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Fernandes GFS, Thompson AM, Castagnolo D, Denny WA, Dos Santos JL. Tuberculosis Drug Discovery: Challenges and New Horizons. J Med Chem 2022; 65:7489-7531. [PMID: 35612311 DOI: 10.1021/acs.jmedchem.2c00227] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the past 2000 years, tuberculosis (TB) has claimed more lives than any other infectious disease. In 2020 alone, TB was responsible for 1.5 million deaths worldwide, comparable to the 1.8 million deaths caused by COVID-19. The World Health Organization has stated that new TB drugs must be developed to end this pandemic. After decades of neglect in this field, a renaissance era of TB drug discovery has arrived, in which many novel candidates have entered clinical trials. However, while hundreds of molecules are reported annually as promising anti-TB agents, very few successfully progress to clinical development. In this Perspective, we critically review those anti-TB compounds published in the last 6 years that demonstrate good in vivo efficacy against Mycobacterium tuberculosis. Additionally, we highlight the main challenges and strategies for developing new TB drugs and the current global pipeline of drug candidates in clinical studies to foment fresh research perspectives.
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Affiliation(s)
- Guilherme F S Fernandes
- Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - Andrew M Thompson
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Daniele Castagnolo
- Department of Chemistry, University College London, 20 Gordon Street, London WC1H 0AJ, United Kingdom
| | - William A Denny
- Auckland Cancer Society Research Centre, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Jean L Dos Santos
- School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara 14800903, Brazil
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2
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Hirano Y, Shinmoto K, Okada Y, Suga K, Bombard J, Murahata S, Shrestha M, Ocheja P, Tanaka A. Machine Learning Approach to Predict Positive Screening of Methicillin-Resistant Staphylococcus aureus During Mechanical Ventilation Using Synthetic Dataset From MIMIC-IV Database. Front Med (Lausanne) 2021; 8:694520. [PMID: 34869405 PMCID: PMC8635043 DOI: 10.3389/fmed.2021.694520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Mechanically ventilated patients are susceptible to nosocomial infections such as ventilator-associated pneumonia. To treat ventilated patients with suspected infection, clinicians select appropriate antibiotics. However, decision-making regarding the use of antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) is challenging, because of the lack of evidence-supported criteria. This study aims to derive a machine learning model to predict MRSA as a possible pathogen responsible for infection in mechanically ventilated patients. Methods: Data were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV database (an openly available database of patients treated at the Beth Israel Deaconess Medical Center in the period 2008-2019). Of 26,409 mechanically ventilated patients, 809 were screened for MRSA during the mechanical ventilation period and included in the study. The outcome was positivity to MRSA on screening, which was highly imbalanced in the dataset, with 93.9% positive outcomes. Therefore, after dividing the dataset into a training set (n = 566) and a test set (n = 243) for validation by stratified random sampling with a 7:3 allocation ratio, synthetic datasets with 50% positive outcomes were created by synthetic minority over-sampling for both sets individually (synthetic training set: n = 1,064; synthetic test set: n = 456). Using these synthetic datasets, we trained and validated an XGBoost machine learning model using 28 predictor variables for outcome prediction. Model performance was evaluated by area under the receiver operating characteristic (AUROC), sensitivity, specificity, and other statistical measurements. Feature importance was computed by the Gini method. Results: In validation, the XGBoost model demonstrated reliable outcome prediction with an AUROC value of 0.89 [95% confidence interval (CI): 0.83-0.95]. The model showed a high sensitivity of 0.98 [CI: 0.95-0.99], but a low specificity of 0.47 [CI: 0.41-0.54] and a positive predictive value of 0.65 [CI: 0.62-0.68]. Important predictor variables included admission from the emergency department, insertion of arterial lines, prior quinolone use, hemodialysis, and admission to a surgical intensive care unit. Conclusions: We were able to develop an effective machine learning model to predict positive MRSA screening during mechanical ventilation using synthetic datasets, thus encouraging further research to develop a clinically relevant machine learning model for antibiotics stewardship.
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Affiliation(s)
- Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Keito Shinmoto
- Department of Internal Medicine, Tokyo bay Ichikawa Urayasu Medical Center, Chiba, Japan
| | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiro Suga
- Department of Mechanical Engineering, Faculty of Engineering, Kogakuin University, Tokyo, Japan
| | | | | | | | - Patrick Ocheja
- Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Santimaleeworagun W, Changpradub D, Hemapanpairoa J, Thunyaharn S. Optimization of Linezolid Dosing Regimens for Treatment of Vancomycin-Resistant Enterococci Infection. Infect Chemother 2021; 53:503-511. [PMID: 34405596 PMCID: PMC8511381 DOI: 10.3947/ic.2021.0034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Linezolid, an oxazolidinone antibiotic, is recommended for vancomycin-resistant enterococci (VRE). However, 100% free-drug concentration above the minimum inhibitory concentration (fT>MIC) and an area under the curve of free drug to MIC ratio (fAUC24/MIC) >100 were associated with favorable clinical outcome with less emerging resistance. A plasma trough concentration (Ctrough) of linezolid ≥9 μg/mL was also related to hematologic toxicity. Thus, linezolid dose optimization is needed for VRE treatment. The study aimed to determine the in vitro linezolid activity against clinical VRE isolates and linezolid dosing regimens in critically ill patients who met the target pharmacokinetics/pharmacodynamics (PK/PD) for VRE treatment. MATERIALS AND METHODS Enterococcal isolates from enterococcal-infected patients were obtained between 2014 and 2018 at Phramongkutklao Hospital. We used Monte Carlo simulation to calculate the probability of target attainment, and the cumulative fraction of response (CFR) of the free area under the curve to MIC ratio (fAUIC24) was used to calculate the fAUC24/MIC 80 - 100 and fT/MIC >85 - 100% of the interval time of administration for clinical response and microbiological eradication as well as the Ctrough ≥9 μg/mL for the probability of hematologic toxicity. RESULTS For linezolid MIC determination, the MIC median (MIC50), MIC for 90% growth (MIC90), and range for linezolid were 1.5 μg/mL, 2 μg/mL, and 0.72 - 2 μg/mL, respectively. A dosing regimen of 1,200 mg either once daily or as a divided dose every 12 h gave target attainments of fAUC24/MICs >80 and >100, which exceeded 90% for MICs ≤1 and ≤1 μg/mL, respectively, with a rate of hematologic toxicity <15%. If the expected fT>MICs were >85% and 100%, a 1,200-mg divided dose every 12 h could cover VRE isolates having linezolid MICs ≤1 μg/mL and ≤0.75 μg/mL. Even 600 mg every 8 h and 1,200 mg as a continuous infusion gave a higher target attainment of fAUC24/MIC and a fT>MIC and the target CFR, but those regimens gave Ctrough ≥9 μg/mL rates of 40.7% and 99.6%. CONCLUSION The current dosing of 1,200 mg/day might be optimal treatment for infection by VRE isolates with documented MICs ≤1 μg/mL. For treatment of VRE with a MIC of 2 μg/mL or to achieve the target CFR, the use of linezolid with other antibiotic combinations might help achieve the PK/PD target, provide better clinical outcome, and prevent resistance.
