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Thirot H, Fage D, Leonhardt A, Clevenbergh P, Besse-Hammer T, Yombi JC, Cornu O, Briquet C, Hites M, Jacobs F, Wijnant GJ, Wicha SG, Cotton F, Tulkens PM, Spinewine A, Van Bambeke F. Towards a better detection of patients at-risk of linezolid toxicity in clinical practice: a prospective study in three Belgian hospital centers. Front Pharmacol 2024; 15:1310309. [PMID: 38313312 PMCID: PMC10834751 DOI: 10.3389/fphar.2024.1310309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction: Linezolid is a last-resort antibiotic for infections caused by multidrug-resistant microorganisms. It is widely used for off-label indications and for longer than recommended treatment durations, exposing patients at higher risk of adverse drug reactions (ADRs), notably thrombocytopenia. This study aimed to investigate ADR incidence and risk factors, identify thrombocytopenia-related trough levels based on treatment duration, and evaluate the performance of predictive scores for ADR development. Methods: Adult in- and outpatients undergoing linezolid therapy were enrolled in three hospitals and ADRs and linezolid trough levels prospectively monitored over time. A population pharmacokinetic (pop-PK model) was used to estimate trough levels for blood samples collected at varying times. Results: A multivariate analysis based on 63 treatments identified treatment duration ≥10 days and trough levels >8 mg/L as independent risk factors of developing thrombocytopenia, with high trough values correlated with impaired renal function. Five patients treated for >28 days did not develop thrombocytopenia but maintained trough values in the target range (<8 mg/L). The Buzelé predictive score, which combines an age-adjusted Charlson comorbidity index with treatment duration, demonstrated 77% specificity and 67% sensitivity to predict the risk of ADR. Conclusion: Our work supports the necessity of establishing guidelines for dose adjustment in patients with renal insufficiency and the systematic use of TDM in patients at-risk in order to keep trough values ≤8 mg/L. The Buzelé predictive score (if ≥7) may help to detect these at-risk patients, and pop-PK models can estimate trough levels based on plasma samples collected at varying times, reducing the logistical burden of TDM in clinical practice.
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Affiliation(s)
- Hélène Thirot
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - David Fage
- Department of Clinical Chemistry, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - Antonia Leonhardt
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hambourg, Germany
| | | | | | - Jean Cyr Yombi
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Olivier Cornu
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Caroline Briquet
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Maya Hites
- Hôpitaux universitaires de Bruxelles-Erasme (HUB), Université libre de Bruxelles, Brussels, Belgium
| | - Frédérique Jacobs
- Hôpitaux universitaires de Bruxelles-Erasme (HUB), Université libre de Bruxelles, Brussels, Belgium
| | - Gert-Jan Wijnant
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Sebastian G Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, Hambourg, Germany
| | - Frédéric Cotton
- Department of Clinical Chemistry, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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2
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Oumar AA, Seydou A, Fofana S, Diarra Z, Mariko D, Diallo A, Coulibaly S, Sidibe LN, Togo B, Dao S, Doumbia S, Tulkens PM. Adverse Drug Reactions to Antiretroviral Therapy: Frequency, Type, and Risk Factors in Children in Mali. J Pediatr Pharmacol Ther 2023; 28:197-203. [PMID: 37303770 PMCID: PMC10249971 DOI: 10.5863/1551-6776-28.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/28/2022] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the frequency, type, and risk factors associated with adverse drug reactions (ADRs) in HIV-positive children with adherence to antiretroviral therapy (ART) at the Unit of Care and Accompaniment for People Living With HIV (USAC) of Bamako. METHODS A cross-sectional study was conducted at USAC of Bamako from May 1, 2014, to July 31, 2015. We included children aged 1 to 14 years with at least 6 months of ARV treatment initiated at USAC, with or without ADRs. Data collection was based on information collected from parents and clinical/biological assessments. RESULTS Median age of participants was 36 months and female sex was predominant (54.8%). Poor adherence during the study was observed in 15% of cases. Of patients in the study, 52% had a CD4 count less than 350 cells/mm3 at the time of adverse events. In bivariate analysis, we found that participants with adherence to ART tended to be younger than those with non-adherence to ART (36 vs 72 months, p = 0.093). In multivariable analysis, prophylactic treatment was the only factor marginally associated with ART adherence in HIV patients (p = 0.09). No other adverse biological effects or clinical conditions were associated with ART adherence in this study. CONCLUSIONS In this study we found that ADRs were frequent in HIV-positive patients but less frequent in ART-adherent HIV-positive children. Therefore, it is essential to regularly monitor children receiving ARVs to detect and treat the complications associated with these therapies according to ART adherence.
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Affiliation(s)
- Aboubacar Alassane Oumar
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
- HIV/TB Research and Training Center (AAO, SC, SDao, SDoumbia), Bamako, Mali
| | - Alassane Seydou
- Clinical Epidemiology Unit (AS), University Hospital Dijon, Dijon France
| | | | - Zoumana Diarra
- Unit of Care and Accompaniment for People Living With HIV (ZD) (USAC) CSREF Commune V, Bamako, Mali
| | - Djeneba Mariko
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
| | - Abdallah Diallo
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
| | - Sanata Coulibaly
- HIV/TB Research and Training Center (AAO, SC, SDao, SDoumbia), Bamako, Mali
| | - Lala N. Sidibe
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
- Department of Pediatrics (LNS, BT), CHU Gabriel Touré, Bamako, Mali
| | - Boubacar Togo
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
- Department of Pediatrics (LNS, BT), CHU Gabriel Touré, Bamako, Mali
| | - Sounkalo Dao
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
- HIV/TB Research and Training Center (AAO, SC, SDao, SDoumbia), Bamako, Mali
- Department of Infectious Diseases (SDao), CHU Point G, Bamako, Mali
| | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology (AAO, DM, AD, LNS, BT, SDao, SDoumbia), Bamako, Mali
- HIV/TB Research and Training Center (AAO, SC, SDao, SDoumbia), Bamako, Mali
| | - Paul M. Tulkens
- Cellular and Molecular Pharmacology and Centre of Clinical Pharmacy (PMT), Catholic University of Louvain, Brussels, Belgium
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Van Bambeke F, Wicha S, Tulkens PM, Zeitlinger M. Editorial for the Special Issue "A Themed Issue in Honor of Professor Hartmut Derendorf-Outstanding Contributions in the Fields of Quantitative Clinical Pharmacology". Antibiotics (Basel) 2023; 12:antibiotics12020353. [PMID: 36830263 PMCID: PMC9952522 DOI: 10.3390/antibiotics12020353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
Pharmacokinetics (PK) is the discipline investigating the absorption, distribution, metabolization and elimination of a drug in the body [...].
