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Pasteran F, Wong O, Mezcord V, Lopez C, Georgeos N, Fua V, Ozuna A, Ramlaoui D, Sánchez C, Marchetti P, Corso A, Tolmasky ME, Bonomo RA, Ramirez MS. Comparison of available methods to evaluate cefiderocol susceptibility in Acinetobacter spp. J Microbiol Methods 2024; 223:106972. [PMID: 38871227 DOI: 10.1016/j.mimet.2024.106972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
Recently, considerable uncertainty has arisen concerning the appropriate susceptibility testing for cefiderocol in gram-negative bacilli, particularly in the context of its application to Acinetobacter spp. The optimal method for assessing the susceptibility levels of Acinetobacter spp. to cefiderocol remains a subject of debate due to substantial disparities observed in the values obtained through various testing procedures. This study employed four minimum inhibitory concentration (MIC) methodologies and the disk diffusion to assess the susceptibility of twenty-seven carbapenem resistant (CR)-Acinetobacter strains to cefiderocol. The results from our study reveal significant variations in the minimum inhibitory concentration (MIC) values obtained with the different methods and in the level of agreement in interpretation categories between the different MIC methods and the disk diffusion test. Among the MIC methods, there was relatively more consistency in reporting the interpretation categories. For European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints, the categorical agreement (CA) for MIC methods ranged between 66.7 and 81.5%. On the other hand, the essential agreement (EA) values were as low as 18.5-29.6%. The CA between MIC methods and disk diffusion was 81.5%. These results emphasize the need for a reliable, accurate, and clinically validated methodology to effectively assess the susceptibility of Acinetobacter spp. to cefiderocol. The wide variability observed in our study highlights the importance of standardizing the susceptibility testing process for cefiderocol to ensure consistent and reliable results for clinical decision-making.
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Affiliation(s)
- Fernando Pasteran
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Olivia Wong
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, USA
| | - Vyanka Mezcord
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, USA
| | - Christina Lopez
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Nardin Georgeos
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Venjaminne Fua
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Alonzo Ozuna
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Dema Ramlaoui
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Cristian Sánchez
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Paulina Marchetti
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Alejandra Corso
- Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, Antimicrobial Service of the National Institute of Infectious Diseases (ANLIS Dr. Carlos G. Malbrán), Buenos Aires, Argentina
| | - Marcelo E Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, USA
| | - Robert A Bonomo
- Research Service and Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Case Western Reserve University (CWRU)-Cleveland Veterans Affairs Medical Center (VAMC) Center for Antimicrobial Resistance and Epidemiology, Case VA Center for Antimicrobial Resistance and Epidemiology (CARES), Cleveland, OH, USA
| | - María Soledad Ramirez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, USA.
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Idris N, Leong KH, Wong EH, Abdul Rahim N. Unveiling synergism of polymyxin B with chloramphenicol derivatives against multidrug-resistant (MDR) Klebsiella pneumoniae. J Antibiot (Tokyo) 2023; 76:711-719. [PMID: 37821539 DOI: 10.1038/s41429-023-00659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
Polymyxins are last-line antibiotics against multidrug-resistant Klebsiella pneumoniae but using polymyxins alone may not be effective due to emerging resistance. A previous study found that combining polymyxin B with chloramphenicol effectively kills MDR K. pneumoniae, although the bone marrow toxicity of chloramphenicol is concerning. The aim of this study is to assess the antibacterial efficacy and cytotoxicity of polymyxin B when combined with chloramphenicol and its derivatives, namely thiamphenicol and florfenicol (reported to have lesser toxicity compared to chloramphenicol). The antibacterial activity was evaluated with antimicrobial susceptibility testing using broth microdilution and time-kill assays, while the cytotoxic effect on normal bone marrow cell line, HS-5 was evaluated using the MTT assay. All bacterial isolates tested were found to be susceptible to polymyxin B, but resistant to chloramphenicol, thiamphenicol, and florfenicol when used alone. The use of polymyxin B alone showed bacterial regrowth for all isolates at 24 h. The combination of polymyxin B and florfenicol demonstrated additive and synergistic effects against all isolates (≥ 2 log10 cfu ml-1 reduction) at 4 and 24 h, respectively, while the combination of polymyxin B and thiamphenicol resulted in synergistic killing at 24 h against ATCC BAA-2146. Furthermore, the combination of polymyxin B with florfenicol had the lowest cytotoxic effect on the HS-5 cells compared to polymyxin B combination with chloramphenicol and thiamphenicol. Overall, the combination of polymyxin B with florfenicol enhanced bacterial killing against MDR K. pneumoniae and exerted minimal cytotoxic effect on HS-5 cell line.