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Affiliation(s)
- Wichai Santimaleeworagun
- Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand.,Antibiotic Optimization and Patient Care Project by Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group [PIRBIG], Nakhon Pathom, Thailand.
| | - Dhitiwat Changpradub
- Division of Infectious Diseases, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Jatapat Hemapanpairoa
- Antibiotic Optimization and Patient Care Project by Pharmaceutical Initiative for Resistant Bacteria and Infectious Diseases Working Group [PIRBIG], Nakhon Pathom, Thailand.,Department of Pharmacy Practice and Pharmaceutical Care, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Sudaluck Thunyaharn
- Faculty of Medical Technology, Nakhonratchasima College, Nakhon Ratchasima, Thailand
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Efficacy and safety of dalbavancin in the treatment of Gram-positive bacterial infections. J Glob Antimicrob Resist 2020; 24:72-80. [PMID: 33279683 DOI: 10.1016/j.jgar.2020.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES In this meta-analysis, we assessed the clinical efficacy and safety of dalbavancin compared with commonly used anti-Gram-positive agents. METHODS PubMed, Embase and Cochrane Library databases were searched from inception up to 25 February 2020. Randomised controlled trials (RCTs) comparing the efficacy and safety of dalbavancin with other antibiotics against Gram-positive infections were included. Reviews, conference abstracts, editorials, case reports, studies on healthy people, or those lacking a comparator group or focusing on different dosages were excluded. RESULTS Seven RCTs comprising 2665 patients were included. Five RCTs included 2109 patients with skin and skin-structure infections (SSSIs) and the other two included patients with catheter-related bloodstream infections (CRBSIs) and osteomyelitis, respectively. Clinical and microbiological responses to dalbavancin were similar to other antibiotics in treating infections caused by Gram-positive bacteria, including the SSSI subgroup. Clinical response to dalbavancin showed superiority in the CRBSI and osteomyelitis subgroups. No significant difference was observed between dalbavancin and other treatments in terms of adverse events (AEs), adverse drug reactions (ADRs) and serious AEs. However, the single-dose regimen had significantly more AEs compared with the comparator group, while the dual-dose regimen resulted in fewer AEs and ADRs and a lower incidence of diarrhoea compared with the comparator group. Moreover, the dalbavancin group showed a decreased mortality risk compared with other treatments. CONCLUSION Dalbavancin was comparable with other antibiotics in treating chronic Gram-positive infections in terms of efficacy and safety. The dual-dose regimen showed a better safety profile compared with the single-dose regimen in the treatment of SSSIs.
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Almeida L, Dhillon-LaBrooy A, Castro CN, Adossa N, Carriche GM, Guderian M, Lippens S, Dennerlein S, Hesse C, Lambrecht BN, Berod L, Schauser L, Blazar BR, Kalesse M, Müller R, Moita LF, Sparwasser T. Ribosome-Targeting Antibiotics Impair T Cell Effector Function and Ameliorate Autoimmunity by Blocking Mitochondrial Protein Synthesis. Immunity 2020; 54:68-83.e6. [PMID: 33238133 PMCID: PMC7837214 DOI: 10.1016/j.immuni.2020.11.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 02/08/2023]
Abstract
While antibiotics are intended to specifically target bacteria, most are known to affect host cell physiology. In addition, some antibiotic classes are reported as immunosuppressive for reasons that remain unclear. Here, we show that Linezolid, a ribosomal-targeting antibiotic (RAbo), effectively blocked the course of a T cell-mediated autoimmune disease. Linezolid and other RAbos were strong inhibitors of T helper-17 cell effector function in vitro, showing that this effect was independent of their antibiotic activity. Perturbing mitochondrial translation in differentiating T cells, either with RAbos or through the inhibition of mitochondrial elongation factor G1 (mEF-G1) progressively compromised the integrity of the electron transport chain. Ultimately, this led to deficient oxidative phosphorylation, diminishing nicotinamide adenine dinucleotide concentrations and impairing cytokine production in differentiating T cells. In accordance, mice lacking mEF-G1 in T cells were protected from experimental autoimmune encephalomyelitis, demonstrating that this pathway is crucial in maintaining T cell function and pathogenicity.
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Affiliation(s)
- Luís Almeida
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany; Institute of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany
| | - Ayesha Dhillon-LaBrooy
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany; Institute of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany
| | - Carla N Castro
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany
| | - Nigatu Adossa
- QIAGEN, Aarhus C 8000, Denmark; University of Turku, Computational Biomedicine, Turku Center for Biotechnology, Turku 20520, Finland
| | - Guilhermina M Carriche
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany; Institute of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany
| | - Melanie Guderian
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany
| | | | - Sven Dennerlein
- Department of Cellular Biochemistry, University Medical Center, Göttingen 37073, Germany
| | - Christina Hesse
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover 30625, Germany
| | | | - Luciana Berod
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany; Institute of Molecular Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Bruce R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN 55454, USA
| | - Markus Kalesse
- Institute for Organic Chemistry, Leibniz University Hannover, Hannover, Germany; Helmholtz Center for Infection Research (HZI), Braunschweig 38124, Germany
| | - Rolf Müller
- Helmholtz Institute for Pharmaceutical Research, Helmholtz Center for Infection Research and Department of Pharmaceutical Biotechnology, Saarland University, Saarbrücken 66123, Germany
| | - Luís F Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Tim Sparwasser
- Institute of Infection Immunology, TWINCORE, Center for Experimental and Clinical Infection Research, Hannover Medical School and the Helmholtz Center for Infection Research, Hannover 30625, Germany; Institute of Medical Microbiology and Hygiene, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany.