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Affiliation(s)
- Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
- Correspondence:
| | - Sebastian Wicha
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Hamburg, 20146 Hamburg, Germany
| | - Paul M. Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, 1090 Vienna, Austria
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Ngougni Pokem P, Matzneller P, Vervaeke S, Wittebole X, Goeman L, Coessens M, Cottone E, Capron A, Wulkersdorfer B, Wallemacq P, Mouton JW, Muller AE, Zeitlinger M, Laterre PF, Tulkens PM, Van Bambeke F. Binding of temocillin to plasma proteins in vitro and in vivo: the importance of plasma protein levels in different populations and of co-medications. J Antimicrob Chemother 2022; 77:2742-2753. [PMID: 36018077 DOI: 10.1093/jac/dkac286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/28/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Temocillin plasma protein binding (PPB) in healthy individuals is reported to be ∼85% but had not been studied in patients. OBJECTIVES To obtain normative data on temocillin PPB in patients in relation to infection and impact of co-medications widely used in ICU. METHODS Plasma was obtained from healthy individuals (Group #1), non-ICU patients with UTI (Group #2), ICU patients with suspected/confirmed ventriculitis (Group #3) or with sepsis/septic shock (Group #4). Total and unbound temocillin concentrations were measured in spiked samples from temocillin-naive donors (in vitro) or in plasma from temocillin-treated subjects (in vivo). The impact of diluting plasma, using pharmaceutical albumin, or adding drugs potentially competing for PPB was tested in spiked samples. Data were analysed using a modified Hill-Langmuir equation taking ligand depletion into account. RESULTS Temocillin PPB was saturable in all groups, both in vitro and in vivo. Maximal binding capacity (Bmax) was 1.2-2-fold lower in patients. At 20 and 200 mg/L (total concentrations), the unbound fraction reached 12%-29%, 23%-42% and 32%-52% in Groups #2, #3, #4. The unbound fraction was inversely correlated with albumin and C-reactive protein concentrations. Binding to albumin was 2-3-fold lower than in plasma and non-saturable. Drugs with high PPB but active at lower molar concentrations than temocillin caused minimal displacement, while fluconazole (low PPB but similar plasma concentrations to temocillin) increased up to 2-fold its unbound fraction. CONCLUSIONS Temocillin PPB is saturable, 2-4-fold lowered in infected patients in relation to disease severity (ICU admission, hypoalbuminaemia, inflammation) and only partially reproducible with albumin. Competition with other drugs must be considered for therapeutic concentrations to be meaningful.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Peter Matzneller
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna Austria
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Xavier Wittebole
- Department of Critical Care Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Lieven Goeman
- Department of Urology, AZ Delta Hospital, Roeselare, Belgium
| | - Marie Coessens
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Eleonora Cottone
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Arnaud Capron
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | - Pierre Wallemacq
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Anouk E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna Austria
| | - Pierre François Laterre
- Department of Critical Care Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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5
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Ngougni Pokem P, Wittebole X, Collienne C, Rodriguez-Villalobos H, Tulkens PM, Elens L, Van Bambeke F, Laterre PF. Population Pharmacokinetics of Temocillin Administered by Continuous Infusion in Patients with Septic Shock Associated with Intra-Abdominal Infection and Ascitic Fluid Effusion. Antibiotics (Basel) 2022; 11:antibiotics11070898. [PMID: 35884152 PMCID: PMC9311849 DOI: 10.3390/antibiotics11070898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Temocillin is active against Gram-negative bacteria, including many extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. We studied its pharmacokinetics in plasma and ascitic fluid after intravenous administration of a loading dose of 2 g over 30 min, followed by continuous infusion of 6 g/24 h, to 19 critically-ill patients with septic shock associated with complicated intra-abdominal infection. We established a pharmacokinetic model describing unbound temocillin concentrations in plasma and ascitic fluid and performed Monte-Carlo simulations to evaluate the probability of target attainment (PTA) of unbound concentrations (100% fT > MIC, i.e., unbound concentrations remaining above the MIC during 100% of the time) for the applied and hypothetical dosing regimens. The temocillin AUC in ascitic fluid was 46% of the plasma AUC. Plasma unbound concentrations were best described by a two-compartment model, and an additional compartment was added to describe unbound concentration in ascitic fluid, with renal clearance as a covariate. Dosing simulations showed that 90% PTA was achieved in the plasma with the current dosing regimen for MIC ≤ 16 mg/L (EUCAST susceptibility breakpoint) but not in the ascitic fluid if renal clearance was ≥40 mL/min. Hypothetical dosing with a higher (a) loading dose or (b) infused dose allowed to reach target concentrations in ascitic fluid (a) more rapidly or (b) sustainably, but these simulations need to be evaluated in the clinics for safety and efficacy.
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Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (P.N.P.); (P.M.T.)
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Xavier Wittebole
- Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (X.W.); (C.C.); (P.-F.L.)
| | - Christine Collienne
- Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (X.W.); (C.C.); (P.-F.L.)
| | | | - Paul M. Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (P.N.P.); (P.M.T.)
| | - Laure Elens
- Integrated PharmacoMetrics, PharmacoGenomics and PharmacoKinetics, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium; (P.N.P.); (P.M.T.)
- Correspondence: ; Tel.: +32-2-764-73-78
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium; (X.W.); (C.C.); (P.-F.L.)
