmacokinetic/pharmacodynamic principles to effectively eradicate organisms deemed resistant by automated susceptibility testing. RESULTS Lower median minimum inhibitory concentrations against enterobacteriaceae were noted for ceftriaxone, cefepime, and doripenem when comparing Etest® to Vitek®. All Pseudomonas aeruginosa isolates were susceptible to cefepime, ciprofloxacin, and doripenem with both susceptibility methods, but higher median minimum inhibitory concentrations were observed with Etest®. Urine concentrations/time profiles were calculated for standard doses of ceftriaxone, cefepime, doripenem, and ciprofloxacin. The data presented in the current study suggests high urine concentrations of antibiotics may effectively eradicate bacteria which were determined to be resistant per in vitro susceptibility testing.
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Affiliation(s)
- Daniel B Chastain
- University of Georgia College of Pharmacy, 1000 Jefferson Street, Albany, GA, 31701, USA.
| | - S Travis King
- Ochsner Medical Center-New Orleans, New Orleans, LA, 70121, USA
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, MS, 39216, USA.,Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, 39216, USA
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24
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Bard JD, Lee F. Why Can't We Just Use PCR? The Role of Genotypic versus Phenotypic Testing for Antimicrobial Resistance Testing. ACTA ACUST UNITED AC 2018; 40:87-95. [PMID: 32287688 PMCID: PMC7132721 DOI: 10.1016/j.clinmicnews.2018.05.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is a need for phenotypic susceptibility testing that is expeditious and that can be performed directly from clinical specimens. While rapid pathogen identification is important, it is the susceptibility result that is essential for antimicrobial optimization. The options for rapid susceptibility testing are limited, with the majority of commercial tests available offering genotypic resistance detection only. In this article, a laboratorian and a clinician discuss the benefits and limitations of genotypic and phenotypic susceptibility testing and provide examples of how results should be interpreted to maximize the clinical utility.
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Affiliation(s)
- Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Francesca Lee
- Division of Infectious Diseases and Department of Pathology, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
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25
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Huh HJ, Song DJ, Shim HJ, Kwon WK, Park MS, Ryu MR, Cho EH, Oh J, Yoo IY, Lee NY. Performance evaluation of the QMAC-dRAST for staphylococci and enterococci isolated from blood culture: a comparative study of performance with the VITEK-2 system. J Antimicrob Chemother 2018; 73:1267-1271. [DOI: 10.1093/jac/dky015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/03/2018] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong Joon Song
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyang Jin Shim
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Won Kyung Kwon
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Seung Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Ra Ryu
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Hye Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jongwon Oh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - In Young Yoo
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Johnsen BO, Handal N, Meisal R, Bjørnholt JV, Gaustad P, Leegaard TM. erm gene distribution among Norwegian Bacteroides isolates and evaluation of phenotypic tests to detect inducible clindamycin resistance in Bacteroides species. Anaerobe 2017; 47:226-232. [DOI: 10.1016/j.anaerobe.2017.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/12/2017] [Accepted: 06/07/2017] [Indexed: 11/16/2022]
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Rapid phenotypic antimicrobial susceptibility testing using nanoliter arrays. Proc Natl Acad Sci U S A 2017; 114:E5787-E5795. [PMID: 28652348 DOI: 10.1073/pnas.1703736114] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Antibiotic resistance is a major global health concern that requires action across all sectors of society. In particular, to allow conservative and effective use of antibiotics clinical settings require better diagnostic tools that provide rapid determination of antimicrobial susceptibility. We present a method for rapid and scalable antimicrobial susceptibility testing using stationary nanoliter droplet arrays that is capable of delivering results in approximately half the time of conventional methods, allowing its results to be used the same working day. In addition, we present an algorithm for automated data analysis and a multiplexing system promoting practicality and translatability for clinical settings. We test the efficacy of our approach on numerous clinical isolates and demonstrate a 2-d reduction in diagnostic time when testing bacteria isolated directly from urine samples.