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6
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Zou D, Xu P, Zhang Y, Lu C, Wang J, Leng B, Zhang W. The first case of teeth discoloration induced by linezolid in children in China Mainland. J Infect Chemother 2020; 26:1062-1065. [DOI: 10.1016/j.jiac.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
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Prolonged infusion of linezolid is associated with improved pharmacokinetic/pharmacodynamic (PK/PD) profiles in patients with external ventricular drains. Eur J Clin Pharmacol 2020; 77:79-86. [PMID: 32812063 DOI: 10.1007/s00228-020-02978-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We previously investigated the pharmacokinetic and pharmacodynamic (PK/PD) parameters of routine linezolid infusions (1 h) in patients with external ventricular drains (EVD). The aim of the study was to determine whether extended linezolid infusions (200 mg/h for 3 h) were more efficacious than short linezolid infusions (600 mg/h for 1 h). METHODS We collected cerebrospinal fluid (CSF) and plasma samples from 10 patients who received linezolid infusions after cerebral hemorrhage surgery with EVDs. Linezolid concentrations were measured by high-performance liquid chromatography (HPLC). A Monte Carlo simulation was used to measure the probability of target attainments (PTA) and the PK/PD indexes at four minimum inhibitory concentrations (MIC). RESULTS When the same dose (600 mg) was given as an extended infusion (3 h), linezolid reached its maximum concentrations in the plasma and CSF at 3.00 h and 4.40 h, respectively. The mean penetration of linezolid in CSF was 41.31%. Using the parameter of AUC0-24 h/MIC ≥ 100, the plasma PTA provided good coverage at > 90% when MIC was ≤ 1 μg/mL, while the values were 0 in CSF. Using the parameter %T (time) > MIC ≥ 85%, the PTA in both the plasma and CSF provided good coverage when MIC ≤ 2 μg/mL. Compared with routine infusions, prolonged infusion times (3 h) showed increased PTA of linezolid. CONCLUSIONS Prolonged infusion times increased the concentration of linezolid in the plasma, leading to improved therapeutic outcomes. However, this improvement did not exist in CSF. Lastly, the PK/PD indicator AUC/MIC ≥ 100 may be used to achieve improved outcomes in patients with critical infections.
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8
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Jorgensen SCJ, Lagnf AM, Bhatia S, Shamim MD, Rybak MJ. Sequential intravenous-to-oral outpatient antibiotic therapy for MRSA bacteraemia: one step closer. J Antimicrob Chemother 2020; 74:489-498. [PMID: 30418557 DOI: 10.1093/jac/dky452] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background Published guidelines call for prolonged courses of intravenous (iv) antibiotics for the treatment of MRSA bloodstream infection (BSI) to ensure eradication of deep foci and decrease relapse risk. Sequential iv-to-oral antibiotic therapy has been successfully applied to other serious infections but has not been evaluated for MRSA BSI. Objectives To compare outcomes in adults completing MRSA BSI therapy with oral versus parenteral antibiotics in the outpatient setting [oral outpatient antibiotic therapy (OOAT) versus outpatient parenteral antibiotic therapy (OPAT)]. Methods This was a single-centre, retrospective, cohort study between 2008 and 2018. The primary outcome was 90 day clinical failure (MRSA BSI recurrence, deep-seated MRSA infection or all-cause mortality). Analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW). Results A total of 492 patients were included (70 OOAT, 422 OPAT). In general, OOAT patients had characteristics consistent with a lower risk of poor outcomes; however, after IPTW key prognostic factors were balanced. In IPTW-adjusted analysis, there was non-significant reduction in the rate of 90 day clinical failure in the OOAT group compared with the OPAT group [adjusted HR (aHR) 0.379, 95% CI 0.131-1.101]. In analyses restricted to pre-specified subgroups defined by index infection complexity and comorbidity burden, findings were consistent with the main analysis. Furthermore, OOAT patients had a significantly reduced rate of 90 day hospital readmission (aHR 0.603, 95% CI 0.388-0.937). Conclusions We provide preliminary evidence that selected patients with MRSA BSI may have at least equivalent clinical outcomes with OOAT versus OPAT and provide support to ongoing and future studies evaluating oral antibiotics for MRSA BSI.
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Affiliation(s)
- Sarah C J Jorgensen
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Sahil Bhatia
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Muhammad-Daniayl Shamim
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.,Department of Pharmacy, Detroit Medical Center, Detroit, MI, USA.,School of Medicine, Wayne State University, Detroit, MI, USA
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The Continuing Threat of Methicillin-Resistant Staphylococcus aureus. Antibiotics (Basel) 2019; 8:antibiotics8020052. [PMID: 31052511 PMCID: PMC6627156 DOI: 10.3390/antibiotics8020052] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus has been an exceptionally successful pathogen, which is still relevant in modern age-medicine due to its adaptability and tenacity. This bacterium may be a causative agent in a plethora of infections, owing to its abundance (in the environment and in the normal flora) and the variety of virulence factors that it possesses. Methicillin-resistant S. aureus (MRSA) strains—first described in 1961—are characterized by an altered penicillin-binding protein (PBP2a/c) and resistance to all penicillins, cephalosporins, and carbapenems, which makes the β-lactam armamentarium clinically ineffective. The acquisition of additional resistance determinants further complicates their eradication; therefore, MRSA can be considered as the first representative of multidrug-resistant bacteria. Based on 230 references, the aim of this review is to recap the history, the emergence, and clinical features of various MRSA infections (hospital-, community-, and livestock-associated), and to summarize the current advances regarding MRSA screening, typing, and therapeutic options (including lipoglycopeptides, oxazolidinones, anti-MRSA cephalosporins, novel pleuromutilin-, tetracycline- and quinolone-derivatives, daptomycin, fusidic acid, in addition to drug candidates in the development phase), both for an audience of clinical microbiologists and infectious disease specialists.