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Nguyen TK, Peyrusson F, Siala W, Pham NH, Nguyen HA, Tulkens PM, Van Bambeke F. Activity of Moxifloxacin Against Biofilms Formed by Clinical Isolates of Staphylococcus aureus Differing by Their Resistant or Persister Character to Fluoroquinolones. Front Microbiol 2021; 12:785573. [PMID: 34975808 PMCID: PMC8715871 DOI: 10.3389/fmicb.2021.785573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus biofilms are poorly responsive to antibiotics. Underlying reasons include a matrix effect preventing drug access to embedded bacteria, or the presence of dormant bacteria with reduced growth rate. Using 18 clinical isolates previously characterized for their moxifloxacin-resistant and moxifloxacin-persister character in stationary-phase culture, we studied their biofilm production and matrix composition and the anti-biofilm activity of moxifloxacin. Biofilms were grown in microtiter plates and their abundance quantified by crystal violet staining and colony counting; their content in polysaccharides, extracellular DNA and proteins was measured. Moxifloxacin activity was assessed after 24 h of incubation with a broad range of concentrations to establish full concentration-response curves. All clinical isolates produced more biofilm biomass than the reference strain ATCC 25923, the difference being more important for those with high relative persister fractions to moxifloxacin, most of which being also resistant. High biofilm producers expressed icaA to higher levels, enriching the matrix in polysaccharides. Moxifloxacin was less potent against biofilms from clinical isolates than from ATCC 25923, especially against moxifloxacin-resistant isolates with high persister fractions, which was ascribed to a lower concentration of moxifloxacin in these biofilms. Time-kill curves in biofilms revealed the presence of a moxifloxacin-tolerant subpopulation, with low multiplication capacity, whatever the persister character of the isolate. Thus, moxifloxacin activity depends on its local concentration in biofilm, which is reduced in most isolates with high-relative persister fractions due to matrix effects, and insufficient to kill resistant isolates due to their high MIC.
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Affiliation(s)
- Tiep K. Nguyen
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Pharmaceutical Industry, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Frédéric Peyrusson
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Wafi Siala
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Nhung H. Pham
- Department of Microbiology, Bach Mai Hospital, Hanoi, Vietnam
| | - Hoang A. Nguyen
- The National Center for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Paul M. Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- *Correspondence: Françoise Van Bambeke,
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7
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Eckmann C, Tulkens PM. Current and future options for treating complicated skin and soft tissue infections: focus on fluoroquinolones and long-acting lipoglycopeptide antibiotics. J Antimicrob Chemother 2021; 76:iv9-iv22. [PMID: 34849999 PMCID: PMC8632788 DOI: 10.1093/jac/dkab351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bacterial skin and soft tissue infections are among the most common bacterial infections and constitute a major burden for patients and healthcare systems. Care is complicated by the variety of potential pathogens, some with resistance to previously effective antimicrobial agents, the wide spectrum of clinical presentations and the risk of progression to life-threatening forms. More-efficient care pathways are needed that can reduce hospital admissions and length of stay, while maintaining a high quality of care and adhering to antimicrobial stewardship principles. Several agents approved recently for treating acute bacterial skin and skin structure infections have characteristics that meet these requirements. We address the clinical and pharmacological characteristics of the fourth-generation fluoroquinolone delafloxacin, and the long-acting lipoglycopeptide agents dalbavancin and oritavancin.
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Affiliation(s)
- Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Klinikum Hannoversch-Muenden, Goettingen University, Germany
| | - Paul M Tulkens
- Cellular and Molecular Pharmacology, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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8
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Clevenbergh P, Maillart E, Tulkens PM. Reply to: 'Clinical efficacy and safety of cefiderocol in the treatment of acute bacterial infections: a systematic review and meta-analysis of randomised controlled trials'. J Glob Antimicrob Resist 2021; 26:342-343. [PMID: 34118480 DOI: 10.1016/j.jgar.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- P Clevenbergh
- Infectious Diseases Clinic, CHU Brugmann, Brussels, Belgium
| | - E Maillart
- Infectious Diseases Clinic, CHU Brugmann, Brussels, Belgium
| | - P M Tulkens
- Cellular and Molecular Pharmacology, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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9
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Peyrusson F, Nguyen TK, Buyck JM, Lemaire S, Wang G, Seral C, Tulkens PM, Van Bambeke F. In Vitro Models for the Study of the Intracellular Activity of Antibiotics. Methods Mol Biol 2021; 2357:239-251. [PMID: 34590263 DOI: 10.1007/978-1-0716-1621-5_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intracellular bacteria are poorly responsive to antibiotic treatment. Pharmacological studies are thus needed to determine the antibiotics which are the most potent or effective against intracellular bacteria as well as to explore the reasons for poor bacterial responsiveness. An in vitro pharmacodynamic model is described, consisting of (1) phagocytosis of preopsonized bacteria by eukaryotic cells, (2) elimination of noninternalized bacteria with gentamicin, (3) incubation of infected cells with antibiotics, and (4) determination of surviving bacteria by viable cell counting and normalization of the counts based on sample protein content. The use of strains expressing fluorescent proteins under the control of an inducible promoter allows to follow intracellular bacterial division at the individual level and therefore to monitor bacterial persisters that do not multiply anymore.