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Affiliation(s)
- Nurulain Idris
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Kok Hoong Leong
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Eng Hwa Wong
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Malaysia
- Medical Advancement for Better Quality of Life Impact Lab, Taylor's University, 47500, Subang Jaya, Malaysia
| | - Nusaibah Abdul Rahim
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Mezcord V, Escalante J, Nishimura B, Traglia GM, Sharma R, Vallé Q, Tuttobene MR, Subils T, Marin I, Pasteran F, Actis LA, Tolmasky ME, Bonomo RA, Rao G, Ramirez MS. Induced Heteroresistance in Carbapenem-Resistant Acinetobacter baumannii (CRAB) via Exposure to Human Pleural Fluid (HPF) and Its Impact on Cefiderocol Susceptibility. Int J Mol Sci 2023; 24:11752. [PMID: 37511511 PMCID: PMC10380697 DOI: 10.3390/ijms241411752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Infections caused by Carbapenem-resistant Acinetobacter baumannii (CRAB) isolates, such as hospital-acquired pneumonia (HAP), bacteremia, and skin and soft tissue infections, among others, are particularly challenging to treat. Cefiderocol, a chlorocatechol-substituted siderophore antibiotic, was approved by the U.S. Food and Drug Administration (FDA) in 2019 and prescribed for the treatment of CRAB infections. Despite the initial positive treatment outcomes with this antimicrobial, recent studies reported a higher-than-average all-cause mortality rate in patients treated with cefiderocol compared to the best available therapy. The cause(s) behind these outcomes remains unconfirmed. A plausible hypothesis is heteroresistance, a phenotype characterized by the survival of a small proportion of cells in a population that is seemingly isogenic. Recent results have demonstrated that the addition of human fluids to CRAB cultures leads to cefiderocol heteroresistance. Here, we describe the molecular and phenotypic analyses of CRAB heteroresistant bacterial subpopulations to better understand the nature of the less-than-expected successful outcomes after cefiderocol treatment. Isolation of heteroresistant variants of the CRAB strain AMA40 was carried out in cultures supplemented with cefiderocol and human pleural fluid (HPF). Two AMA40 variants, AMA40 IHC1 and IHC2, were resistant to cefiderocol. To identify mutations and gene expression changes associated with cefiderocol heteroresistance, we subjected these variants to whole genome sequencing and global transcriptional analysis. We then assessed the impact of these mutations on the pharmacodynamic activity of cefiderocol via susceptibility testing, EDTA and boronic acid inhibition analysis, biofilm formation, and static time-kill assays. Heteroresistant variants AMA40 IHC1 and AMA40 IHC2 have 53 chromosomal mutations, of which 40 are common to both strains. None of the mutations occurred in genes associated with high affinity iron-uptake systems or β-lactam resistance. However, transcriptional analyses demonstrated significant modifications in levels of expression of genes associated with iron-uptake systems or β-lactam resistance. The blaNDM-1 and blaADC-2, as well as various iron-uptake system genes, were expressed at higher levels than the parental strain. On the other hand, the carO and ompA genes' expression was reduced. One of the mutations common to both heteroresistant strains was mapped within ppiA, a gene associated with iron homeostasis in other species. Static time-kill assays demonstrated that supplementing cation-adjusted Mueller-Hinton broth with human serum albumin (HAS), the main protein component of HPF, considerably reduced cefiderocol killing activity for all three strains tested. Notably, collateral resistance to amikacin was observed in both variants. We conclude that exposing CRAB to fluids with high HSA concentrations facilitates the rise of heteroresistance associated with point mutations and transcriptional upregulation of genes coding for β-lactamases and biofilm formation. The findings from this study hold significant implications for understanding the emergence of CRAB resistance mechanisms against cefiderocol treatment. This understanding is vital for the development of treatment guidelines that can effectively address the challenges posed by CRAB infections.
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Affiliation(s)
- Vyanka Mezcord
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (V.M.)
| | - Jenny Escalante
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (V.M.)
| | - Brent Nishimura
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (V.M.)
| | - German M. Traglia
- Unidad de Genómica y Bioinformática, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Universidad de la República, Salto 50000, Uruguay
| | - Rajnikant Sharma
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA (Q.V.)
| | - Quentin Vallé
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA (Q.V.)
| | - Marisel R. Tuttobene
- Área Biología Molecular, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario 2000, Argentina
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR), Rosario 2000, Argentina
| | - Tomás Subils
- Instituto de Procesos Biotecnológicos y Químicos de Rosario (IPROBYQ, CONICET-UNR), Rosario 2000, Argentina
| | - Ingrid Marin
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (V.M.)
| | - Fernando Pasteran
- National Regional Reference Laboratory for Antimicrobial Resistance (NRL), Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires 1282, Argentina
| | - Luis A. Actis
- Department of Microbiology, Miami University, Oxford, OH 45056, USA
| | - Marcelo E. Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (V.M.)
| | - Robert A. Bonomo
- Research Service and GRECC, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, USA
- Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Biochemistry, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH 44106, USA
| | - Gauri Rao
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA (Q.V.)
| | - María S. Ramirez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA 92831, USA; (V.M.)