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Hong SK, Choi SJ, Shin S, Lee W, Pinto N, Shin N, Lee K, Hong SG, Kim YA, Lee H, Kim H, Song W, Lee SH, Yong D, Lee K, Chong Y. Establishing quality control ranges for antimicrobial susceptibility testing of Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus: a cornerstone to develop reference strains for Korean clinical microbiology laboratories. Ann Lab Med 2016; 35:635-8. [PMID: 26354353 PMCID: PMC4579109 DOI: 10.3343/alm.2015.35.6.635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/06/2015] [Accepted: 08/20/2015] [Indexed: 11/19/2022] Open
Abstract
Quality control (QC) processes are being performed in the majority of clinical microbiology laboratories to ensure the performance of microbial identification and antimicrobial susceptibility testing by using ATCC strains. To obtain these ATCC strains, some inconveniences are encountered concerning the purchase cost of the strains and the shipping time required. This study was focused on constructing a database of reference strains for QC processes using domestic bacterial strains, concentrating primarily on antimicrobial susceptibility testing. Three strains (Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus) that showed legible results in preliminary testing were selected. The minimal inhibitory concentrations (MICs) and zone diameters (ZDs) of eight antimicrobials for each strain were determined according to the CLSI M23. All resulting MIC and ZD ranges included at least 95% of the data. The ZD QC ranges obtained by using the CLSI method were less than 12 mm, and the MIC QC ranges extended no more than five dilutions. This study is a preliminary attempt to construct a bank of Korean QC strains. With further studies, a positive outcome toward cost and time reduction can be anticipated.
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Affiliation(s)
- Sung Kuk Hong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Jun Choi
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Saeam Shin
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Wonmok Lee
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Naina Pinto
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Nari Shin
- Division of High-risk Pathogen Research, Korea Center for Disease Control and Prevention, Osong, Korea
| | - Kwangjun Lee
- Division of High-risk Pathogen Research, Korea Center for Disease Control and Prevention, Osong, Korea
| | - Seong Geun Hong
- Department of Laboratory Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea
| | - Heejung Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | | | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Yunsop Chong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
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Antibiotic failure mediated by a resistant subpopulation in Enterobacter cloacae. Nat Microbiol 2016; 1:16053. [PMID: 27572838 DOI: 10.1038/nmicrobiol.2016.53] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/22/2016] [Indexed: 12/28/2022]
Abstract
Antibiotic resistance is a major public health threat, further complicated by unexplained treatment failures caused by bacteria that appear antibiotic susceptible. We describe an Enterobacter cloacae isolate harbouring a minor subpopulation that is highly resistant to the last-line antibiotic colistin. This subpopulation was distinct from persisters, became predominant in colistin, returned to baseline after colistin removal and was dependent on the histidine kinase PhoQ. During murine infection, but in the absence of colistin, innate immune defences led to an increased frequency of the resistant subpopulation, leading to inefficacy of subsequent colistin therapy. An isolate with a lower-frequency colistin-resistant subpopulation similarly caused treatment failure but was misclassified as susceptible by current diagnostics once cultured outside the host. These data demonstrate the ability of low-frequency bacterial subpopulations to contribute to clinically relevant antibiotic resistance, elucidating an enigmatic cause of antibiotic treatment failure and highlighting the critical need for more sensitive diagnostics.