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Affiliation(s)
- Frédéric Peyrusson
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Tiep K Nguyen
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Julien M Buyck
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,INSERM U1070 "Pharmacology of Anti-infective Agents", Université de Poitiers, Poitiers, France
| | - Sandrine Lemaire
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,GSK Biologicals, Rixensart, Belgium
| | - Gang Wang
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Cristina Seral
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Department of Microbiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Paul M Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
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10
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Tulkens PM, Milosevic TV, Vertenoeil G, Vainchenker W, Constantinescu SN, Van Bambeke F. 1616. Mechanism of Thrombocytopenia Induced by Oxazolidinones Antibiotics (Linezolid, Tedizolid): Demonstration of Impairment of Megakaryocyte Differentiation From Human Hematopoietic Stem Cells associated with Mitochondrial Toxicity. Open Forum Infect Dis 2020. [PMCID: PMC7776155 DOI: 10.1093/ofid/ofaa439.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Linezolid causes thrombocytopenia, which limits its use. In cell culture and in tissues from treated patients, linezolid impairs mitochondrial protein synthesis (due to structural similarities and common binding sites between bacterial and mitochondrial ribosomes). Recent studies have shown that mitochondria act as a key relay in the process leading from activation of the thrombopoietin receptor to megakaryocytes differentiation. Methods Validated ex-vivo human model of hematopoietic stem cells (HSC) differentiation for (i) measuring megakaryocytes, granulocyte-monocytes, and burst-forming unit-erythroids colony formation; (ii) differentiation into megakaryocytes (conversion of CD34+ into CD41+/CD42+ cells; morphology) and proplatelets formation, (iii) mitochondrial toxicity (electron microscopy; cytochrome c-oxidase activity [partly encoded by the mitochondrial genome]). Results We show that linezolid (and the recently approved tedizolid), both at concentrations corresponding to their human serum concentrations) inhibit the maturation of HSC into fully differentiated megakaryocytes (CD41 and CD42-positive cells) and the formation of proplatelets. Optic and Electron microscopy) showed an impairment of the formation of typical megakaryocytes (lack of large polylobulated nuclei and of intracellular demarcation membrane system [required for platelet formation]), together with disappearance of the internal structure of mitochondria. Biochemical studies showed a complete suppression of the activity of cytochrome c-oxidase (a key enzyme of the mitochondrial respiratory chain). Conclusion Our study provides for the first time insights in the mechanism of thrombocytopenia induced by linezolid and tedizolid, identifying mitochondria as their target and showing that the drugs will impair the differentiation of hematopoietic stem cells into mature platelets-releasing megakaryocytes. It illustrates how mitochondria dysfunction may play a key role in toxicology and diseases, while paving the way for rational approaches for the design and screening of less toxic derivatives for the benefit of future patients. Disclosures Paul M. Tulkens, MD, PhD, Bayer (Consultant, Advisor or Review Panel member, Speaker’s Bureau)Menarini (Speaker’s Bureau)Merck (Advisor or Review Panel member, Speaker’s Bureau)Trius (now part of Merck) (Advisor or Review Panel member, Research Grant or Support) Françoise Van Bambeke, PharmD, PhD, Bayer (Speaker’s Bureau)
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Affiliation(s)
- Paul M Tulkens
- Université catholique de Louvain, Bruxelles, Brussels Hoofdstedelijk Gewest, Belgium
| | - Tamara V Milosevic
- Université catholique de Louvain, Bruxelles, Brussels Hoofdstedelijk Gewest, Belgium
| | - Gaëlle Vertenoeil
- Université catholique de Louvain, Bruxelles, Brussels Hoofdstedelijk Gewest, Belgium
| | | | | | - Françoise Van Bambeke
- Université catholique de Louvain, Bruxelles, Brussels Hoofdstedelijk Gewest, Belgium
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11
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Nguyen TK, Peyrusson F, Dodémont M, Pham NH, Nguyen HA, Tulkens PM, Van Bambeke F. The Persister Character of Clinical Isolates of Staphylococcus aureus Contributes to Faster Evolution to Resistance and Higher Survival in THP-1 Monocytes: A Study With Moxifloxacin. Front Microbiol 2020; 11:587364. [PMID: 33329458 PMCID: PMC7719683 DOI: 10.3389/fmicb.2020.587364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
Staphylococcus aureus may cause relapsing infections. We previously showed that S. aureus SH1000 surviving intracellularly to bactericidal antibiotics are persisters. Here, we used 54 non-duplicate clinical isolates to assess links between persistence, resistance evolution, and intracellular survival, using moxifloxacin throughout as test bactericidal antibiotic. The relative persister fraction (RPF: percentage of inoculum surviving to 100× MIC moxifloxacin in stationary phase culture for each isolate relative to ATCC 25923) was determined to categorize isolates with low (≤10) or high (>10) RPF. Evolution to resistance (moxifloxacin MIC ≥ 0.5 mg/L) was triggered by serial passages at 0.5× MIC (with daily concentration readjustments). Intracellular moxifloxacin maximal efficacy (Emax) was determined by 24 h concentration-response experiments [pharmacodynamic model (Hill-Langmuir)] with infected THP-1 monocytes exposed to moxifloxacin (0.01 to 100× MIC) after phagocytosis. Division of intracellular survivors was followed by green fluorescence protein dilution (FACS). Most (30/36) moxifloxacin-susceptible isolates showed low RPF but all moxifloxacin-resistant (n = 18) isolates harbored high RPF. Evolution to resistance of susceptible isolates was faster for those with high vs. low RPF (with SOS response and topoisomerase-encoding genes overexpression). Intracellularly, moxifloxacin Emax was decreased (less negative) for isolates with high vs. low RPF, independently from resistance. Moxifloxacin intracellular survivors were non-dividing. The data demonstrate and quantitate persisters in clinical isolates of S. aureus, and show that this phenotype accelerates resistance evolution and is associated with intracellular survival in spite of high antibiotic concentrations. Isolates with high RPF may represent a possible cause of treatment failure not directly related to resistance in patients receiving active antibiotics.
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Affiliation(s)
- Tiep K Nguyen
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium.,Department of Pharmaceutical Industry, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Frédéric Peyrusson
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Magali Dodémont
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme - Cliniques Universitaires de Bruxelles, Brussels, Belgium
| | - Nhung H Pham
- Department of Microbiology, Bach Mai Hospital, Hanoi, Vietnam.,Microbiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Hoang A Nguyen
- The National Center for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Paul M Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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12
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Tulkens PM. Phosphocholine May Allow for Listeriolysin-Mediated Escape of Phagocytized Listeria From Vacuolar Compartments Into the Host Cytosol While Protecting Against Overt Destruction of the Infected Cell. J Infect Dis 2020; 222:1425-1427. [PMID: 31965180 DOI: 10.1093/infdis/jiaa023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paul M Tulkens
- Cellular and Molecular Pharmacology, Louvain Drug Research Institute, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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13
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Kapepula PM, Kabengele JK, Kingombe M, Van Bambeke F, Tulkens PM, Sadiki Kishabongo A, Decloedt E, Zumla A, Tiberi S, Suleman F, Tshilolo L, Muyembe-TamFum JJ, Zumla A, Nachega JB. Artemisia Spp. Derivatives for COVID-19 Treatment: Anecdotal Use, Political Hype, Treatment Potential, Challenges, and Road Map to Randomized Clinical Trials. Am J Trop Med Hyg 2020; 103:960-964. [PMID: 32705976 PMCID: PMC7470522 DOI: 10.4269/ajtmh.20-0820] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The world is currently facing a novel COVID-19 pandemic caused by SARS-CoV-2 that, as of July 12, 2020, has caused a reported 12,322,395 cases and 556,335 deaths. To date, only two treatments, remdesivir and dexamethasone, have demonstrated clinical efficacy through randomized controlled trials (RCTs) in seriously ill patients. The search for new or repurposed drugs for treatment of COVID-19 continues. We have witnessed anecdotal use of herbal medicines, including Artemisia spp. extracts, in low-income countries, and exaggerated claims of their efficacies that are not evidence based, with subsequent political controversy. These events highlight the urgent need for further research on herbal compounds to evaluate efficacy through RCTs, and, when efficacious compounds are identified, to establish the active ingredients, develop formulations and dosing, and define pharmacokinetics, toxicology, and safety to enable drug development. Derivatives from the herb Artemisia annua have been used as traditional medicine over centuries for the treatment of fevers, malaria, and respiratory tract infections. We review the bioactive compounds, pharmacological and immunological effects, and traditional uses for Artemisia spp. derivatives, and discuss the challenges and controversies surrounding current efforts and the scientific road map to advance them to prevent or treat COVID-19.