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Deusdará TT, Félix MKC, de S Brito H, Cangussu EWS, de S Moura W, Albuquerque B, Silva MG, Dos Santos GR, de Morais PB, da Silva EF, Chaves YO, Mariúba LAM, Nogueira PA, Astolfi-Filho S, Assunção EN, Epiphanio S, Marinho CRF, Brandi IV, Viana KF, Oliveira EE, Cangussu ASR. Using an Aluminum Hydroxide–Chitosan Matrix Increased the Vaccine Potential and Immune Response of Mice against Multi-Drug-Resistant Acinetobacter baumannii. Vaccines (Basel) 2023; 11:vaccines11030669. [PMID: 36992253 DOI: 10.3390/vaccines11030669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Acinetobacter baumannii is a Gram-negative, immobile, aerobic nosocomial opportunistic coccobacillus that causes pneumonia, septicemia, and urinary tract infections in immunosuppressed patients. There are no commercially available alternative antimicrobials, and multi-drug resistance is an urgent concern that requires emergency measures and new therapeutic strategies. This study evaluated a multi-drug-resistant A. baumannii whole-cell vaccine, inactivated and adsorbed on an aluminum hydroxide–chitosan (mAhC) matrix, in an A. baumannii sepsis model in immunosuppressed mice by cyclophosphamide (CY). CY-treated mice were divided into immunized, non-immunized, and adjuvant-inoculated groups. Three vaccine doses were given at 0D, 14D, and 28D, followed by a lethal dose of 4.0 × 108 CFU/mL of A. baumannii. Immunized CY-treated mice underwent a significant humoral response, with the highest IgG levels and a higher survival rate (85%); this differed from the non-immunized CY-treated mice, none of whom survived (p < 0.001), and from the adjuvant group, with 45% survival (p < 0.05). Histological data revealed the evident expansion of white spleen pulp from immunized CY-treated mice, whereas, in non-immunized and adjuvanted CY-treated mice, there was more significant organ tissue damage. Our results confirmed the proof-of-concept of the immune response and vaccine protection in a sepsis model in CY-treated mice, contributing to the advancement of new alternatives for protection against A. baumannii infections.
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Affiliation(s)
- Túllio T Deusdará
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
| | - Mellanie K C Félix
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
| | - Helio de S Brito
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
| | - Edson W S Cangussu
- Graduate Program in Biotechnology, Federal University of Tocantins, Gurupi 77425-000, TO, Brazil
| | - Wellington de S Moura
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
| | - Benedito Albuquerque
- Graduate Program in Biotechnology, Federal University of Tocantins, Gurupi 77425-000, TO, Brazil
| | - Marcos G Silva
- Graduate Program in Biotechnology, Federal University of Tocantins, Gurupi 77425-000, TO, Brazil
| | - Gil R Dos Santos
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
- Graduate Program in Biotechnology, Federal University of Tocantins, Gurupi 77425-000, TO, Brazil
| | - Paula B de Morais
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
| | - Elizangela F da Silva
- Instituto Leônidas e Maria Deane, Oswaldo Cruz Foundation-Fiocruz Amazônia, Manaus 69057-070, AM, Brazil
| | - Yury O Chaves
- Instituto Leônidas e Maria Deane, Oswaldo Cruz Foundation-Fiocruz Amazônia, Manaus 69057-070, AM, Brazil
| | - Luis Andre M Mariúba
- Instituto Leônidas e Maria Deane, Oswaldo Cruz Foundation-Fiocruz Amazônia, Manaus 69057-070, AM, Brazil
| | - Paulo A Nogueira
- Instituto Leônidas e Maria Deane, Oswaldo Cruz Foundation-Fiocruz Amazônia, Manaus 69057-070, AM, Brazil
| | - Spartaco Astolfi-Filho
- Laboratory of DNA Technology, Biotechnology Department, Multidisciplinary Support Center, Federal University of Amazonas, Manaus 69080-900, AM, Brazil
| | - Enedina N Assunção
- Laboratory of DNA Technology, Biotechnology Department, Multidisciplinary Support Center, Federal University of Amazonas, Manaus 69080-900, AM, Brazil
| | - Sabrina Epiphanio
- Department of Immunology, Biomedical Science Institute, University of São Paulo (USP), São Paulo 05508-060, SP, Brazil
| | - Claudio R F Marinho
- Department of Immunology, Biomedical Science Institute, University of São Paulo (USP), São Paulo 05508-060, SP, Brazil
| | - Igor V Brandi
- Institute of Agricultural Sciences, Federal University of Minas Gerais, Montes Claros 39400-310, MG, Brazil
- Department of Biotchnology, State University of Montes Claros, Montes Claros 39401-089, MG, Brazil
| | - Kelvinson F Viana
- Interdisciplinary Center for Life Sciences and Nature, Federal University of Latin American Integration (UNILA), Foz do Iguaçu 85866-000, PR, Brazil
| | - Eugenio E Oliveira
- Graduate Program in Biotechnology, Federal University of Tocantins, Gurupi 77425-000, TO, Brazil
- Departamento de Entomologia, Universidade Federal de Viçosa, Viçosa 36570-900, MG, Brazil
| | - Alex Sander R Cangussu
- Graduate Program for Biodiversity and Biotechnology of Legal Amazon, Federal University of Tocantins, Palmas 77001-090, TO, Brazil
- Graduate Program in Biotechnology, Federal University of Tocantins, Gurupi 77425-000, TO, Brazil
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Qu X, Bian X, Chen Y, Hu J, Huang X, Wang Y, Fan Y, Wu H, Li X, Li Y, Guo B, Liu X, Zhang J. Polymyxin B Combined with Minocycline: A Potentially Effective Combination against blaOXA-23-harboring CRAB in In Vitro PK/PD Model. Molecules 2022; 27:molecules27031085. [PMID: 35164349 PMCID: PMC8840471 DOI: 10.3390/molecules27031085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
Abstract
Polymyxin-based combination therapy is commonly used to treat carbapenem-resistant Acinetobacter baumannii (CRAB) infections. In the present study, the bactericidal effect of polymyxin B and minocycline combination was tested in three CRAB strains containing blaOXA-23 by the checkerboard assay and in vitro dynamic pharmacokinetics/pharmacodynamics (PK/PD) model. The combination showed synergistic or partial synergistic effect (fractional inhibitory concentration index ≤0.56) on the tested strains in checkboard assays. The antibacterial activity was enhanced in the combination group compared with either monotherapy in in vitro PK/PD model. The combination regimen (simultaneous infusion of 0.75 mg/kg polymyxin B and 100 mg minocycline via 2 h infusion) reduced bacterial colony counts by 0.9–3.5 log10 colony forming units per milliliter (CFU/mL) compared with either drug alone at 24 h. In conclusion, 0.75 mg/kg polymyxin B combined with 100 mg minocycline via 2 h infusion could be a promising treatment option for CRAB bloodstream infections.