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Lalitha P, Manoharan G, Karpagam R, Prajna NV, Srinivasan M, Mascarenhas J, Das M, Porco TC, Lietman TM, Cevallos V, Keenan JD. Trends in antibiotic resistance in bacterial keratitis isolates from South India. Br J Ophthalmol 2016; 101:108-113. [PMID: 27130916 DOI: 10.1136/bjophthalmol-2016-308487] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/03/2022]
Abstract
AIMS To report trends in antibiotic resistance in cases of bacterial keratitis from a large eye hospital in South India. METHODS In this retrospective cross-sectional study, the microbiology laboratory records of patients with infectious keratitis diagnosed at an eye hospital in South India from 2002 to 2013 were reviewed to determine the proportion with antibiotic non-susceptibility. RESULTS 3685 bacterial isolates had susceptibility testing performed over the 12-year period. The two most common organisms with resistance were Streptococcus pneumoniae (n=1204) and Pseudomonas aeruginosa (n=894). Antibiotic non-susceptibility was generally uncommon for these two organisms and no significant trends were detected over the course of the study. In contrast, Staphylococcus aureus (N=211) isolates demonstrated a significant increase in fluoroquinolone non-susceptibility over the 12-year study period. This coincided with a significant increase in methicillin-resistant S. aureus (MRSA) during the study period, though the increase in fluoroquinolone resistance was likewise seen in methicillin-sensitive S. aureus (MSSA). For example, ofloxacin resistance in MSSA increased from 11.1% in 2002 to 66.7% in 2013 (p=0.002). No trends were apparent for the aminoglycosides, cefazolin or vancomycin, for which in vitro non-susceptibility generally appeared to be low. CONCLUSION Resistance to antibiotics was generally stable for infectious keratitis isolates from a large eye hospital in South India, except for S. aureus, which experienced a significant increase in fluoroquinolone resistance from 2002 to 2013. Fluoroquinolone antibiotics currently have poor in vitro activity against both MRSA and MSSA in South India and are therefore not the ideal therapy for Staphylococcal corneal ulcers.
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Affiliation(s)
- Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Geetha Manoharan
- Department of Ocular Microbiology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Rajaram Karpagam
- Department of Ocular Microbiology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Namperumalsamy V Prajna
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Muthiah Srinivasan
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Jeena Mascarenhas
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Manoranjan Das
- Department of Cornea and External Diseases, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA.,Department of Ophthalmology, University of California, San Francisco, California, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA.,Department of Ophthalmology, University of California, San Francisco, California, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Vicky Cevallos
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA.,Department of Ophthalmology, University of California, San Francisco, California, USA
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Wiener ES, Heil EL, Hynicka LM, Johnson JK. Are Fluoroquinolones Appropriate for the Treatment of Extended-Spectrum β-Lactamase-Producing Gram-Negative Bacilli? J Pharm Technol 2015; 32:16-21. [DOI: 10.1177/8755122515599407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To review the data analyzing the role of fluoroquinolones in the treatment of extended-spectrum β-lactamase (ESBL)-producing infections and rates and methods of co-transmission of resistance. Data Sources: A MEDLINE literature search was performed using the search terms extended-spectrum beta-lactamase, fluoroquinolone, ciprofloxacin, levofloxacin, plasmid transmission, and resistance from 1996 to June 2015. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: All English-language retrospective studies, prospective studies, and meta-analyses assessing efficacy of fluoroquinolone use in ESBL infections, assessing methods of resistance transmission, or analyzing patient risk factors were reviewed. Data Synthesis: A total of 18 studies that analyzed fluoroquinolone resistance and association to ESBL producing bacteria from either molecular or clinical perspectives were idenitifed. Four studies evaluated the genetic association between ESBL transmission and fluoroquinolone resistance. Plasmid mediated quinolone resistance was found in higher rates in ESBL-producing bacteria. Numerous studies analyzed the risk factors of co-occurring resistance identifying nosocomial acquired infections, recent hospitalization, long-term care facility residence, and intensive care unit stay as the most common. Conclusive clinical data are lacking; however, a meta-analysis showed fluoroquinolones had higher odds of all-cause mortality when used empirically to treat ESBL bacteremia compared with carbapenems. Conclusions: Fluoroquinolone resistance may be co-transmitted in ESBL-producing Enterobacteriaceae. There are limited data on the efficacy for fluoroquinolones in the treatment of ESBL-producing infections. Additional prospective trials are needed to definitively determine the role of fluoroquinolones in ESBL infections.