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Affiliation(s)
- Paulin M Kapepula
- Faculty of Pharmaceutical Sciences, Centre d'Etudes des Substances Naturelles d'Origine Végétale (CESNOV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jimmy K Kabengele
- Faculty of Pharmaceutical Sciences, Centre d'Etudes des Substances Naturelles d'Origine Végétale (CESNOV), University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Micheline Kingombe
- National Program for the Promotion of Traditional Medicine and Medicinal Plants (PNMT-PM), Ministry of Public Health, Kinshasa, Democratic Republic of Congo
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Antoine Sadiki Kishabongo
- Department of Clinical Biology, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adam Zumla
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Simon Tiberi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Fatima Suleman
- Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Léon Tshilolo
- Department of Pediatrics, Official University of Mbuji-Mayi (UOM), Kinshasa, Democratic Republic of Congo.,Le Centre de Formation et d'Appui Sanitaire (CEFA), Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo.,Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of Congo
| | - Jean-Jacques Muyembe-TamFum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.,National Institute of Biomedical Research (INRB), Kinshasa, Democratic Republic of Congo
| | - Alimuddin Zumla
- National Institute for Health Research Biomedical Research Centre, University College London, Hospitals, London, United Kingdom.,Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom
| | - Jean B Nachega
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Center for Global Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Departments of Epidemiology, Infectious Diseases, and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.,Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ngougni Pokem P, Capron A, Wallemacq P, Tulkens PM, Van Bambeke F, Laterre PF. Temocillin plasma and pancreatic tissue concentrations in a critically ill patient with septic shock. J Antimicrob Chemother 2020; 74:1459-1461. [PMID: 30649374 DOI: 10.1093/jac/dky565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Perrin Ngougni Pokem
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Arnaud Capron
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Wallemacq
- Department of Clinical Chemistry, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Pierre-François Laterre
- Department of Critical Care Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
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15
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Peyrusson F, Van Wessem A, Dieppois G, Van Bambeke F, Tulkens PM. Cellular pharmacokinetics and intracellular activity of the bacterial fatty acid synthesis inhibitor, afabicin desphosphono against different resistance phenotypes of Staphylococcus aureus in models of cultured phagocytic cells. Int J Antimicrob Agents 2020; 55:105848. [DOI: 10.1016/j.ijantimicag.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 11/30/2022]
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16
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Nguyen TK, Argudín MA, Deplano A, Nhung PH, Nguyen HA, Tulkens PM, Dodemont M, Van Bambeke F. Antibiotic Resistance, Biofilm Formation, and Intracellular Survival As Possible Determinants of Persistent or Recurrent Infections by Staphylococcus aureus in a Vietnamese Tertiary Hospital: Focus on Bacterial Response to Moxifloxacin. Microb Drug Resist 2019; 26:537-544. [PMID: 31825276 DOI: 10.1089/mdr.2019.0282] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Resistance is notoriously high in Asia but may not entirely explain therapeutic failures. Specific modes of bacterial life, such as biofilm or intracellular survival, may also contribute to the persistent and/or recurrent character of infections. Most Staphylococcus aureus isolates form biofilm and many survive and even thrive intracellularly. We collected 36 nonduplicate S. aureus isolates (including 18 methicillin-resistant S. aureus) from patients with clinical evidence of persistent or recurrent infections in a large tertiary Vietnamese hospital. We examined their antibiotic resistance profile (minimal inhibitory concentration determination) and clonal relatedness (spa and agr typing, pulsed field gel electrophoresis profiles). We then assessed the activity of moxifloxacin in both biofilms and infected phagocytes (moxifloxacin previously proved to be one of the most active antibiotics against reference strains in these models). spa-types t189 and t437 and agr group I were the most frequent. Among the 36 isolates, 30 were multidrug resistant but 30 were recovered from patients having received an active drug. All tested isolates produced biofilm and survived inside phagocytes. At its human Cmax, moxifloxacin was inactive on biofilms made by moxifloxacin-susceptible as well as moxifloxacin-resistant isolates. It caused only a modest intracellular colony-forming unit decrease against moxifloxacin-susceptible isolates and was inactive against those resistant to moxifloxacin. While our data confirm for this collection the high resistance levels and prevalence of endemic spa- or agr- types in Asia, they show that tolerance in both biofilm and phagocytes are correlated and markedly limit moxifloxacin activity, which goes in line with the suggested role of these modes of life in persistence or recurrence of infections.
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Affiliation(s)
- Tiep Khac Nguyen
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Maria A Argudín
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme-Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Ariane Deplano
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme-Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Pham Hong Nhung
- Department of Microbiology, Bach Mai Hospital, Hanoi, Vietnam
| | - Hoang Anh Nguyen
- The National Center for Drug Information and Adverse Drug Reactions Monitoring, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Paul M Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Magali Dodemont
- Centre National de Référence des Staphylocoques, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) Site Anderlecht, Hôpital Erasme-Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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17
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Vu DH, Nguyen DA, Delattre IK, Ho TT, Do HG, Pham HN, Dao XC, Tran NT, Nguyen GB, Van Bambeke F, Tulkens PM, Nguyen HA. Determination of optimal loading and maintenance doses for continuous infusion of vancomycin in critically ill patients: Population pharmacokinetic modelling and simulations for improved dosing schemes. Int J Antimicrob Agents 2019; 54:702-708. [PMID: 31600554 DOI: 10.1016/j.ijantimicag.2019.09.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Despite extensive clinical use, limited data are available on optimal loading and maintenance doses of vancomycin in critically ill patients. This study aimed to develop a rational approach for optimised dosage of vancomycin given in a continuous infusion in critically ill patients. METHODS Vancomycin pharmacokinetic (PK) data (total serum concentrations) were obtained from 55 intensive care unit (ICU) patients (Bach Mai Hospital, Hanoi, Vietnam) receiving a 20 mg/kg loading dose followed by continuous infusion stratified by creatinine clearance (CLCr). Population PK modelling and Monte Carlo simulations were performed using a nonlinear mixed-effects modelling (NONMEM) program for a target of 20-30 mg/L to optimise efficacy and minimise nephrotoxicity. RESULTS A two-compartment model with first-order elimination best fitted the PK data with central and peripheral volumes of distribution of 1.01 and 2.39 L/kg, respectively (allometric scaling to a 70 kg standard subject). The population total clearance of 3.63 L/h was only explained by renal function in the covariate and final model. The simulations showed that a 25-mg/kg loading dose infused over 90 minutes was optimal to reach the target range. The optimal maintenance dose for low renal function (CLCr < 45 mL/min) was 1000-1500 mg/day. For augmented renal clearance (CLCr > 130 mL/min) the dose should be up to 3500 mg/day or even 4500 mg/day to achieve adequate exposure. These simulated maintenance doses were larger than previously proposed for non-ICU patients. CONCLUSION Large loading and maintenance doses of vancomycin are generally needed in critically ill patients. Because of high interindividual variability in vancomycin PK, drug monitoring may still be necessary.