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Affiliation(s)
- Xingyi Qu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Phase I Unit, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xingchen Bian
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Department of Biological Medicines & Shanghai Engineering Research Center of Immunotherapeutics, School of Pharmacy, Fudan University, Shanghai 201203, China
| | - Yuancheng Chen
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Phase I Unit, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jiali Hu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Xiaolan Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Yu Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Hailan Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Xin Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Yi Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Correspondence: (X.L.); (J.Z.); Tel.: +86-21-52888190 (J.Z.)
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai 200040, China; (X.Q.); (X.B.); (J.H.); (X.H.); (Y.W.); (Y.F.); (H.W.); (X.L.); (Y.L.); (B.G.)
- Key Laboratory of Clinical Pharmacology of Antibiotics, Shanghai 200040, China
- National Health Commission & National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China;
- Phase I Unit, Huashan Hospital, Fudan University, Shanghai 200040, China
- Correspondence: (X.L.); (J.Z.); Tel.: +86-21-52888190 (J.Z.)
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Sørensen PE, Ng DYK, Duchateau L, Ingmer H, Garmyn A, Butaye P. Classification of In Vitro Phage-Host Population Growth Dynamics. Microorganisms 2021; 9:2470. [PMID: 34946072 PMCID: PMC8708399 DOI: 10.3390/microorganisms9122470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
The therapeutic use of bacteriophages (phage therapy) represents a promising alternative to antibiotics to control bacterial pathogens. However, the understanding of the phage-bacterium interactions and population dynamics seems essential for successful phage therapy implementation. Here, we investigated the effect of three factors: phage species (18 lytic E. coli-infecting phages); bacterial strain (10 APEC strains); and multiplicity of infection (MOI) (MOI 10, 1, and 0.1) on the bacterial growth dynamics. All factors had a significant effect, but the phage appeared to be the most important. The results showed seven distinct growth patterns. The first pattern corresponded to the normal bacterial growth pattern in the absence of a phage. The second pattern was complete bacterial killing. The remaining patterns were in-between, characterised by delayed growth and/or variable killing of the bacterial cells. In conclusion, this study demonstrates that the phage-host dynamics is an important factor in the capacity of a phage to eliminate bacteria. The classified patterns show that this is an essential factor to consider when developing a phage therapy. This methodology can be used to rapidly screen for novel phage candidates for phage therapy. Accordingly, the most promising candidates were phages found in Group 2, characterised by growth dynamics with high bacterial killing.
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Affiliation(s)
- Patricia E. Sørensen
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.G.); (P.B.)
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre 42123, Saint Kitts and Nevis
| | - Duncan Y. K. Ng
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, 2300 Copenhagen, Denmark;
| | - Luc Duchateau
- Biometrics Research Center, Ghent University, 9820 Merelbeke, Belgium;
| | - Hanne Ingmer
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark;
| | - An Garmyn
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.G.); (P.B.)
| | - Patrick Butaye
- Department of Pathobiology, Pharmacology and Zoological Medicine, Ghent University, 9820 Merelbeke, Belgium; (A.G.); (P.B.)