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Affiliation(s)
| | - Emily L. Heil
- University of Maryland Medical Center, Baltimore, MD, USA
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Sardana K, Gupta T, Garg VK, Ghunawat S. Antibiotic resistance toPropionobacterium acnes: worldwide scenario, diagnosis and management. Expert Rev Anti Infect Ther 2015; 13:883-96. [DOI: 10.1586/14787210.2015.1040765] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Lubbers BV, Turnidge J. Antimicrobial susceptibility testing for bovine respiratory disease: Getting more from diagnostic results. Vet J 2015; 203:149-54. [DOI: 10.1016/j.tvjl.2014.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/25/2014] [Accepted: 12/09/2014] [Indexed: 12/23/2022]
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Griffith MM, Patel JA, Sutton SH, Bolon MK, Esterly JS, Gross AE, Postelnick MJ, Zembower TR, Scheetz MH. Prospective Approach to Managing Antimicrobial Drug Shortages. Infect Control Hosp Epidemiol 2015; 33:745-52. [DOI: 10.1086/666332] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Antimicrobial drug shortages continue to increase, with few new therapeutic options available. Nationally, proposals have been offered to alleviate drug shortages; however, these recommendations are unlikely to effect change in the near future. Thus, antimicrobial stewardship leaders in acute care hospitals must develop a prospective management strategy to lessen the impact of these shortages on patient care. Herein, we describe several resources available to aid professionals in antimicrobial stewardship and healthcare epidemiology to manage drug shortages. An effective approach should include prospectively tracking shortages and maximizing inventory by appropriately managing usage. Several tenets should underpin this management. Alternative agents should be rationally chosen before the inventory of the primary agent has reached zero, ethical considerations should be taken into account, and timely notification and communication with key stakeholders should occur throughout the prescribing and dispensing process.
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Falcione BA, Meyer SM. Development of an antimicrobial stewardship-based infectious diseases elective that incorporates human patient simulation technology. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2014; 78:151. [PMID: 25386016 PMCID: PMC4226288 DOI: 10.5688/ajpe788151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/01/2014] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To design an elective for pharmacy students that facilitates antimicrobial stewardship awareness, knowledge, and skill development by solving clinical cases, using human patient simulation technology. DESIGN The elective was designed for PharmD students to describe principles and functions of stewardship programs, select, evaluate, refine, or redesign patient-specific plans for infectious diseases in the context of antimicrobial stewardship, and propose criteria and stewardship management strategies for an antimicrobial class at a health care institution. Teaching methods included active learning and lectures. Cases of bacterial endocarditis and cryptococcal meningitis were developed that incorporated human patient simulation technology. ASSESSMENT Forty-five pharmacy students completed an antimicrobial stewardship elective between 2010 and 2013. Outcomes were assessed using student perceptions of and performance on rubric-graded assignments. CONCLUSION A PharmD elective using active learning, including novel cases conducted with human patient simulation technology, enabled outcomes consistent with those desired of pharmacists assisting in antimicrobial stewardship programs.
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Affiliation(s)
- Bonnie A Falcione
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Susan M Meyer
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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36
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Köser CU, Ellington MJ, Peacock SJ. Whole-genome sequencing to control antimicrobial resistance. Trends Genet 2014; 30:401-7. [PMID: 25096945 PMCID: PMC4156311 DOI: 10.1016/j.tig.2014.07.003] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 11/18/2022]
Abstract
Following recent improvements in sequencing technologies, whole-genome sequencing (WGS) is positioned to become an essential tool in the control of antibiotic resistance, a major threat in modern healthcare. WGS has already found numerous applications in this area, ranging from the development of novel antibiotics and diagnostic tests through to antibiotic stewardship of currently available drugs via surveillance and the elucidation of the factors that allow the emergence and persistence of resistance. Numerous proof-of-principle studies have also highlighted the value of WGS as a tool for day-to-day infection control and, for some pathogens, as a primary diagnostic tool to detect antibiotic resistance. However, appropriate data analysis platforms will need to be developed before routine WGS can be introduced on a large scale.