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Affiliation(s)
- Dinh H Vu
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam.
| | - Duy A Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Isabelle K Delattre
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Trong T Ho
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hong G Do
- Department of Pharmacy, Bach Mai Hospital, Hanoi, Vietnam
| | - Hong N Pham
- Department of Microbiology, Bạch Mai Hospital, Hanoi, Vietnam
| | - Xuan C Dao
- Intensive Care Unit, Bạch Mai Hospital, Hanoi, Vietnam
| | - Nhan T Tran
- Department of Pharmacy, Bach Mai Hospital, Hanoi, Vietnam
| | - Gia B Nguyen
- Intensive Care Unit, Bạch Mai Hospital, Hanoi, Vietnam
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Hoang A Nguyen
- National Drug Information and Adverse Drug Reaction Monitoring Center, Hanoi University of Pharmacy, Hanoi, Vietnam
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18
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Miranda Bastos AC, Vandecasteele SJ, Spinewine A, Tulkens PM, Van Bambeke F. Temocillin dosing in haemodialysis patients based on population pharmacokinetics of total and unbound concentrations and Monte Carlo simulations. J Antimicrob Chemother 2019; 73:1630-1638. [PMID: 29579214 DOI: 10.1093/jac/dky078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/11/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To develop a population model describing temocillin pharmacokinetics (PK) in patients undergoing haemodialysis and investigate how pharmacokinetic/pharmacodynamic (PD) targets can be met with different dosage regimens. Patients and methods Sixteen patients received the currently licenced dosing of 1, 2 or 3 g of temocillin (total of 61 doses) corresponding to an inter-dialytic period of 20, 44 or 68 h, respectively, and a dialysis period of 4 h. A non-linear mixed-effects model was developed jointly for total and unbound temocillin serum concentrations. The performance of clinically feasible dosing regimens was evaluated using a 5000-subject Monte Carlo (MC) simulation for determining the highest MIC for which the PK/PD target of 40%ƒT>MIC would be reached in 90% of patients [probability of target attainment (PTA)]. This PK study was registered at ClinicalTrials.gov (NCT02285075). Results Temocillin unbound and total serum concentrations (429 samples) were used to fit an open two-compartment model with non-linear albumin binding and first-order elimination. In addition to total body clearance, dialysis clearance was modelled using the Michaels function. The currently licenced dosing achieved a 90% PTA for an MIC up to 8 mg/L. A new temocillin dosage regimen was designed that would achieve a 90% PTA for an MIC of 16 mg/L (MIC90 of target organisms) adjusted to patient weight and inter-dialytic period. Conclusions Currently licensed dosage regimen is suboptimal for MICs >8 mg/L (frequently found in clinical isolates). Model-based simulations allowed suggestion of a new dosage regimen with improved probability of microbiological success, applicability in routine clinical practice and more appropriate for empirical therapy.
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Affiliation(s)
- Ana C Miranda Bastos
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Stefaan J Vandecasteele
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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19
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Milosevic TV, Vertenoeil G, Payen VL, Sonveaux P, Tulkens PM, Constantinescu SN, Van Bambeke F. Prolonged inhibition and incomplete recovery of mitochondrial function in oxazolidinone-treated megakaryoblastic cell lines. Int J Antimicrob Agents 2019; 54:661-667. [PMID: 31374333 DOI: 10.1016/j.ijantimicag.2019.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/21/2019] [Indexed: 12/01/2022]
Abstract
Thrombocytopenia is commonly seen in patients receiving linezolid for >14 days. Linezolid is a reversible inhibitor of mitochondrial function in various cell types. This study investigated the inhibitory effects of linezolid and tedizolid, and their potential recovery on (i) CYTox I expression (subunit I of cytochrome c-oxidase; encoded by the mitochondrial genome), (ii) cytochrome c-oxidase activity and (iii) mitochondrial respiration (Seahorse bioanalysis) in two megakaryocytic cell lines [UT-7 WT (human acute megakaryoblastic leukaemia cells) and UT-7 MPL (transduced to express the thrombopoietin receptor)]. Cells were exposed to linezolid (0.5-25 mg/L) or tedizolid (0.1-5 mg/L) for up to 5 days and recovery followed after drug removal. Both oxazolidinones caused concentration- and time-dependent inhibition of CYTox I expression, cytochrome c-oxidase activity and mitochondrial spare capacity. On electron microscopy, mitochondria appeared dilated with a loss of cristae. Globally, tedizolid exerted stronger effects than linezolid. While CYTox I expression recovered completely after 6 days of drug washout, only partial (linezolid) or no (tedizolid) recovery of cytochrome c-oxidase activity, and no rescue of mitochondrial spare capacity (after 3 days) was observed. Thus, and in contrast to previous studies using a variety of cell lines unrelated to megakaryocytic lineages, the inhibitory effects exerted by oxazolidinones on the mitochondrial function of megakaryoblastic cells appear to be particularly protracted. Given the dynamics of platelet production and destruction, these results may explain why oxazolidinone-induced thrombocytopenia is one of the most common side effects in patients exposed to these antibiotics.