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Wu X, Tang Y, Zhang X, Wu C, Kong L. Pharmacokinetics and pharmacodynamics of linezolid in plasma/cerebrospinal fluid in patients with cerebral hemorrhage after lateral ventricular drainage by Monte Carlo simulation. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1679-1684. [PMID: 29928111 PMCID: PMC6001839 DOI: 10.2147/dddt.s168757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective We investigated the pharmacokinetic (PK) and pharmacodynamic (PD) parameters of linezolid in patients who had suffered cerebral hemorrhage after lateral ventricular drainage. Materials and methods Ten patients with cerebral hemorrhage after lateral ventricular drainage with stroke-associated pneumonia who were given linezolid were enrolled. Plasma and cerebrospinal fluid (CSF) samples were taken at appropriate intervals after the first administration of linezolid and assayed by high-performance liquid chromatography (HPLC). Then, PK parameters were estimated, and a Monte Carlo simulation was used to calculate the probability of target attainments (PTAs) for linezolid achieving the PK/PD index at different minimal inhibitory concentrations (MICs). Results The maximum concentration of linezolid in plasma and CSF was reached at 1.00 h and 3.10 h, respectively. The average penetration of linezolid in CSF was 56.81%. If the area under the plasma concentration vs time curve from zero to the final sampling time (AUC0-24 h)/MIC ≥ 59.1 was applied as a parameter, the PTA of linezolid in plasma could provide good coverage (PTA ≥ 90%) only for pathogens with a MIC of ≤2 μg/mL, whereas it could be achieved in CSF with a MIC of ≤1 μg/mL. If %T > MIC ≥ 40% was applied as a parameter, the PTA of linezolid in plasma/CSF could provide good coverage if the MIC was ≤4 μg/mL. Conclusions For patients with infection of the central nervous system and who are sensitive to the drug, the usual dosing regimens of linezolid can achieve a good therapeutic effect. However, for critically ill or drug-resistant patients, an increase in dose, the frequency of administration, or longer infusion may be needed to improve the curative effect.
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Affiliation(s)
- Xiaofei Wu
- Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Yan Tang
- Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Xiaohua Zhang
- Department of Emergency Internal Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Chenchen Wu
- Department of Endocrinology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
| | - Lingti Kong
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, People's Republic of China
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Tang Y, Kong L, Wu C, Zhang X, Lu G, Wu X. Pharmacokinetics of linezolid in plasma and cerebrospinal fluid in patients with cerebral hemorrhage post-surgical intervention. Eur J Clin Pharmacol 2017; 73:919-921. [PMID: 28342065 DOI: 10.1007/s00228-017-2239-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Yan Tang
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Lingti Kong
- Departmen of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Chenchen Wu
- Department of Endocrinology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Xiaohua Zhang
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Guoyu Lu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China
| | - Xiaofei Wu
- Department of Emergency Internal Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, 233004, China.
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Jia X, Ma W, Xu X, Yang S, Zhang L. Retrospective analysis of hospital-acquired linezolid-nonsusceptible enterococci infection in Chongqing, China, 2011-2014. Am J Infect Control 2015; 43:e101-6. [PMID: 26315061 DOI: 10.1016/j.ajic.2015.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/17/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Linezolid-nonsusceptible enterococci (LNSE) is an increasingly emerging multidrug-resistant pathogen, and the caused nosocomial infections are difficult to manage. However, data on the host-related risk factors and clinical outcomes for LNSE infection are poorly characterized. METHODS A retrospective case-case-control study of risk factors and clinical outcomes of hospitalized patients with LNSE infection during the period 2011-2014 was conducted in a teaching hospital in Chongqing, China. Case patients with LNSE and those with linezolid-susceptible enterococci (LSE) and controls with no enterococcal infection were compared at a ratio of 1:1:4. Two parallel multivariate logistic regression models were used to evaluate independent predictors for acquiring LNSE and LSE, respectively. RESULTS Forty-four LNSE cases, 44 LSE cases, and 176 uninfected controls were analyzed. Multivariable analysis indicated that transferring from another hospital (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.58-8.09), peripheral vascular disease (OR, 4.36; 95% CI, 1.64-11.60), and exposure to cephalosporins (OR, 4.24; 95% CI, 1.85-9.71) were unique independent predictors for acquiring LNSE. Gallbladder disease (OR, 3.64; 95% CI, 1.36-9.74) was independently associated with LSE acquisition. Polymicrobial infection was the only factor identified in both LNSE and LSE groups compared with controls; however, no statistical significance was observed in in-hospital mortality. CONCLUSION Timely control efforts and appropriate antibiotic stewardship programs are necessary to effectively reduce the burden of LNSE infections among high-risk patients.
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The use of bone cement for the localized, controlled release of the antibiotics vancomycin, linezolid, or fusidic acid: effect of additives on drug release rates and mechanical strength. Drug Deliv Transl Res 2015; 1:121-31. [PMID: 25788111 DOI: 10.1007/s13346-011-0015-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone cement containing antibiotics is commonly used to treat orthopedic related infections. However, effective treatment (especially of resistant bacteria, methacillin-resistant Staphylococcus aureus (MRSA)) is compromised by very low levels of drug release so that typically less than 10% of loaded drug is released over a 6-week period. The objective of this study was to investigate the effect of incorporation of water soluble excipients (polyethylene glycol, sodium chloride, or dextran) into antibiotic-loaded cement on mechanical strength and drug release properties. Poly(methyl methylacrylate) cement implants containing various amounts of drug (vancomycin, linezolid or fusidic acid (all MRSA active)) and excipients were cast in the form of beads or films and characterized using differential scanning calorimetry. Mechanical strength as assessed by Young's modulus was determined by thermo-mechanical analysis. Drug release was measured by incubation in phosphate buffered saline with analysis by HPLC methods. The inclusion of sodium chloride up to 20% w/w caused only minor reductions in Young's modulus. Vancomycin and linezolid released very slowly from unmodified bone cement beads (less than 3% released by 4 weeks) whereas fusidic acid released more quickly (approximately 8% released by 4 weeks). The inclusion of sodium chloride or dextran in bone cement resulted in major increases in the release rate of vancomycin, linezolid and fusidic acid. These studies support the inclusion of sodium chloride and dextran in bone cement to increase the release rate of vancomycin, linezolid, or fusidic acid without compromising the mechanical strength of the composite material.
