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Tang PC, Sánchez-Hevia DL, Westhoff S, Fatsis-Kavalopoulos N, Andersson DI. Within-species variability of antibiotic interactions in Gram-negative bacteria. mBio 2024; 15:e0019624. [PMID: 38391196 PMCID: PMC10936430 DOI: 10.1128/mbio.00196-24] [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: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Treatments with antibiotic combinations are becoming increasingly important even though the supposed clinical benefits of combinations are, in many cases, unclear. Here, we systematically examined how several clinically used antibiotics interact and affect the antimicrobial efficacy against five especially problematic Gram-negative pathogens. A total of 232 bacterial isolates were tested against different pairwise antibiotic combinations spanning five classes, and the ability of all combinations in inhibiting growth was quantified. Descriptive statistics, principal component analysis (PCA), and Spearman's rank correlation matrix were used to determine the correlations between the different combinations on interaction outcome. Several important conclusions can be drawn from the 696 examined interactions. Firstly, within a species, the interactions are in general conserved but can be isolate-specific for a given antibiotic combination and can range from antagonistic to synergistic. Secondly, additive and antagonistic interactions are the most common observed across species and antibiotics, with 87.1% of isolate-antibiotic combinations being additive, 11.6% antagonistic, and only 0.3% showing synergy. These findings suggest that to achieve the highest precision and efficacy of combination therapy, not only isolate-specific interaction profiling ought to be routinely performed, in particular to avoid using drug combinations that show antagonistic interaction and an expected associated reduction in efficacy, but also discovering rare and potentially valuable synergistic interactions.IMPORTANCEAntibiotic combinations are often used to treat bacterial infections, which aim to increase treatment efficacy and reduce resistance evolution. Typically, it is assumed that one specific antibiotic combination has the same effect on different isolates of the same species, i.e., the interaction is conserved. Here, we tested this idea by examining how several clinically used antibiotics interact and affect the antimicrobial efficacy against several bacterial pathogens. Our results show that, even though within a species the interactions are often conserved, there are also isolate-specific differences for a given antibiotic combination that can range from antagonistic to synergistic. These findings suggest that isolate-specific interaction profiling ought to be performed in clinical microbiology routine to avoid using antagonistic drug combinations that might reduce treatment efficacy.
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Affiliation(s)
- Po-Cheng Tang
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Dione L. Sánchez-Hevia
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | - Sanne Westhoff
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
| | | | - Dan I. Andersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
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Hammond RJH. Investigating Combination Therapy as a Means to Enhance Activity and Repurpose Antimicrobials. Methods Mol Biol 2024; 2833:43-49. [PMID: 38949699 DOI: 10.1007/978-1-0716-3981-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Current clinical practice assumes that a single antibiotic given as a bolus or as a course will successfully treat most infections. In modern medicine, this is becoming less and less true with drug-resistant, multi-drug-resistant, extensively drug-resistant, and untreatable infections becoming more common. Where single-drug therapy (monotherapy) fails, we will turn to multi-drug therapy. Alternatively, combination therapy could be useful to prevent the emergence of resistance. Multi-drug therapy is already standard for some multi-drug resistant infections and is the standard for the treatment of some pathogens such as Mycobacterium tuberculosis.The use of combination therapy for everyday infections could be a clear course out of the current AMR crisis we are facing. With every additional drug added to a combination (n + 1) the likelihood of the pathogen evolving resistance drops exponentially.Many generic antibiotics are cheap to manufacture as they have fallen out of patent protection but are less effective at pharmacologically effective doses due to overuse in the past. Combination therapy can combine these generic compounds into cocktails that can not only treat susceptible and resistant infections but can also reduce the risk of new resistances arising and can resuscitate the use of antimicrobials once thought defunct.In this chapter, we will summarize theory behind combination therapy and standard in vitro methodologies used.
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Affiliation(s)
- Robert J H Hammond
- Division of Infection and Global Health, University of St Andrews, St Andrews, Scotland, UK.