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Affiliation(s)
- Tamara V Milosevic
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Gaëlle Vertenoeil
- Signal Transduction and Molecular Haematology, Ludwig Institute for Cancer Research, Brussels Branch, Brussels, Belgium; de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Valéry L Payen
- Pole of Pharmacology and Therapeutics, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Sonveaux
- Pole of Pharmacology and Therapeutics, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
| | - Stefan N Constantinescu
- Signal Transduction and Molecular Haematology, Ludwig Institute for Cancer Research, Brussels Branch, Brussels, Belgium; de Duve Institute, Université catholique de Louvain, Brussels, Belgium; Walloon Excellence in Life Science and Biotechnology, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
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Oumar AA, Dakouo M, Tchibozo A, Maiga M, Landouré G, Abdi-Bogoreh R, Tulkens PM, Dao S, Yombi JC. Antiretroviral-induced adverse drug reactions in HIV-infected patients in Mali: a resource-limited setting experience. ACTA ACUST UNITED AC 2019; 8:831-836. [PMID: 31879663 PMCID: PMC6931397 DOI: 10.18203/2319-2003.ijbcp20191565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background There are few reports in the literature from sub-Saharan Africa (SSA) regarding antiretroviral-induced adverse drug reactions (ADRs). Antiretroviral therapy (ART) is now widely available in SSA, and ADRs during HIV infection are also frequent. In this study, we reported the frequency and risk factors of ART-induced ADRs in a Malian population. Methods This prospective cohort study was performed in the HIV Care and Counseling Centre (CESAC) of Mali from 2011 to 2012. Adult patients infected with HIV and who had recently started ART were included and followed-up clinically Were included in this study, adult patients living with HIV and had recently started ART who were followed up for at least 6 months to determine the incidence of ADRs using Naranjo's classification scale. Results During this study, 357 (42.3%) patients presented ADRs (40.1% of our patients (n=338) experienced at least one ADR, and 2.2% (n=19) experienced at least two ADRs). The prevalence of ADRs by organ system was: 45.9% neurological (n=164); 29.4% metabolic (blood chemistry) (n=105); 15.4% hematological (n=55). High probable rate of ADR was observed as indicated by the Naranjo score in 83.7% of the cases. Zidovudine (AZT) and stavudine (d4T) use was identified as a risk factor for either anaemia or peripheral neuropathy whereas nevirapine (NVP) and female gender were risk factors for skin reactions. Patients with advance disease had the highest rate of ADRs compared to the others. Conclusions Based on the Naranjo probability scale, our data show that ADRs such as peripheral neuropathy and anemia are very frequent. These ADR was linked to AZT and D4T. Our findings highlight the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population.
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Affiliation(s)
| | - Mamadou Dakouo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Anicet Tchibozo
- Department of Public Health, Université de Montreal, Montreal, Canada
| | - Mamoudou Maiga
- Department of Global Health, Northwestern University, Chicago, USA
| | - Guida Landouré
- Department of Neurology, Centre Hospital, University du Point «G», Bamako, Mali
| | | | - Paul M Tulkens
- Department of Cellular & Molecular Pharmacology, Catholic University of Louvain, Brussels, Belgium
| | - Sounkalo Dao
- Department of Infectious Diseases, Centre Hospital, University du Point «G», Bamako
| | - Jean Cyr Yombi
- Department of Internal Medicine & Infectious Diseases, AIDS Reference Center, Catholic University of Louvain, Brussels, Belgium
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Abstract
Fluoroquinolones have been in clinical use for over 50 years with significant efficacy. However, increasing resistance and emergence of some marked adverse events have limited their usage. The most recently approved class member, delafloxacin, is the only available anionic (non-zwitterionic) fluoroquinolone. Its unique molecular structure provides improved in vitro activity against most Gram-positive pathogens, including quinolone-resistant strains, which is further enhanced at acid pH. Delafloxacin shows favorable pharmacological properties, with about 60% bioavailability after oral administration, only mild inhibition of cytochrome P450 3A, and no evidence of cardiac- or phototoxicity in healthy volunteers (tested against positive controls). Its twice daily dosing, suitability for intravenous, oral, or switch dosing, the lack of many clinically significant drug-drug interactions, and acceptable adverse event profile in registration clinical trials supports its use in the treatment of acute bacterial skin and skin structure infections, and potentially in other infections, where resistance to other agents, safety, and/or the need for early discharge is of concern.
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Affiliation(s)
- Paul M Tulkens
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Stephen H Zinner
- Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
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22
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Khandekar S, Liebens V, Fauvart M, Tulkens PM, Michiels J, Van Bambeke F. The Putative De- N-acetylase DnpA Contributes to Intracellular and Biofilm-Associated Persistence of Pseudomonas aeruginosa Exposed to Fluoroquinolones. Front Microbiol 2018; 9:1455. [PMID: 30042739 PMCID: PMC6048251 DOI: 10.3389/fmicb.2018.01455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022] Open
Abstract
Persisters are the fraction of antibiotic-exposed bacteria transiently refractory to killing and are recognized as a cause of antibiotic treatment failure. The putative de-N-acetylase DnpA increases persister levels in Pseudomonas aeruginosa upon exposure to fluoroquinolones in broth. In this study the wild-type PAO1 and its dnpA insertion mutant (dnpA::Tn) were used in parallel and compared for their capacity to generate persisters in broth (surviving fraction after exposure to high antibiotic concentrations) and their susceptibility to antibiotics in models of intracellular infection of THP-1 monocytes and of biofilms grown in microtiter plates. Multiplication in monocytes was evaluated by fluorescence dilution of GFP (expressed under the control of an inducible promoter) using flow cytometry. Gene expression was measured by quantitative RT-PCR. When exposed to fluoroquinolones (ciprofloxacin or levofloxacin) but not to meropenem or amikacin, the dnpA::Tn mutant showed a 3- to 10-fold lower persister fraction in broth. In infected monocytes, fluoroquinolones (but not the other antibiotics) were more effective (difference in Emax: 1.5 log cfu) against the dnpA::Tn mutant than against the wild-type PAO1. Dividing intracellular bacteria were more frequently seen (1.5 to 1.9-fold) with the fluoroquinolone-exposed dnpA::Tn mutant than with its parental strain. Fluoroquinolones (but not the other antibiotics) were also 3-fold more potent to prevent biofilm formation by the dnpA::Tn mutant than by PAO1 as well as to act upon biofilms (1–3 days of maturity) formed by the mutant than by the parental strain. Fluoroquinolones induced the expression of gyrA (4.5–7 fold) and mexX (3.6–5.4 fold) in the parental strain but to a lower extent (3–4-fold for gyrA and 1.8–2.8-fold for mexX, respectively) in the dnpA::Tn mutant. Thus, our data show that a dnpA insertion mutant of P. aeruginosa is more receptive to fluoroquinolone antibacterial effects than its parental strain in infected monocytes or in biofilms. The mechanism of this higher responsiveness could involve a reduced overexpression of the fluoroquinolone target.