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Co-prescribing of linezolid and serotonergic agents in a general hospital setting. Ir J Psychol Med 2014; 31:191-193. [PMID: 30189491 DOI: 10.1017/ipm.2014.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Co-prescription of linezolid and serotonergic agents (SSRIs, SNRIs, NaSSA, TCAs) can lead to serotonin syndrome, this study seeks to identify prescribing practise of these agents. METHODS Study of all general hospital inpatients prescribed intravenous linezolid in a 3-month period, using drug charts and clinical notes. RESULTS Co-prescription occurred in 20% with SSRIs most frequently concurrently used. There were no cases of serotonin syndrome. There was no evidence in clinical notes of vigilance for potential interaction. CONCLUSION Co-prescription is common; awareness of potentially serious interaction is not evident in current practice.
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15
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Effect of linezolid on hematological and oxidative parameters in rats. J Antibiot (Tokyo) 2014; 67:433-7. [DOI: 10.1038/ja.2014.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/18/2014] [Accepted: 02/27/2014] [Indexed: 11/08/2022]
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Abstract
BACKGROUND Vancomycin is considered the drug of choice for methicillin-resistant Staphylococcus aureus infection; however, it has also been linked with nephrotoxicity in the past, sometimes leading to its substitution with linezolid. We hypothesized that patients treated with vancomycin for gram-positive (GP) infections would have an increased incidence of rise in creatinine and need for hemodialysis (HD) compared with patients receiving linezolid. METHODS This was a retrospective cohort study of a prospectively maintained database of all surgical patients treated with either vancomycin or linezolid for GP infections in a single intensive care unit from 2001 to 2008 and managed under a cycling antibiotic protocol. Patients were followed up until hospital discharge. Categorical and continuous variables were evaluated. Multivariable logistic regression was performed. RESULTS A total of 545 patients were treated for 1,046 GP infections (571 with vancomycin, 475 with linezolid) over 7 years. Patient demographics were similar between groups; however, the vancomycin group was associated with a longer treatment course (16.2 [0.5] days vs. 14.3 [0.5] days; p = 0.022). Unadjusted outcomes were similar between groups. Multivariable analysis revealed that Acute Physiology and Chronic Health Evaluation II score predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (relative risk [RR], 3.01; 95% confidence interval [CI], 1.22-7.42) and subsequent need for HD (RR, 3.07; 95% CI, 1.23-7.62). In addition, initial creatinine level predicted an increase in creatinine levels greater than 1.0 following antibiotic therapy (RR, 4.36; 95% CI, 1.46-12.99) and subsequent need for HD (RR, 10.83; 95% CI, 3.19-36.77). Linezolid was found to be protective regarding rise in creatinine levels greater than 1.0 following antibiotic therapy; however, this was only experienced when vancomycin trough levels greater than 20 were encountered (RR, 5.4;95% CI, 1.19-24.51). CONCLUSION These data suggest that vancomycin is minimally nephrotoxic and has a similar nephrotoxic profile as compared with linezolid when appropriate dosing is used, even among critically ill patients with complex infections. LEVEL OF EVIDENCE Therapeutic/care management, level II.
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Abstract
Staphylococcus aureus, the most virulent of the many staphylococcal species, has remained a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics. S. aureus causes disease through both toxin-mediated and non-toxin-mediated mechanisms. This organism is responsible for both healthcare associated and community-based infections ranging from relatively minor skin and soft tissue infections to severe life threatening systemic infections. Patients with diabetes mellitus are at increased risk of invasive S. aureus infections. This article focuses on the spectrum of invasive S. aureus infections and discusses the clinical features, investigations and management of these infections in patients with diabetes mellitus.
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Vardakas KZ, Kontopidis I, Gkegkes ID, Rafailidis PI, Falagas ME. Incidence, characteristics, and outcomes of patients with bone and joint infections due to community-associated methicillin-resistant Staphylococcus aureus: a systematic review. Eur J Clin Microbiol Infect Dis 2013; 32:711-21. [DOI: 10.1007/s10096-012-1807-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/17/2012] [Indexed: 11/29/2022]
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Grüger T, Schmidt T, Schnitzler N, Nidermajer S, Brandenburg K, Zündorf J. Negative impact of linezolid on human neutrophil functions in vitro. Chemotherapy 2012; 58:206-11. [PMID: 22759803 DOI: 10.1159/000338390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS In a recent phase III clinical trial on linezolid, more patients in the linezolid treatment arm acquired Gram-negative catheter-related bloodstream infections despite the adequate therapy of infections caused by Gram-negative bacteria. We tested our hypothesis that linezolid impairs phagocytosis and the killing of Gram-negative bacteria by polymorphonuclear leukocytes (PMN). METHODS The influence of clinically relevant concentrations (5, 20 and 50 mg/l) of linezolid on granulocyte function in vitro was tested. Phagocytosis was determined by flow cytometry, and killing of bacteria was evaluated by plate counting. Chemotaxis was examined by an under-agarose cell migration assay. Gram-positive and Gram-negative bacteria were used. RESULTS Linezolid significantly impaired phagocytosis of a specific Escherichia coli strain in a concentration-dependent manner, whereas the effect on Pseudomonas aeruginosa was less prominent. No such effects were observed with a different E. coli strain or Staphylococcus aureus. Neither killing nor the chemotactic behaviour of PMN was significantly affected by linezolid. CONCLUSIONS The observed concentration-dependent impairment of the phagocytic function might contribute to the higher frequency of catheter-related Gram-negative bloodstream infections in patients treated with linezolid. Individual patient risk may also depend on the causative Gram-negative strain.
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Affiliation(s)
- Thomas Grüger
- Federal Institute for Drugs and Medical Devices, Biosafety Laboratory, Bonn, Germany
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20
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Ager S, Gould K. Clinical update on linezolid in the treatment of Gram-positive bacterial infections. Infect Drug Resist 2012; 5:87-102. [PMID: 22787406 PMCID: PMC3392139 DOI: 10.2147/idr.s25890] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Gram-positive pathogens are a significant cause of morbidity and mortality in both community and health care settings. Glycopeptides have traditionally been the antibiotics of choice for multiresistant Gram-positive pathogens but there are problems with their use, including the emergence of glycopeptide-resistant strains, tissue penetration, and achieving and monitoring adequate serum levels. Newer antibiotics such as linezolid, a synthetic oxazolidinone, are available for the treatment of resistant Gram-positive bacteria. Linezolid is active against a wide range of Gram-positive bacteria and has been generally available for the treatment of Gram-positive infections since 2000. There are potential problems with linezolid use, including its bacteriostatic action and the relatively high incidence of reported adverse effects, particularly with long-term use. Long-term use may also be complicated by the development of resistance. However, linezolid has been shown to be clinically useful in the treatment of several serious infections where traditionally bacteriocidal agents have been required and many of its adverse effects are reversible on cessation. It has also been shown to be a cost-effective treatment option in several studies, with its high oral bioavailability allowing an early change from intravenous to oral formulations with consequent earlier patient discharge and lower inpatient costs.