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Sah BK, Dahal P, Mallik SK, Paul AD, Mainali U, Shah C, Dahal P. Uropathogens and their antimicrobial-resistant pattern among suspected urinary tract infections patients in eastern Nepal: A hospital inpatients-based study. SAGE Open Med 2023; 11:20503121231220821. [PMID: 38148764 PMCID: PMC10750547 DOI: 10.1177/20503121231220821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
Background Urinary tract infections are the primary factors that cause mortality and morbidity in patients with underlying comorbid conditions and are responsible for most hospital admissions worldwide. Objectives The study aims to identify the common bacterial uropathogens and determine their antimicrobial susceptibility pattern, including multidrug-resistant/extensively drug-resistant bacteria. Methods The descriptive cross-sectional study was conducted among inpatients provisionally suspected of urinary tract infections in the medical ward of Koshi Hospital, Biratnagar, Nepal. Samples were inoculated in a cystine lysine electrolyte-deficient medium, and pure growth of significant bacteria was further subjected Gram staining, biochemical identification, and antimicrobial susceptibility testing as per laboratory standard procedure and Clinical Laboratory Standards Institute guidelines, respectively. Descriptive and inferential statistical analysis was performed to analyze the outcomes and a p-value < 0.05 was considered statistically significant. Results A total of 305 patients urine specimens were examined, of which 251 (82.29%) samples resulted in significant bacterial growth in the culture. Escherichia coli (62.94%) was the most predominantly isolated organism, followed by Klebsiella pneumoniae (12.35%), Staphylococcus aureus (9.16%), and Pseudomonas aeruginosa (8.76%). Among antimicrobials, colistin had shown absolute susceptibility (100%) toward gram-negative uropathogens followed by carbapenem and aminoglycosides in a majority of uropathogens. Escherichia coli was found to be the leading drug-resistant bacteria (70%) among uropathogens. The presence of multidrug-resistant/extensively drug-resistant bacteria uropathogens was found to be significantly associated with diabetes mellitus and those with combined antimicrobial therapies. Diabetic patients were twice (OR~2) more likely to colonize and develop uropathogens as compared to non-diabetics. Conclusion Escherichia coli was the most common uropathogens followed by Klebsiella pneumoniae in urinary tract infection patients. The polymyxin group (colistin) of antimicrobials was found to be effective in all multidrug-resistant and extensively drug-resistant uropathogens. The study recommends the need of optimized antimicrobial stewardship program to develop effective strategies in the management of urinary tract infections in diverse healthcare settings.
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Affiliation(s)
- Bikash Kumar Sah
- Purbanchal University School of Health Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | - Prasanna Dahal
- Purbanchal University School of Health Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | - Shyam Kumar Mallik
- Purbanchal University School of Health Sciences, Purbanchal University, Gothgaun, Morang, Nepal
| | - A Deevan Paul
- Chettinad School of Pharmaceutical Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, TN, India
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Abstract
PURPOSE OF REVIEW This review focuses on the management of severe Pseudomonas aeruginosa infections in critically ill patients. RECENT FINDINGS Pseudomonas aeruginosa is the most common pathogen in intensive care; the main related infections are nosocomial pneumonias, then bloodstream infections. Antimicrobial resistance is common; despite new antibiotics, it is associated with increased mortality, and can lead to a therapeutic deadlock. SUMMARY Carbapenem resistance in difficult-to-treat P. aeruginosa (DTR-PA) strains is primarily mediated by loss or reduction of the OprD porin, overexpression of the cephalosporinase AmpC, and/or overexpression of efflux pumps. However, the role of carbapenemases, particularly metallo-β-lactamases, has become more important. Ceftolozane-tazobactam, ceftazidime-avibactam and imipenem-relebactam are useful against DTR phenotypes (noncarbapenemase producers). Other new agents, such as aztreonam-ceftazidime-avibactam or cefiderocol, or colistin, might be effective for carbapenemase producers. Regarding nonantibiotic agents, only phages might be considered, pending further clinical trials. Combination therapy does not reduce mortality, but may be necessary for empirical treatment. Short-term treatment of severe P. aeruginosa infections should be preferred when it is expected that the clinical situation resolves rapidly.
