Urgent need for novel antibiotics in Republic of Korea to combat multidrug-resistant bacteria

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.

Roxithromycin and rhEGF Co-loaded Reactive Oxygen Species Responsive Nanoparticles for Accelerating Wound Healing

BACKGROUND

Bacterial infection can delay wound healing and is therefore a major threat to public health. Although various strategies have been developed to treat bacterial infections, antibiotics remain the best option to combat infections. The inclusion of growth factors in the treatment approach can also accelerate wound healing. The co-delivery of antibiotics and growth factors for the combined treatment of wounds needs further investigation.

OBJECTIVE

Here we aimed to develop antibiotic and growth factor co-loaded nanoparticles (NPs) to treat Staphylococcus aureus-infected wounds.

METHODS

By using our previously prepared reactive oxygen species-responsive material (Oxi-αCD), roxithromycin (ROX)-loaded NPs (ROX/Oxi-αCD NPs) and recombinant human epidermal growth factor (rhEGF)/ROX co-loaded NPs (rhEGF/ROX/Oxi-αCD NPs) were successfully fabricated. The in vivo efficacy of this prepared nanomedicine was evaluated in mice with S. aureus-infected wounds.

RESULTS

ROX/Oxi-αCD NPs and rhEGF/ROX/Oxi-αCD NPs had a spherical structure and their particle sizes were 164 ± 5 nm and 190 ± 8 nm, respectively. The in vitro antibacterial experiments showed that ROX/Oxi-αCD NPs had a lower minimum inhibitory concentration than ROX. The in vivo animal experiments demonstrated that rhEGF/ROX/Oxi-αCD NPs could significantly accelerate the healing of S. aureus-infected wounds as compared to the free ROX drug and ROX/Oxi-αCD NPs (P < 0.05).

CONCLUSION

ROX and rhEGF co-loaded NPs can effectively eliminate bacteria in wounds and accelerate wound healing. Our present work could provide a new strategy to combat bacteria-infected wounds.

Use of prophylactic perioperative antibiotics for lumbar spinal fusions: A nationwide population-based cohort study

BACKGROUND

Perioperative prophylactic antibiotic (PPA) use in spine surgery is known to reduce the rate of surgical site infections. In the past decade, several evidence-based guidelines have been published and surveillance systems to monitor the proper use of antimicrobials had been adapted by many institutes.

OBJECTIVE

To report the trends of PPA prescription in lumbar fusion surgeries nationwide in the Republic of Korea.

METHODS

This is a nationwide registry study. Using the population-based data from the Republic of Korea provided by the Korean Health Insurance Review and Assessment Service, data of all lumbar spinal fusion surgeries performed between 2010 and 2018 in adult patients (age ≥19 years) were reviewed.

RESULTS

The most frequently used antibiotics were first-generation cephalosporins, which accounted for 38.2 % of total PPA prescriptions and were prescribed in 58.96 % of lumbar fusion surgeries. A gradual increase in prescription trends was observed. The second most frequently used PPAs were second-generation cephalosporins, which showed decrease in use from 2016. The frequency of vancomycin prescriptions gradually increased over the observation period and showed an almost four-fold increase in 2018 compared to 2010. First- and second-generation cephalosporins were prescribed less frequently to patients with renal disease.

CONCLUSION

The pattern of PPA use has changed remarkably over the observation period. Furthermore, specific differences in PPA prescriptions were observed among patients with certain co-morbidities.

Antibiotics for multidrug-resistant gram-positive bacteria

Background: Antimicrobial resistance is a major global threat to public health and is associated with increased morbidity and mortality. A few therapeutic options for the treatment of multidrug resistant (MDR) gram-positive bacteria, such as methicillin resistant Staphylococcus aureus, MDR Streptococcus pneumoniae, vancomycin resistant Enterococci, are available.Current Concepts: As a result of comprehensive efforts, a dozen novel antibiotics have been developed and approved for the treatment of MDR gram-positive bacteria in the United States and Europe over the past 15 years. However, only a few antibiotics have been introduced in the Republic of Korea. The purpose of this review is to evaluate the antibiotics that act against MDR gram-positive bacteria as a primary therapeutic option. Particularly, this review focuses on novel antibiotics, including ceftaroline, ceftobiprole, telavancin, dalbavancin, oritavancin, tedizolid, delafloxacin, omadacycline, and lefamulin.Discussion and Conclusion: Novel antibiotics against MDR gram-positive bacteria have not yet been sufficiently studied in various clinical settings, and therefore, the approved indications are limited. However, these antibiotics are expected to play a major role in the treatment of MDR gram-positive bacteria owing to their advantages, including broad anti-bacterial spectrum, rapid bactericidal effect, minimal drug-drug interaction, a favorable safety profile, availability of both intravenous and oral formulations, convenient dosing scheme, and a single dose (or once a week) regimen owing to long half-life. It is crucial to introduce these novel antibiotics in the Republic of Korea for the treatment of patients suffering from MDR bacterial infections.

Antibiotics for multidrug-resistant gram-negative bacteria

Background: Increase in antimicrobial-resistant bacteria continues to be challenge to physicians. Particularly, multidrug-resistant (MDR) gram-negative bacilli (GNB), such as extended-spectrum beta-lactamase (ESBL)-producers and carbapenem-resistant pathogens, are becoming a major human health problem globally.Current Concepts: Gram-negative bacteria have developed resistance via mechanisms encoding AmpC beta-lactamases, ESBLs, and carbapenemases. The therapeutic options available for these pathogens are extremely limited. Infection by MDR bacteria is associated with ineffective antimicrobial therapy, which poses a major threat to the survival of patients with serious infections. Physicians should be familiar with the local epidemiology of MDR bacterial infections and the available therapeutic options. Carbapenems are considered as the drugs of choice for treating ESBL or AmpC-producers. However, increased use of carbapenems in response to an increased prevalence of MDR pathogens could be associated with the rapid emergence of carbapenem resistance. Therefore, there is an ongoing quest for carbapenem-sparing regimens for the treatment of MDR-GNB. Treatment of MDR-GNB infections need not be limited to carbapenems as novel antimicrobial agents are now available.Discussion and Conclusion: This comprehensive review aims to describe therapeutic options available for MDR-GNB infections in Korea, a country with a high prevalence of MDR pathogens. Recently developed antimicrobial agents that should be urgently introduced in Korea include ceftolozane-tazobactam, ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, and cefiderocol. These drugs have been shown to be effective against carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii.

Multidrug-resistant bacteria: a national challenge requiring urgent addressal

Background: Multidrug-resistant bacterial infections are a worldwide threat owing to their increased prevalence, and poor prognosis due to inadequate antibacterial drugs.Current Concepts: Until 2019, several new antibacterial agents, targeting gram-positive bacteria—including telavancin, oritavancin, dalbavancin, ceftaroline, lefamulin, and delafloxacin—had been approved for use in the United States and Europe. Newer antibiotics targeting gram-negative bacteria include ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam, cefiderocol, eravacycline, and plazomicin. The guidance on the treatment of multidrug-resistant bacteria by the Infectious Diseases Society of America, published in February 2022, recommend the use of new antibacterial agents recently approved. However these drugs have not yet been introduced in Korea, thus impeding their prescription by physicians. Multidrug-resistant bacterial infections demonstrably contribute to a high mortality rate and socioeconomic burden.Discussion and Conclusion: Considering the societal impact of antibiotic resistance, the government should monitor and encourage antimicrobial stewardship to reduce the prevalence of multidrug-resistant bacteria, and hasten the introduction of new antibacterial agents for treating multidrug-resistant bacterial infections in Korea.