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Affiliation(s)
- Sally Ager
- Department of Microbiology, Newcastle upon Tyne Hospitals Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
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21
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Vardakas KZ, Mavros MN, Roussos N, Falagas ME. Meta-analysis of randomized controlled trials of vancomycin for the treatment of patients with gram-positive infections: focus on the study design. Mayo Clin Proc 2012; 87:349-63. [PMID: 22469348 PMCID: PMC3538415 DOI: 10.1016/j.mayocp.2011.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/24/2011] [Accepted: 12/02/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To study the effectiveness and safety of vancomycin compared with that of other antibiotics for the treatment of gram-positive infections. METHODS Major electronic databases were searched. Data from published randomized controlled trials (January 1, 1950, to September 15, 2011) were pooled using a meta-analytic method. RESULTS Fifty-three trials comparing vancomycin with linezolid, daptomycin, quinupristin-dalfopristin, tigecycline, ceftaroline, ceftobiprole, telavancin, teicoplanin, iclaprim, and dalbavancin were included in the meta-analysis. Individual antibiotics were as effective as vancomycin, except for linezolid, which was more effective than vancomycin for the treatment of skin and soft tissue infections (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.07-2.43). Comparators were as effective as vancomycin in the intent-to-treat population (OR, 1.08; 95% CI, 0.98-1.18) but were more effective in the clinically evaluable population (OR, 1.14; 95% CI, 1.02-1.27) when all infections were pooled. When available data from all trials were pooled, no differences were noted when patients with febrile neutropenia (OR, 1.07; 95% CI, 0.82-1.39), pneumonia (OR, 1.10; 95% CI, 0.87-1.37), bacteremia (OR, 1.05; 95% CI, 0.76-1.45), and skin and soft tissue infections (OR, 1.11; 95% CI, 0.89-1.39) were studied. Comparators were more effective in open-label (OR, 1.28; 95% CI, 1.08-1.50) but not in double-blind trials (OR, 1.04; 95% CI, 0.90-1.20). Total adverse events attributed to studied antibiotics (OR, 1.07; 95% CI, 0.90-1.28) and patients withdrawn from trials (OR, 0.86; 95% CI, 0.68-1.09) were similar in the compared groups. Mortality was not different between vancomycin and comparator antibiotics when all trials were included in the analysis (OR, 1.09; 95% CI, 0.96-1.23). Comparators were associated with higher mortality in open-label (OR, 1.27; 95% CI, 1.05-1.54) but not double-blind trials (OR, 0.96; 95% CI, 0.80-1.14). CONCLUSION On the basis mainly of data from open-label trials, vancomycin is a treatment choice that is as effective as other available antibiotics for patients with gram-positive infections. Study design seems to make a major contribution to the outcome.
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Affiliation(s)
- Konstantinos Z. Vardakas
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Internal Medicine, Henry Dunant Hospital, Athens, Greece
| | | | | | - Matthew E. Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece
- Department of Internal Medicine, Henry Dunant Hospital, Athens, Greece
- Department of Internal Medicine, Tufts University School of Medicine, Boston, MA
- Correspondence: Address to Matthew E. Falagas, MD, MSc, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos St, 151 23 Marousi, Greece
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Cai Y, Chai D, Falagas ME, Vouloumanou EK, Wang R, Guo D, Bai N, Liang B, Liu Y. Immediate hematological toxicity of linezolid in healthy volunteers with different body weight: a phase I clinical trial. J Antibiot (Tokyo) 2012; 65:175-8. [PMID: 22274702 DOI: 10.1038/ja.2011.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Linezolid is an important therapeutic option for infections from multi-drug resistant Gram-positive pathogens. However, prolonged linezolid treatment (>14 days) is considered to increase the risk of hematological adverse events. We aimed to evaluate the hematological safety profile of an i.v. single dose of linezolid in healthy volunteers of different body weight. We conducted a phase I clinical trial involving 20 healthy male Chinese volunteers that received an i.v. single dose of linezolid (600 mg). The study participants were assigned to two groups: low-weight (LW) group: 50 kg <body weight ≤55 kg and high-weight (HW) group: ≥80 kg. A significant decrease in the hemoglobin (Hb) levels and red blood cell (RBC) count was observed at the end of administration of the study drug in both groups. White blood cell (WBC) count was simultaneously decreased in the HW group. In the LW group, Hb levels and RBC count were also significantly decreased at 5, 7 and 24 h. In the HW group, both values were significantly decreased at 5 h. At 48 h all values were normal. The observed decreases were numerically higher in the LW group compared with the HW group. Yet, no statistical significance was noted. No difference was observed in the platelet count in both the groups. Our findings suggest that linezolid-associated hematological toxicity may also occur shortly after the i.v. administration of the drug in both LW and HW healthy volunteers. Early initiated continuous monitoring of hematological values and linezolid dosage adjustment for body weight are recommended.