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Affiliation(s)
- Hermann Do Rego
- AP-HP, Bichat Hospital, Medical and infectious diseases intensive care unit
| | - Jean-François Timsit
- AP-HP, Bichat Hospital, Medical and infectious diseases intensive care unit
- IAME Université Paris Cité, UMR 1137, Paris
- Meta-network PROMISE, Inserm, Limoges Universit, Limoges University hospital (CHU), UMR1092, Limoges, France
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Le Berre C, Houard M, Vachée A, Georges H, Wallet F, Patoz P, Herbecq P, Nseir S, Delannoy PY, Meybeck A. Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae-A Multicentric Retrospective Cohort Study. Microorganisms 2023; 11:2676. [PMID: 38004688 PMCID: PMC10673552 DOI: 10.3390/microorganisms11112676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
National and international guidelines were recently published regarding the treatment of Enterobacteriaceae resistant to third-generation cephalosporins infections. We aimed to assess the implementation of the French guidelines in critically ill patients suffering from extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infection (ESBL-E BSI). We conducted a retrospective observational cohort study in the ICU of three French hospitals. Patients treated between 2018 and 2022 for ESBL-E BSI were included. The primary assessment criterion was the proportion of adequate empirical carbapenem prescriptions, defined as prescriptions consistent with the French guidelines. Among the 185 included patients, 175 received an empirical anti-biotherapy within 24 h of ESBL-E BSI onset, with a carbapenem for 100 of them. The proportion of carbapenem prescriptions consistent with the guidelines was 81%. Inconsistent prescriptions were due to a lack of prescriptions of a carbapenem, while it was recommended in 25% of cases. The only factor independently associated with adequate empirical carbapenem prescription was ESBL-E colonization (OR: 107.921 [9.303-1251.910], p = 0.0002). The initial empirical anti-biotherapy was found to be appropriate in 83/98 patients (85%) receiving anti-biotherapy in line with the guidelines and in 56/77 (73%) patients receiving inadequate anti-biotherapy (p = 0.06). Our results illustrate the willingness of intensivists to spare carbapenems. Promoting implementation of the guidelines could improve the proportion of initial appropriate anti-biotherapy in critically ill patients with ESBL-E BSI.
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Affiliation(s)
- Camille Le Berre
- Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France; (C.L.B.); (H.G.); (P.-Y.D.)
| | - Marion Houard
- Service de Réanimation Médicale, CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France; (M.H.); (S.N.)
| | - Anne Vachée
- Laboratoire de Microbiologie, Centre Hospitalier de Roubaix, 11 Boulevard Lacordaire, 59100 Roubaix, France;
| | - Hugues Georges
- Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France; (C.L.B.); (H.G.); (P.-Y.D.)
| | - Frederic Wallet
- Laboratoire de Microbiologie, CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France;
| | - Pierre Patoz
- Laboratoire de Microbiologie, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France;
| | - Patrick Herbecq
- Service de Réanimation, Centre Hospitalier de Roubaix, 11 Boulevard Lacordaire, 59100 Roubaix, France;
| | - Saad Nseir
- Service de Réanimation Médicale, CHRU de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France; (M.H.); (S.N.)
| | - Pierre-Yves Delannoy
- Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France; (C.L.B.); (H.G.); (P.-Y.D.)
| | - Agnès Meybeck
- Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, 135 Rue du Président Coty, 59200 Tourcoing, France; (C.L.B.); (H.G.); (P.-Y.D.)