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre 42123, Saint Kitts and Nevis
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7
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Shukla SK, Sharma AK, Gupta V, Kalonia A, Shaw P. Challenges with Wound Infection Models in Drug Development. Curr Drug Targets 2021; 21:1301-1312. [PMID: 32116189 DOI: 10.2174/1389450121666200302093312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 01/05/2023]
Abstract
Wound research is an evolving science trying to unfold the complex untold mechanisms behind the wound healing cascade. In particular, interest is growing regarding the role of microorganisms in both acute and chronic wound healing. Microbial burden plays an important role in the persistence of chronic wounds, ultimately resulting in delayed wound healing. It is therefore important for clinicians to understand the evolution of infection science and its various etiologies. Therefore, to understand the role of bacterial biofilm in chronic wound pathogenesis, various in vitro and in vivo models are required to investigate biofilms in wound-like settings. Infection models should be refined comprising an important signet of biofilms. These models are eminent for translational research to obtain data for designing an improved wound care formulation. However, all the existing models possess limitations and do not fit properly in the model frame for developing wound care agents. Among various impediments, one of the major drawbacks of such models is that the wound they possess does not mimic the wound a human develops. Therefore, a novel wound infection model is required which can imitate the human wounds. This review article mainly discusses various in vitro and in vivo models showing microbial colonization, their advantages and challenges. Apart from these models, there are also present ex vivo wound infection models, but this review mainly focused on various in vitro and in vivo models available for studying wound infection in controlled conditions. This information might be useful in designing an ideal wound infection model for developing an effective wound healing formulation.
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Affiliation(s)
- Sandeep K Shukla
- Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, SK Mazumdar Marg, Timarpur, Delhi-110054, India
| | - Ajay K Sharma
- Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, SK Mazumdar Marg, Timarpur, Delhi-110054, India
| | - Vanya Gupta
- Graphic Era deemed to be University, Dehradun, India
| | - Aman Kalonia
- Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, SK Mazumdar Marg, Timarpur, Delhi-110054, India
| | - Priyanka Shaw
- Institute of Nuclear Medicine & Allied Sciences, Defence Research and Development Organization, SK Mazumdar Marg, Timarpur, Delhi-110054, India
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Namivandi-Zangeneh R, Wong EHH, Boyer C. Synthetic Antimicrobial Polymers in Combination Therapy: Tackling Antibiotic Resistance. ACS Infect Dis 2021; 7:215-253. [PMID: 33433995 DOI: 10.1021/acsinfecdis.0c00635] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Antibiotic resistance is a critical global healthcare issue that urgently needs new effective solutions. While small molecule antibiotics have been safeguarding us for nearly a century since the discovery of penicillin by Alexander Fleming, the emergence of a new class of antimicrobials in the form of synthetic antimicrobial polymers, which was driven by the advances in controlled polymerization techniques and the desire to mimic naturally occurring antimicrobial peptides, could play a key role in fighting multidrug resistant bacteria in the near future. By harnessing the ability to control chemical and structural properties of polymers almost at will, synthetic antimicrobial polymers can be strategically utilized in combination therapy with various antimicrobial coagents in different formats to yield more potent (synergistic) outcomes. In this review, we present a short summary of the different combination therapies involving synthetic antimicrobial polymers, focusing on their combinations with nitric oxide, antibiotics, essential oils, and metal- and carbon-based inorganics.
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Affiliation(s)
- Rashin Namivandi-Zangeneh
- Centre for Advanced Macromolecular Design (CAMD) and Australian Centre for NanoMedicine (ACN), School of Chemical Engineering, UNSW Australia, Sydney, New South Wales 2052, Australia
| | - Edgar H. H. Wong
- Centre for Advanced Macromolecular Design (CAMD) and Australian Centre for NanoMedicine (ACN), School of Chemical Engineering, UNSW Australia, Sydney, New South Wales 2052, Australia
| | - Cyrille Boyer
- Centre for Advanced Macromolecular Design (CAMD) and Australian Centre for NanoMedicine (ACN), School of Chemical Engineering, UNSW Australia, Sydney, New South Wales 2052, Australia
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Qu J, Yu R, Wang Q, Feng C, Lv X. Synergistic Antibacterial Activity of Combined Antimicrobials and the Clinical Outcome of Patients With Carbapenemase-Producing Acinetobacter baumannii Infection. Front Microbiol 2020; 11:541423. [PMID: 33178144 PMCID: PMC7593402 DOI: 10.3389/fmicb.2020.541423] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
This study aimed to explore the activity of combined antimicrobials in vitro, and the relationship among resistance mechanisms, antimicrobial regimens, and the clinical outcome of patients with carbapenem-resistant Acinetobacter baumannii (CRAB) infections in western China. A total of 89 CRAB strains were collected from patients with CRAB infection from January 2018 to June 2018. The checkerboard assay was used to study the combined effects in vitro. Carbapenemase-encoding genes were detected by polymerase chain reaction (PCR) or multiplex PCR technique. The clinical data of 86 patients were collected. CRAB showed high susceptibility to tigecycline (91.01% inhibition) and polymyxin (83.15% inhibition). Polymyxin plus sulbactam exhibited the highest synergistic effect at a rate of 82.35%. Production of carbapenemase (blaOXA–23) was the main resistance mechanism of CRAB to carbapenem (95.35%). Excessive expression of active efflux pump genes (adeB, adeJ, and abeM) and deletion of the CarO protein accounted for 13.95% (12/86) and 84.88% (73/86), respectively. The synergistic effect of the sulbactam-based combination was higher than that of the polymyxin B-tigecycline combination