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Affiliation(s)
- Yun Cai
- Department of Clinical Pharmacology, PLA General Hospital, Beijing, PR China
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23
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Use of linezolid in neonatal and pediatric inpatient facilities—results of a retrospective multicenter survey. Eur J Clin Microbiol Infect Dis 2011; 31:1435-42. [DOI: 10.1007/s10096-011-1461-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/11/2011] [Indexed: 11/27/2022]
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Go AC, Golightly LK, Barber GR, Barron MA. Linezolid interaction with serotonin reuptake inhibitors: report of two cases and incidence assessment. ACTA ACUST UNITED AC 2011; 25:41-7. [PMID: 21417793 DOI: 10.1515/dmdi.2010.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Prompted by the advent of potentially life-threatening neuromuscular symptoms following initiation of linezolid therapy in two patients receiving treatment with a serotonin reuptake inhibitor antidepressant, an evaluation was conducted to determine the incidence and characteristics of symptomatic serotonin toxicity among hospitalized patients receiving combined treatment with these medications. METHODS Patients admitted between January 1, 2006 and August 30, 2008 who received linezolid concurrently with citalopram or escitalopram were identified and their medical records were examined. Patients were judged to have serotonin toxicity if their records contained documentation of clinical evidence adequate to fulfill requisites of the Hunter Serotonin Toxicity Criteria. Severity of serotonin-related symptoms was graded according to previously established criteria. RESULTS During the period of observation, 24 patients received concurrent treatment with linezolid and citalopram or escitalopram. Of these, one patient (4%) treated with citalopram met evidentiary requirements for diagnosis of serotonin toxicity. The severity of symptoms in this patient was graded as mild. No evidence of serious harm related to a possible drug interaction was identified. CONCLUSIONS Severe symptoms associated with serotonin toxicity were shown to be uncommon in patients receiving linezolid and selected serotonin reuptake inhibitors. Nonetheless, serious interaction-related toxicity has been observed at our institution and reported in detail by others. Accordingly, concurrent use of these medications is categorized as contraindicated. Alternative antimicrobial therapy should be instituted in most cases. If no suitable alternative is available, recipient patients should be hospitalized for expectant observation and rigorous monitoring.
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Affiliation(s)
- Amy C Go
- University of Colorado Hospital, Aurora, CO 80045-2515, USA
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25
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Gould FK. Linezolid: safety and efficacy in special populations. J Antimicrob Chemother 2011; 66 Suppl 4:iv3-iv6. [PMID: 21521705 DOI: 10.1093/jac/dkr071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Linezolid has been in general use in the UK since 2000. Although toxicity, particularly haematological and neurological, has been an issue, linezolid has proved to be an effective alternative to glycopeptides in the treatment of Gram-positive infections. Since its original licence for the treatment of skin and soft tissue infections and pneumonia, there have been reports of its successful use in the treatment of bone and joint infections, endocarditis, and other difficult-to-treat infections.
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Affiliation(s)
- F Kate Gould
- Department of Microbiology, Newcastle upon Tyne Hospitals Trust, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK.
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Montserrat M, Levêque D, Schneider F, Beretz L. Utilisation du linézolide dans un service de réanimation médicale. Med Mal Infect 2011; 41:396-7. [DOI: 10.1016/j.medmal.2011.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/23/2010] [Accepted: 01/12/2011] [Indexed: 10/17/2022]
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Rasmussen RV, Fowler VG, Skov R, Bruun NE. Future challenges and treatment of Staphylococcus aureus bacteremia with emphasis on MRSA. Future Microbiol 2011; 6:43-56. [PMID: 21162635 DOI: 10.2217/fmb.10.155] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is an urgent medical problem due to its growing frequency and its poor associated outcome. As healthcare delivery increasingly involves invasive procedures and implantable devices, the number of patients at risk for SAB and its complications is likely to grow. Compounding this problem is the growing prevalence of methicillin-resistant S. aureus (MRSA) and the dwindling efficacy of vancomycin, long the treatment of choice for this pathogen. Despite the recent availability of several new antibiotics for S. aureus, new strategies for treatment and prevention are required for this serious, common cause of human infection.
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Affiliation(s)
- Rasmus V Rasmussen
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Copenhagen, Denmark
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28
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Hou Z, Zhou Y, Wang H, Bai H, Meng J, Xue X, Luo X. Co-blockade of mecR1/blaR1 signal pathway to restore antibiotic susceptibility in clinical isolates of methicillin-resistant Staphylococcus aureus. Arch Med Sci 2011; 7:414-22. [PMID: 22295022 PMCID: PMC3258742 DOI: 10.5114/aoms.2011.23404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/15/2010] [Accepted: 12/07/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is caused by the production of low-affinity penicillin-binding protein 2a and β-lactamases, which are encoded by mecA and blaZ, respectively. Expressions of the two key genes are mutually regulated by MecI and BlaI. The aim of this study was to design specific anti-mecR1 and anti-blaR1 deoxyribozymes and identify the restoration of susceptibility in MRSA isolates with mecI or blaI or no deletions by interfering with the mutual regulation of mecA and blaZ. MATERIAL AND METHODS Specific deoxyribozymes were designed by using the program RNA structure 4.6. RNA substrates were obtained by transcription in vitro and used to assess the target cleavage of DNAzymes. Transcription of mecR1-mecA and blaR1-blaZ was analysed by real time RT-PCR. The susceptibility of MRSA was tested. RESULTS Specific deoxyribozymes showed efficient catalytic activity to each own substrate mecR1 or blaR1 in vitro and caused the reduction of mecR1 and blaR1 transcription in vivo. Furthermore, simultaneous administration of two DNAzymes to knockdown mecR1 and blaR1 resulted in increased susceptibility of all MRSA strains tested in this study. CONCLUSIONS These results demonstrated that combined use of the two specific phosphorothioate deoxyribozymes could be a viable and promising strategy to restore the susceptibility of almost all MRSA clinical isolates.