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Alvarado-Martinez Z, Julianingsih D, Tabashsum Z, Aditya A, Tung CW, Phung A, Suh G, Hshieh K, Wall M, Kapadia S, Canagarajah C, Maskey S, Sellers G, Scriba A, Biswas D. Assessment of the prevalence, serotype, and antibiotic resistance pattern of Salmonella enterica in integrated farming systems in the Maryland-DC area. Front Microbiol 2023; 14:1240458. [PMID: 37637118 PMCID: PMC10448900 DOI: 10.3389/fmicb.2023.1240458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
Implementation of organic/pasture farming practices has been increasing in the USA regardless of official certification. These practices have created an increasingly growing demand for marketing safe products which are produced through these systems. Products from these farming systems have been reported to be at greater risk of transmitting foodborne pathogens because of current trends in their practices. Salmonella enterica (SE) is a ubiquitous foodborne pathogen that remains a public health issue given its prevalence in various food products, but also in the environment and as part of the microbial flora of many domestic animals. Monitoring antibiotic resistance and identifying potential sources contamination are increasingly important given the growing trend of organic/pasture markets. This study aimed to quantify prevalence of SE at the pre- and post-harvest levels of various integrated farms and sites in Maryland-Washington D.C. area, as well as identify the most prevalent serovars and antibiotic resistance patterns. Samples from various elements within the farm environment were collected and screened for SE through culture and molecular techniques, which served to identify and serotype SE, using species and serovar-specific primers, while antibiotic resistance was evaluated using an antibiogram assay. Results showed a prevalence of 7.80% of SE pre-harvest and 1.91% post-harvest. These results also showed the main sources of contamination to be soil (2.17%), grass (1.28%), feces (1.42%) and unprocessed produce (1.48%). The most commonly identified serovar was Typhimurium (11.32%) at the pre-harvest level, while the only identified serovar from post-harvest samples was Montevideo (4.35%). With respect to antibiotic resistance, out of the 13 clinically relevant antibiotics tested, gentamycin and kanamycin were the most effective, demonstrating 78.93 and 76.40% of isolates, respectively, to be susceptible. However, ampicillin, amoxicillin and cephradine had the lowest number of susceptible isolates with them being 10.95, 12.36, and 9.83%, respectively. These results help inform farms striving to implement organic practices on how to produce safer products by recognizing areas that pose greater risks as potential sources of contamination, in addition to identifying serotypes of interest, while also showcasing the current state of antibiotic efficacy and how this can influence antibiotic resistance trends in the future.
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Affiliation(s)
- Zabdiel Alvarado-Martinez
- Biological Sciences Program, Molecular and Cellular Biology, University of Maryland, College Park, College Park, MD, United States
| | - Dita Julianingsih
- Department of Animal and Avian Sciences, University of Maryland, College Park, College Park, MD, United States
| | - Zajeba Tabashsum
- Biological Sciences Program, Molecular and Cellular Biology, University of Maryland, College Park, College Park, MD, United States
| | - Arpita Aditya
- Department of Animal and Avian Sciences, University of Maryland, College Park, College Park, MD, United States
| | - Chuan-Wei Tung
- Department of Animal and Avian Sciences, University of Maryland, College Park, College Park, MD, United States
| | - Anna Phung
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Grace Suh
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Katherine Hshieh
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Matthew Wall
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Sarika Kapadia
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Christa Canagarajah
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Saloni Maskey
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - George Sellers
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Aaron Scriba
- Department of Biology, University of Maryland, College Park, College Park, MD, United States
| | - Debabrata Biswas
- Biological Sciences Program, Molecular and Cellular Biology, University of Maryland, College Park, College Park, MD, United States
- Department of Animal and Avian Sciences, University of Maryland, College Park, College Park, MD, United States
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Lazar V, Oprea E, Ditu LM. Resistance, Tolerance, Virulence and Bacterial Pathogen Fitness-Current State and Envisioned Solutions for the Near Future. Pathogens 2023; 12:pathogens12050746. [PMID: 37242416 DOI: 10.3390/pathogens12050746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
The current antibiotic crisis and the global phenomena of bacterial resistance, inherited and non-inherited, and tolerance-associated with biofilm formation-are prompting dire predictions of a post-antibiotic era in the near future. These predictions refer to increases in morbidity and mortality rates as a consequence of infections with multidrug-resistant or pandrug-resistant microbial strains. In this context, we aimed to highlight the current status of the antibiotic resistance phenomenon and the significance of bacterial virulence properties/fitness for human health and to review the main strategies alternative or complementary to antibiotic therapy, some of them being already clinically applied or in clinical trials, others only foreseen and in the research phase.
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Affiliation(s)
- Veronica Lazar
- Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, 1-3 Portocalelor Street, 060101 Bucharest, Romania
| | - Eliza Oprea
- Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, 1-3 Portocalelor Street, 060101 Bucharest, Romania
| | - Lia-Mara Ditu
- Department of Botany and Microbiology, Faculty of Biology, University of Bucharest, 1-3 Portocalelor Street, 060101 Bucharest, Romania
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