for carbapenemase-producing CRAB (P < 0.05). The clinical outcome was not affected by the resistance mechanisms (P > 0.05). Advanced age, multiple organ dysfunction syndromes (MODS), and admission to the intensive care unit (ICU) were associated with treatment failure (P < 0.05). Appropriate antibiotic therapy did not improve the clinical outcome of critically ill patients. Higher minimum inhibitory concentrations (MICs) of tigecycline were associated with treatment failure (P < 0.05). A multivariate analysis showed that ICU stay (OR = 15.123, 95% CI: 2.600–87.951, P = 0.002) and procalcitonin ≥2 ng/ml (OR = 2.636, 95% CI: 1.173–5.924, P = 0.019) were the risk factors for treatment failure. In conclusion, this study demonstrated that the sulbactam-based combination exhibited a synergistic effect in vitro. The clinical outcome of patients was not associated with resistance mechanisms. This indicates that the early control of the progression from infection to severe disease may be important.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Rujia Yu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Qujue Wang
- Department of Infectious Diseases, Renshou County People's Hospital, Renshou, China
| | - Chunlu Feng
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
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10
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Hyaluronic acid and antimicrobial peptide-modified gold/silver hybrid nanocages to combat bacterial multidrug resistance. Int J Pharm 2020; 586:119505. [DOI: 10.1016/j.ijpharm.2020.119505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/16/2020] [Accepted: 06/01/2020] [Indexed: 01/20/2023]
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11
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Wang B, Zhang P, Li Y, Wang Y. Klebsiella pneumoniae-induced multiple invasive abscesses: A case report and literature review. Medicine (Baltimore) 2019; 98:e17362. [PMID: 31574882 PMCID: PMC6775414 DOI: 10.1097/md.0000000000017362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Klebsiella pneumoniae infection can induce multiple invasive abscesses, and the invasive infection is severe and life-threatening. PATIENT CONCERNS A 69-year-old previously healthy Chinese male presented with fever, chill, backache, and ocular pain. DIAGNOSIS The blood culture results indicated Klebsiella pneumoniae of the K1 serotype. Multiple invasive abscesses in liver, lung, eye, soft tissue, and central nervous system were identified by imaging examination. Subsequently, the patient experienced right ocular pain accompanied by visual disturbance. Tyndall sign was strongly positive, and lens opacity was observed by the ophthalmologist. INTERVENTIONS Full-dose and long-term treatment with meropenem was performed. Intraventricular injection of glass and anterior chamber puncture with antibiotics were performed twice. The patient also underwent an evacuation of the brain abscess. OUTCOMES The patient's headache and lumbar backache were relieved, his ophthalmodynia disappeared, and his vision recovered after nearly 3 months of treatment. LESSONS Imaging examination is very important for severe Klebsiella pneumoniae infection. The choice of antibiotics is complex, and the antimicrobial regimen should be adjusted according to the assessment of illness and the therapeutic effect. Surgical intervention must be considered for patients with multiple invasive abscesses.
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12
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Fragkou PC, Poulakou G, Blizou A, Blizou M, Rapti V, Karageorgopoulos DE, Koulenti D, Papadopoulos A, Matthaiou DK, Tsiodras S. The Role of Minocycline in the Treatment of Nosocomial Infections Caused by Multidrug, Extensively Drug and Pandrug Resistant Acinetobacter baumannii: A Systematic Review of Clinical Evidence. Microorganisms 2019; 7:microorganisms7060159. [PMID: 31159398 PMCID: PMC6617316 DOI: 10.3390/microorganisms7060159] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022] Open
Abstract
Treatment options for multidrug resistant Acinetobacter baumannii strains (MDR-AB) are limited. Minocycline has been used alone or in combination in the treatment of infections associated with AB. A systematic review of the clinical use of minocycline in nosocomial infections associated with MDR-AB was performed according to the PRISMA-P guidelines. PubMed-Medline, Scopus and Web of Science TM databases were searched from their inception until March 2019. Additional Google Scholar free searches were performed. Out of 2990 articles, 10 clinical studies (9 retrospective case series and 1 prospective single center trial) met the eligibility criteria. In total, 223 out of 268 (83.2%) evaluated patients received a minocycline-based regimen; and 200 out of 218 (91.7%) patients with available data received minocycline as part of a combination antimicrobial regimen (most frequently colistin or carbapenems). Pneumonia was the most common infection type in the 268 cases (80.6% with 50.4% ventilator-associated pneumonia). The clinical and microbiological success rates following minocycline treatment were 72.6% and 60.2%, respectively. Mortality was 20.9% among 167 patients with relevant data. In this systematic review, minocycline demonstrated promising activity against MDR-AB isolates. This review sets the ground for further studies exploring the role of minocycline in the treatment of MDR-AB associated infections.
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Affiliation(s)
- Paraskevi C Fragkou
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Garyfallia Poulakou
- rd Department of Medicine, Sotiria General Hospital, National and Kapodistrian University of Athens, Athens, 11527, Greece.
| | - Andromachi Blizou
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Myrto Blizou
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Vasiliki Rapti
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Drosos E Karageorgopoulos
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Despoina Koulenti
- Adult Critical Care Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
- TCCRC, UQCCR, Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia.
| | - Antonios Papadopoulos
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Dimitrios K Matthaiou
- Adult Critical Care Unit, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
| | - Sotirios Tsiodras
- th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, 12462, Greece.