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Affiliation(s)
- Zheng Hou
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, China
- Zheng Hou and Ying Zhou contributed equally to this study
| | - Ying Zhou
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, China
- Zheng Hou and Ying Zhou contributed equally to this study
| | - Haifang Wang
- Faculty of Life Sciences, Northwestern Polytechnical University, Xi’an, Shaanxi, China
| | - Hui Bai
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, China
| | - Jingru Meng
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, China
| | - Xiaoyan Xue
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, China
| | - Xiaoxing Luo
- Department of Pharmacology, School of Pharmacy, Fourth Military Medical University, China
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De Bus L, Depuydt P, Libbrecht L, Vandekerckhove L, Nollet J, Benoit D, Vogelaers D, Van Vlierberghe H. Severe drug-induced liver injury associated with prolonged use of linezolid. J Med Toxicol 2010; 6:322-6. [PMID: 20358416 PMCID: PMC3550492 DOI: 10.1007/s13181-010-0047-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
This study aims to describe a patient developing concomitant severe liver failure and lactic acidosis after long-term treatment with linezolid. A 55-year-old Caucasian woman developed concomitant severe liver failure and lactic acidosis after a treatment with linezolid for 50 days because of infected hip prosthesis. Other causes of liver failure and lactic acidosis were excluded by extensive diagnostic workup. A liver biopsy showed microvesicular steatosis. As linezolid toxicity was considered to be the cause of the lactic acidosis and the severe hepatic failure, the antibiotic was withdrawn. After 4 days of supportive therapy and hemodialysis, the serum lactate level returned within normal limits. The prothrombin time ratio and thrombocytes recovered within 2 weeks. Bilirubin levels normalized within 14 weeks. Since no other cause could be identified, liver injury was considered to be drug-related. Resolution of the hepatotoxicity occurred after discontinuation of linezolid, supportive treatment measures, and hemodialysis. Both lactic acidosis and microvesicular steatosis after the use of linezolid are related to mitochondrial dysfunction. The Council for International Organizations of Medical Sciences/Roussel Ucalf Causality Assessment Method scale revealed that the adverse drug event was probable. Prolonged exposure to linezolid may induce severe hepatotoxicity. Clinicians should be aware of this possible adverse effect especially in case of long-term treatment.
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Affiliation(s)
- Liesbet De Bus
- Department of Intensive Care, University Hospital, 12K12IB, 185 De Pintelaan, 9000, Ghent, Belgium.
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Renslo AR. Antibacterial oxazolidinones: emerging structure-toxicity relationships. Expert Rev Anti Infect Ther 2010; 8:565-74. [PMID: 20455685 DOI: 10.1586/eri.10.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The oxazolidinones are an important class of synthetic bacterial protein synthesis inhibitors with activity against Gram-positive and some fastidious Gram-negative bacteria. Key toxicological issues with the class include reversible inhibition of monoamine oxidase enzymes and reversible myelosuppression that can occur in patients treated for longer than the recommended course of therapy. Recent studies have uncovered the likely molecular mechanism underlying oxazolidinone-related myelosuppression and other toxicities, and these will be discussed here. Also reviewed are recent reports of structural modifications that can attenuate one or more of the undesired effects of oxazolidinones, while retaining the desired antibacterial effect.
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Affiliation(s)
- Adam R Renslo
- Department of Pharmaceutical Chemistry and the Small Molecule Discovery Center, University of California, San Francisco, 1700 4th Street, San Francisco, CA 94158, USA.
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Raponi G, Ghezzi MC, Gherardi G, Lorino G, Dicuonzo G. Analysis of methods commonly used for glycopeptide and oxazolidinone susceptibility testing in Enterococcus faecium isolates. J Med Microbiol 2010; 59:672-678. [DOI: 10.1099/jmm.0.016444-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The susceptibility to teicoplanin, vancomycin and linezolid of 30 clinical isolates of Enterococcus faecium was tested by Vitek 2, Phoenix, Etest, broth microdilution and disc diffusion tests. The vanA and vanB resistance genes and the 23S rRNA gene G2576T mutation were detected by PCR and PCR-RFLP, respectively. Resistance rates to teicoplanin ranged from 3 % for Vitek 2 to 57.6 % for the Phoenix test, and those to vancomycin ranged from 56.7 % for Vitek 2 to 86.7 % for the Phoenix test. Only two out of 25 strains carrying the vanA gene were univocally recognized as the VanA phenotype. The only strain with the G2576T mutation did not carry the vanA gene and showed resistance to linezolid by the disc diffusion, Vitek 2 and broth dilution methods (MIC >8 μg ml−1), but was susceptible when tested with the Phoenix test and Etest (MIC ≤4 μg ml−1). Therefore, the resistance to glycopeptides and linezolid was not univocally detected by the susceptibility testing methods used in this study.
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Affiliation(s)
- Giammarco Raponi
- Dipartimento di Scienze di Sanità Pubblica, ‘Sapienza’ University of Rome, Rome, Italy
| | - Maria Cristina Ghezzi
- Dipartimento di Scienze di Sanità Pubblica, ‘Sapienza’ University of Rome, Rome, Italy
| | - Giovanni Gherardi
- Dipartimento di Scienze Biomediche, ‘Campus Bio-Medico’ University, Rome, Italy
| | - Giulia Lorino
- Dipartimento di Scienze di Sanità Pubblica, ‘Sapienza’ University of Rome, Rome, Italy
| | - Giordano Dicuonzo
- Dipartimento di Scienze Biomediche, ‘Campus Bio-Medico’ University, Rome, Italy
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Linezolid an oral treatment option for staphylococcal liver abscess in chronic granulomatous disease. Pediatr Infect Dis J 2009; 28:1036-7. [PMID: 19859022 DOI: 10.1097/inf.0b013e3181ba6caa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pneumonia due to methicillin-resistant Staphylococcus aureus: clinical features, diagnosis and management. Curr Opin Pulm Med 2009; 15:218-22. [PMID: 19373090 DOI: 10.1097/mcp.0b013e3283292666] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The review highlights the clinical findings and the management of community-acquired, health-care associated and nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). RECENT FINDINGS Although previously considered as a purely nosocomial event, community-acquired MRSA pneumonia is underestimated and is spreading worldwide. A retrospective study showed that almost half of patients with nonnosocomial MRSA pneumonia admitted to a large teaching hospital did not present established criteria for healthcare-associated infections. Recent data show that MRSA ventilator-associated pneumonia is associated with significantly higher mortality than ventilator-associated pneumonia caused by methicillin-susceptible Staphylococcus aureus. Therefore, prompt and appropriate therapy is essential. The optimal therapy for MRSA pneumonia has not been fully elucidated. Although vancomycin has been considered the gold standard for the treatment of MRSA infections, clinical failures have also been reported in the presence of in-vitro susceptibility. Linezolid may provide improved outcomes compared with vancomycin in patients with MRSA pneumonia, but validation in a prospective trial is currently lacking. Recently licensed tigecycline and dalbavancin, a drug in phase III trial, look promising. Animal models showed that immunization against a cytolytic toxin secreted by most Staphylococcus aureus strains protects against lethal pneumonia. SUMMARY Rapid recognition of possible staphylococcal infection in patients with severe pneumonia is essential. The treatment of MRSA pneumonia must be prompt and effective in order to allow a fast microbiological clearance and to successfully manage the infection.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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