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Affiliation(s)
- Claudio U Köser
- Department of Medicine, University of Cambridge, Cambridge, UK.
| | - Matthew J Ellington
- Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, UK
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, UK; Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, UK; Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, UK; Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
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37
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Cunha BA. Potential pitfalls of basing specific antibiotic therapy on rapid susceptibility reporting. Am J Health Syst Pharm 2014; 71:1246-7. [PMID: 25027529 DOI: 10.2146/ajhp140141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rapid antimicrobial susceptibility testing with electrokinetics enhanced biosensors for diagnosis of acute bacterial infections. Ann Biomed Eng 2014; 42:2314-21. [PMID: 24889716 DOI: 10.1007/s10439-014-1040-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/21/2014] [Indexed: 01/08/2023]
Abstract
Rapid pathogen detection and antimicrobial susceptibility testing (AST) are required in diagnosis of acute bacterial infections to determine the appropriate antibiotic treatment. Molecular approaches for AST are often based on the detection of known antibiotic resistance genes. Phenotypic culture analysis requires several days from sample collection to result reporting. Toward rapid diagnosis of bacterial infection in non-traditional healthcare settings, we have developed a rapid AST approach that combines phenotypic culture of bacterial pathogens in physiological samples and electrochemical sensing of bacterial 16S rRNA. The assay determines the susceptibility of pathogens by detecting bacterial growth under various antibiotic conditions. AC electrokinetic fluid motion and Joule heating induced temperature elevation are optimized to enhance the sensor signal and minimize the matrix effect, which improve the overall sensitivity of the assay. The electrokinetics enhanced biosensor directly detects the bacterial pathogens in blood culture without prior purification. Rapid determination of the antibiotic resistance profile of Escherichia coli clinical isolates is demonstrated.
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In situ evaluation of Paenibacillus alvei in reducing carriage of Salmonella enterica serovar Newport on whole tomato plants. Appl Environ Microbiol 2014; 80:3842-9. [PMID: 24747888 DOI: 10.1128/aem.00835-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently, tomatoes have been implicated as a primary vehicle in food-borne outbreaks of Salmonella enterica serovar Newport and other Salmonella serovars. Long-term intervention measures to reduce Salmonella prevalence on tomatoes remain elusive for growing and postharvest environments. A naturally occurring bacterium identified by 16S rRNA gene sequencing as Paenibacillus alvei was isolated epiphytically from plants native to the Virginia Eastern Shore tomato-growing region. After initial antimicrobial activity screening against Salmonella and 10 other bacterial pathogens associated with the human food supply, strain TS-15 was further used to challenge an attenuated strain of S. Newport on inoculated fruits, leaves, and blossoms of tomato plants in an insect-screened high tunnel with a split-plot design. Survival of Salmonella after inoculation was measured for groups with and those without the antagonist at days 0, 1, 2, and 3 and either day 5 for blossoms or day 6 for fruits and leaves. Strain TS-15 exhibited broad-range antimicrobial activity against both major food-borne pathogens and major bacterial phytopathogens of tomato. After P. alvei strain TS-15 was applied onto the fruits, leaves, and blossoms of tomato plants, the concentration of S. Newport declined significantly (P ≤ 0.05) compared with controls. Astonishingly, >90% of the plants had no detectable levels of Salmonella by day 5 for blossoms. The naturally occurring antagonist strain TS-15 is highly effective in reducing the carriage of Salmonella Newport on whole tomato plants. The application of P. alvei strain TS-15 is a promising approach for reducing the risk of Salmonella contamination during tomato production.
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Latent class comparison of test accuracy when evaluating antimicrobial susceptibility using disk diffusion and broth microdilution to testEscherichia coliandMannheimia haemolyticaisolates recovered from beef feedlot cattle. Epidemiol Infect 2014; 142:2314-25. [DOI: 10.1017/s0950268813003300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
SUMMARYThe study objective was to use Bayesian latent class analysis to evaluate the accuracy of susceptibility test results obtained from disk diffusion and broth microdilution using bacteria recovered from beef feedlot cattle. Isolates ofEscherichia coliandMannheimia haemolyticawere tested for susceptibility to ampicillin, ceftiofur, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Results showed that neither testing method was always or even generally superior to the other. Specificity (ability to correctly classify non-resistant isolates) was extremely high for both testing methods, but sensitivity (ability to correctly classify resistant isolates) was lower, variable in the drugs evaluated, and variable between the two bacterial species. Predictive values estimated using Bayesian Markov chain Monte Carlo models showed that the ability to predict true susceptibility status was equivalent for test results obtained with the two testing methods for some drugs, but for others there were marked differences between results obtained from disk diffusion and broth microdilution tests.