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13
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Zhu W, Wang Y, Cao W, Cao S, Zhang J. In vitro evaluation of antimicrobial combinations against imipenem-resistant Acinetobacter baumannii of different MICs. J Infect Public Health 2018; 11:856-860. [DOI: 10.1016/j.jiph.2018.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/06/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022] Open
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14
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Antibiotic resistance of pathogenic Acinetobacter species and emerging combination therapy. J Microbiol 2017; 55:837-849. [PMID: 29076065 DOI: 10.1007/s12275-017-7288-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 01/08/2023]
Abstract
The increasing antibiotic resistance of Acinetobacter species in both natural and hospital environments has become a serious problem worldwide in recent decades. Because of both intrinsic and acquired antimicrobial resistance (AMR) against last-resort antibiotics such as carbapenems, novel therapeutics are urgently required to treat Acinetobacter-associated infectious diseases. Among the many pathogenic Acinetobacter species, A. baumannii has been reported to be resistant to all classes of antibiotics and contains many AMR genes, such as bla ADC (Acinetobacter-derived cephalosporinase). The AMR of pathogenic Acinetobacter species is the result of several different mechanisms, including active efflux pumps, mutations in antibiotic targets, antibiotic modification, and low antibiotic membrane permeability. To overcome the limitations of existing drugs, combination theraphy that can increase the activity of antibiotics should be considered in the treatment of Acinetobacter infections. Understanding the molecular mechanisms behind Acinetobacter AMR resistance will provide vital information for drug development and therapeutic strategies using combination treatment. Here, we summarize the classic mechanisms of Acinetobacter AMR, along with newly-discovered genetic AMR factors and currently available antimicrobial adjuvants that can enhance drug efficacy in the treatment of A. baumannii infections.
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15
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Li J, Yang X, Chen L, Duan X, Jiang Z. In Vitro Activity of Various Antibiotics in Combination with Tigecycline Against Acinetobacter baumannii: A Systematic Review and Meta-Analysis. Microb Drug Resist 2017; 23:982-993. [PMID: 28437233 DOI: 10.1089/mdr.2016.0279] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Given that tigecycline-based combination therapy is recognized as a valuable option for the treatment of tigecycline-resistant Acinetobacter baumannii, we conducted this systematic review and meta-analysis to assess the overall evidence of its effectiveness. The synergy rate was defined as the primary outcome that was calculated separately for time-kill, Etest, and checkerboard microdilution methods. The secondary outcomes were bactericidal activity and the efficacy of combination treatment on the development of resistance. In total, 37 published papers and 16 conference proceedings were included. Nine classes consisting of 22 antibiotic types in combination with tigecycline against 1,159 A. baumannii strains were reported in the analysis. For the time-kill studies, combination therapy showed a synergy rate of 37.9% (95% confidence interval [CI], 30.7-46.5); the highest synergy rate was 67.4% (95% CI, 27.3-91.9) for tigecycline in combination with colistin. Moreover, combination with amikacin or colistin could efficiently inhibit the development of tigecycline resistance. Compared with checkerboard microdilution and Etest methods, time-kill studies always showed higher synergy rates. Altogether, these results suggest that the in vitro tigecycline-based combinations resulted in moderate synergy rates and that several combinations could suppress the resistance of A. baumannii to tigecycline, which should be further confirmed in animal models and clinical trials.
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Affiliation(s)
- Jian Li
- 1 Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command , Guangzhou, China .,2 Guangzhou Key Laboratory of Rational Drug Use for the Elderly with Chronic Disease , Guangzhou, China
| | - Xianghai Yang
- 1 Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command , Guangzhou, China .,2 Guangzhou Key Laboratory of Rational Drug Use for the Elderly with Chronic Disease , Guangzhou, China .,3 School of Traditional Chinese Medicine, Guangdong Pharmaceutical University , Guangzhou, China
| | - Lidan Chen
- 4 Department of Laboratory Medicine, Guangzhou General Hospital of Guangzhou Military Command , Guangzhou, China
| | - Xinran Duan
- 1 Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command , Guangzhou, China .,2 Guangzhou Key Laboratory of Rational Drug Use for the Elderly with Chronic Disease , Guangzhou, China .,3 School of Traditional Chinese Medicine, Guangdong Pharmaceutical University , Guangzhou, China
| | - Zhihui Jiang
- 1 Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command , Guangzhou, China .,2 Guangzhou Key Laboratory of Rational Drug Use for the Elderly with Chronic Disease , Guangzhou, China .,5 College of Pharmacy, Jinan University , Guangzhou, China
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16
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Abstract
Intravenous minocycline (Minocin®) is approved in the USA for use in patients with infections due to susceptible strains of Gram-positive and Gram-negative pathogens, including infections due to Acinetobacter spp. Minocycline is a synthetic tetracycline derivative that was originally introduced in the 1960s. A new intravenous formulation of minocycline was recently approved and introduced to address the increasing prevalence of multidrug-resistant (MDR) pathogens. Minocycline shows antibacterial activity against A. baumannii clinical isolates worldwide, and exhibits synergistic bactericidal activity against MDR and extensively drug-resistant (XDR) A. baumannii isolates when combined with other antibacterial agents. In retrospective studies, intravenous minocycline provided high rates of clinical success or improvement and was generally well tolerated among patients with MDR or carbapenem-resistant A. baumannii infections. While randomized clinical trial data would be useful to fully establish the place of minocycline in the management of these infections for which there are currently very few available options, clinical trials in patients with infections due to Acinetobacter spp. are difficult to perform. Nevertheless, current data indicate a potential role for intravenous minocycline in the treatment of patients MDR A. baumannii infections, particularly when combined with a second antibacterial agent (e.g. colistin).
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Affiliation(s)
- Sarah L Greig
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Lesley J Scott
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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Lee CR, Lee JH, Park M, Park KS, Bae IK, Kim YB, Cha CJ, Jeong BC, Lee SH. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front Cell Infect Microbiol 2017; 7:55. [PMID: 28348979 PMCID: PMC5346588 DOI: 10.3389/fcimb.2017.00055] [Citation(s) in RCA: 496] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/13/2017] [Indexed: 12/27/2022] Open
Abstract
Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized.
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Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Moonhee Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji UniversityYongin, South Korea; DNA Analysis Division, Seoul Institute, National Forensic ServiceSeoul, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Il Kwon Bae
- Department of Dental Hygiene, College of Health and Welfare, Silla University Busan, South Korea
| | - Young Bae Kim
- Biotechnology Program, North Shore Community College Danvers, MA, USA
| | - Chang-Jun Cha
- Department of Systems Biotechnology, College of Biotechnology and Natural Resources, Chung-Ang University Anseong, South Korea
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
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18
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Park JY, Park C, Chun HS, Byun JH, Cho SY, Lee DG. Establishment of Experimental Murine Peritonitis Model with Hog Gastric Mucin for Carbapenem-Resistant Gram-Negative Bacteria. Infect Chemother 2017; 49:57-61. [PMID: 28271653 PMCID: PMC5382051 DOI: 10.3947/ic.2017.49.1.57] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023] Open
Abstract
Animal models are essential to studies of infectious diseases. The use of mice to test bacterial infection has been extensively reported. However, methods applied to clinical isolates, particularly for carbapenem-resistant bacteria, must be tailored according to the infection models and bacteria used. In this study, we infected 6-week-old female BALB/c mice intraperitoneally with different strains of resistant bacteria plus 3% hog gastric mucin. This method was found to be efficient and readily applicable for investigation of carbapenem-resisant Gram-negative pathogens (e.g., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) detected in Korea.
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Affiliation(s)
- Jung Yeon Park
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chulmin Park
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Sun Chun
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyun Byun
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Yeon Cho
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Gun Lee
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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19
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Wang X, Zhang L, Sun A, Yang X, Sang W, Jiang Y, Cheng J, Wang J, Zhou M, Chen B, Ouyang J. Acinetobacter baumannii bacteraemia in patients with haematological malignancy: a multicentre retrospective study from the Infection Working Party of Jiangsu Society of Hematology. Eur J Clin Microbiol Infect Dis 2017; 36:1073-1081. [DOI: 10.1007/s10096-016-2895-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/14/2016] [Indexed: 12/14/2022]
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20
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Fang C, Chen X, Zhou M. Epidemiology and Cytokine Levels among Children with Nosocomial Multidrug-Resistant Acinetobacter baumannii Complex in a Tertiary Hospital of Eastern China. PLoS One 2016; 11:e0161690. [PMID: 27579592 PMCID: PMC5007015 DOI: 10.1371/journal.pone.0161690] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/10/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND AIM The present study was aimed at assessing the characteristics of children with nosocomial multidrug-resistant Acinetobacter baumannii complex (MDR ABC) in a tertiary hospital of eastern China. MDR ABC poses a serious threat to public health. However, information on nosocomial MDR ABC in children is lacking. METHOD This study retrospectively reviewed the cases in a tertiary hospital of eastern China between January 1, 2011, and December 31, 2014 (excluding outpatients). RESULTS A total of 377 non-duplicated nosocomial ABC isolates were collected from various samples including 200 (53.1%) MDR ABC isolates. Moreover, 158 of the 200 MDR ABC isolates were collected from intensive care units (ICUs; MDR constituent ratios, 62.5%), while 98 of the 200 MDR ABC isolates were collected from children older than 1 year (MDR constituent ratios, 62.8%). Multivariate logistic analysis revealed that being in the surgical intensive care unit (SICU), prolonged hospital stay, surgical intervention, and mechanical ventilation were independent risk factors for MDR acquisition among children with nosocomial ABC. The interleukin (IL)-6 level of children with nosocomial MDR ABC was significantly lower than that of the children with nosocomial non-MDR ABC. CONCLUSION Nosocomial MDR ABC infection is a serious concern in pediatric patients. Being in the SICU, prolonged hospital stay, surgical intervention, and mechanical ventilation increased the risk of nosocomial MDR ABC. IL-6 might be involved in developing nosocomial MDR ABC among children.
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Affiliation(s)
- Chao Fang
- Clinical Laboratory Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- * E-mail:
| | - Xuejun Chen
- Clinical Laboratory Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Mingming Zhou
- Clinical Laboratory Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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