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Abstract
Rapid antibiotic susceptibility testing is in high demand in health care fields as antimicrobial-resistant bacterial strains emerge and spread. Here, we describe an optical screening system (oCelloScope) which, based on time-lapse imaging of 96 bacteria-antibiotic combinations at a time, introduces real-time detection of bacterial growth and antimicrobial susceptibility with imaging material to support the automatically generated graphs. Automated antibiotic susceptibility tests of a monoculture showed statistically significant antibiotic effects within 6 min and within 30 min in complex samples from pigs suffering from catheter-associated urinary tract infections. The oCelloScope system provides a fast high-throughput screening method for detecting bacterial susceptibility that might entail an earlier diagnosis and introduction of appropriate targeted therapy and thus combat the threat from multidrug-resistant pathogenic bacteria. The oCelloScope system can be employed for a broad range of applications within bacteriology and might present new vistas as a point-of-care instrument in clinical and veterinary settings.
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42
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Lu Y, Gao J, Zhang DD, Gau V, Liao JC, Wong PK. Single cell antimicrobial susceptibility testing by confined microchannels and electrokinetic loading. Anal Chem 2013; 85:3971-6. [PMID: 23445209 DOI: 10.1021/ac4004248] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Multidrug-resistant pathogens are an emerging global health problem. In addition to the need of developing new antibiotics in the pipeline, the ability to rapidly determine the antibiotic resistance profiles of bacteria represents one of the most crucial steps toward the management of infectious diseases and the prevention of multidrug-resistant pathogens. Here, we report a single cell antimicrobial susceptibility testing (AST) approach for rapid determination of the antibiotic resistance of bacterial pathogens. By confining individual bacteria in gas permeable microchannels with dimensions comparable to a single bacterium, the antibiotic resistance of the bacteria can be monitored in real-time at the single cell level. To facilitate the dynamic loading of the bacteria into the confined microchannels for observation, AC electrokinetics is demonstrated for capturing bacteria to defined locations in high-conductivity AST buffer. The electrokinetic technique achieves a loading efficiency of about 75% with a negligible effect on the bacterial growth rate. To optimize the protocol for single cell AST, the bacterial growth rate of individual bacteria under different antibiotic conditions has been determined systematically. The applicability of single cell AST is demonstrated by the rapid determination of the antimicrobial resistant profiles of uropathogenic clinical isolates in Mueller-Hinton media and in urine. The antibiotic resistance profiles of bacteria can be determined in less than 1 h compared to days in standard culture-based AST techniques.
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Affiliation(s)
- Yi Lu
- Department of Aerospace and Mechanical Engineering, The University of Arizona, Tucson, Arizona 85721, United States
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Kuper KM, Coyle EA, Wanger A. Antifungal Susceptibility Testing: A Primer for Clinicians. Pharmacotherapy 2012; 32:1112-22. [DOI: 10.1002/phar.1146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kristi M. Kuper
- Department of Quality Services; Cardinal Health; Houston; Texas
| | | | - Audrey Wanger
- Department of Pathology; University of Texas Medical School; Houston; Texas
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Duggal S, Gaind R, Tandon N, Deb M, Chugh TD. Comparison of an automated system with conventional identification and antimicrobial susceptibility testing. ISRN MICROBIOLOGY 2012; 2012:107203. [PMID: 23762748 PMCID: PMC3664201 DOI: 10.5402/2012/107203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 08/23/2012] [Indexed: 11/23/2022]
Abstract
The present study was designed to compare a fully automated identification/antibiotic susceptibility testing (AST) system BD Phoenix (BD) for its efficacy in rapid and accurate identification and AST with conventional manual methods and to determine if the errors reported in AST, such as the (very major errors) VME (false susceptibility), (major errors) ME (false resistance), and (minor errors) MiE (intermediate category interpretation) were within the range certified by FDA. Identification and antimicrobial susceptibility test results of eighty-five clinical isolates including both gram-positive and negative were compared on Phoenix considering the results obtained from conventional manual methods of identification and disc diffusion testing of antibiotics as standards for comparison. Phoenix performed favorably well. There was 100% concordance in identification for gram-negative isolates and 94.83% for gram-positive isolates. In seven cases, Phoenix proved better than conventional identification. For antibiotic results, categorical agreement was 98.02% for gram-positive and 95.7% for gram-negative isolates. VME was 0.33%, ME 0.66%, MiE 0.99% for gram-positive isolates and 1.23% VME, 1.23% ME, and 1.85% MiE for gram-negative isolates. Therefore, this automated system can be used as a tool to facilitate early identification and susceptibility pattern of aerobic bacteria in routine microbiology laboratories.
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Affiliation(s)
- Shalini Duggal
- Department of Microbiology, Dr. Baba Saheb Ambedkar Hospital, Rohini, New Delhi 110085, India
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45
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Abstract
PURPOSE OF REVIEW Antibiotic resistance continues to rise, whereas development of new agents to counter it has slowed. A heightened need exists to maintain the effectiveness of currently available agents. This review focuses on the need for better antimicrobial stewardship, expected benefits of well designed antimicrobial stewardship programs (ASPs), and provides suggestions for development of an effective ASP. RECENT FINDINGS Healthcare-associated infections (HAIs) are a significant cause of poor treatment outcomes and elevated healthcare and societal costs worldwide. HAIs are often caused by antibiotic-resistant pathogens; overuse of antibiotics has been linked with antibiotic resistance. Benefits of improved antimicrobial stewardship include reduced emergence of antibiotic resistance, limitation of drug-related adverse events, minimization of other consequences of antibiotic use (e.g., superinfection), and reduction of societal and healthcare-related costs. In 2007, the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) provided guidelines for the development of institutional programs to enhance antimicrobial stewardship. Experiences at The Ohio State University Medical Center (OSUMC) reinforce this message, while providing specific examples of ways to optimize ASP development and implementation. The focus of an ASP should be on improving quality of care, reducing drug resistance, and cost savings. When implementing an ASP, it is important to identify those most likely to resist the ASP, understand their concerns, and develop easy-to-understand messages that address these concerns and highlight the benefits of the proposed changes. Antibiograms play a key role in identifying local and interdepartmental trends in antibiotic susceptibility or resistance. These data are important not only in devising best-treatment practices for the institution, but also in evaluating the impact of a recently implemented ASP. Other measures of the impact of an ASP should include patient outcomes and overall costs or savings. SUMMARY Better antimicrobial stewardship is needed to limit the emergence of antibiotic resistance, prolong the effectiveness of currently available agents, improve patient outcomes, and reduce healthcare and societal costs associated with HAIs. Guidelines from the IDSA/SHEA and experiences at OSUMC provide examples of how best to develop an institutional ASP to accomplish these goals.
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[How the new generations of microbiologists view the specialty]. Enferm Infecc Microbiol Clin 2010; 28 Suppl 3:45-50. [PMID: 21129586 DOI: 10.1016/s0213-005x(10)70019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite their pivotal role in the Spanish healthcare system, clinical microbiology laboratories are experiencing difficult times and tough challenges. The following changes are required to adapt to the new situation: a) the use of molecular diagnostics to provide rapid diagnosis; b) the development of diagnostic capabilities to identify emerging or imported infectious diseases; c) the ability to advise on the interpretation of microbiological results; d) encouragement of the implantation of point-of-care testing and assessment of its performance and development; e) the implantation of quality control systems in the laboratory; f) the implementation of laboratory information systems to support real-time communication between hospital and community clinicians, public health laboratories and managers; g) the design of networking systems with professionals from other disciplines, and h) the promotion of training and teaching programs. Only if they are well prepared will clinical microbiology laboratories be able to implant the new technologies, be recognized as a cornerstone of the healthcare system, and achieve better recognition by society at large, hospital administrators and healthcare authorities.
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