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Affiliation(s)
- Shaunak Khandekar
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Veerle Liebens
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
| | - Maarten Fauvart
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium.,Center for Microbiology, Vlaams Instituut voor Biotechnologie, Leuven, Belgium.,imec, Leuven, Belgium
| | - Paul M Tulkens
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Jan Michiels
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium.,Center for Microbiology, Vlaams Instituut voor Biotechnologie, Leuven, Belgium
| | - Françoise Van Bambeke
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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Buyck JM, Luyckx C, Muccioli GG, Krause KM, Nichols WW, Tulkens PM, Van Bambeke F. Pharmacodynamics of ceftazidime/avibactam against extracellular and intracellular forms of Pseudomonas aeruginosa. J Antimicrob Chemother 2018; 72:1400-1409. [PMID: 28137941 DOI: 10.1093/jac/dkw587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/20/2016] [Indexed: 02/05/2023] Open
Abstract
Objectives When tested in broth, avibactam reverses ceftazidime resistance in many Pseudomonas aeruginosa that express ESBLs. We examined whether similar reversal is observed against intracellular forms of P. aeruginosa . Methods Strains: reference strains; two engineered strains with basal non-inducible expression of AmpC and their isogenic mutants with stably derepressed AmpC; and clinical isolates with complete, partial or no resistance to reversion with avibactam. Pharmacodynamic model: 24 h concentration-response to ceftazidime [0.01-200 mg/L alone or with avibactam (4 mg/L)] of bacteria in broth or bacteria phagocytosed by THP-1 monocytes, with calculation of ceftazidime relative potency ( C s : concentration yielding a static effect) and maximal relative effect [ E max : cfu decrease at infinitely large antibiotic concentrations (efficacy in the model)] using the Hill equation. Cellular content of avibactam: quantification by LC-MS/MS. Results For both extracellular and intracellular bacteria, ceftazidime C s was always close to its MIC. For ceftazidime-resistant strains, avibactam addition shifted ceftazidime C s to values close to the MIC of the combination in broth. E max was systematically below the detection limit (-5 log 10 ) for extracellular bacteria, but limited to -1.3 log 10 for intracellular bacteria (except for two isolates) with no effect of avibactam. The cellular concentration of avibactam reflected extracellular concentration and was not influenced by ceftazidime (0-160 mg/L). Conclusions The potential for avibactam to inhibit β-lactamases does not differ for extracellular and intracellular forms of P. aeruginosa , denoting an unhindered access to its target in both situations. The loss of maximal relative efficacy of ceftazidime against intracellular P. aeruginosa was unrelated to resistance via avibactam-inhibitable β-lactamases.
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Affiliation(s)
- J M Buyck
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - C Luyckx
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - G G Muccioli
- MASSMET Platform, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | | | - W W Nichols
- AstraZeneca Pharmaceuticals, Waltham, MA, USA
| | - P M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - F Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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Delattre IK, Taccone FS, Jacobs F, Hites M, Dugernier T, Spapen H, Laterre PF, Wallemacq PE, Van Bambeke F, Tulkens PM. Optimizing β-lactams treatment in critically-ill patients using pharmacokinetics/pharmacodynamics targets: are first conventional doses effective? Expert Rev Anti Infect Ther 2017; 15:677-688. [PMID: 28571493 DOI: 10.1080/14787210.2017.1338139] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The pharmacokinetic/pharmacodynamic index determining β-lactam activity is the percentage of the dosing interval (%T) during which their free serum concentration remains above a critical threshold over the minimum inhibitory concentration (MIC). Regrettably, neither the value of %T nor that of the threshold are clearly defined for critically-ill patients. Areas covered: We review and assess the targets proposed for β-lactams in critical illness by screening the literature since 1997. Depending on the study intention (clinical cure vs. suppression of resistance), targets proposed range from 20%T > 1xMIC to 100%T > 5xMIC. Assessment and comparative analysis of their respective clinical efficacy suggest that a value of 100%T > 4xMIC may be needed. Simulation studies, however, show that this target will not be reached at first dose for the majority of critically-ill patients if using the most commonly recommended doses. Expert commentary: Considering that critically-ill patients are highly vulnerable and likely to experience antibiotic underexposure, and because effective initial treatment is a key determinant of clinical outcome, we support the use of a target of 100%T > 4xMIC, which could not only maximize efficacy but also minimize emergence of resistance. Clinical and microbiological studies are needed to test for the feasibility and effectiveness of reaching such a demanding target.
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Affiliation(s)
- Isabelle K Delattre
- a Louvain Drug Research Institute , Université catholique de Louvain , Brussels , Belgium.,b Department of Clinical Chemistry , Cliniques Universitaires St-Luc , Brussels , Belgium
| | - Fabio S Taccone
- c Department of Intensive Care , Hôpital Erasme , Brussels , Belgium
| | - Frédérique Jacobs
- d Department of Infectious Diseases , Hôpital Erasme , Brussels , Belgium
| | - Maya Hites
- d Department of Infectious Diseases , Hôpital Erasme , Brussels , Belgium
| | - Thierry Dugernier
- e Department of Intensive Care , Clinique St-Pierre , Ottignies , Belgium
| | - Herbert Spapen
- f Department of Intensive Care , Universitair Ziekenhuis Brussel , Brussels , Belgium
| | | | - Pierre E Wallemacq
- b Department of Clinical Chemistry , Cliniques Universitaires St-Luc , Brussels , Belgium
| | - Françoise Van Bambeke
- a Louvain Drug Research Institute , Université catholique de Louvain , Brussels , Belgium
| | - Paul M Tulkens
- a Louvain Drug Research Institute , Université catholique de Louvain , Brussels , Belgium
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Mustafa MH, Khandekar S, Tunney MM, Elborn J, Kahl BC, Denis O, Plésiat P, Traore H, Tulkens PM, Vanderbist F, Van Bambeke F. Acquired resistance to macrolides inPseudomonas aeruginosafrom cystic fibrosis patients. Eur Respir J 2017; 49:49/5/1601847. [DOI: 10.1183/13993003.01847-2016] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/15/2017] [Indexed: 11/05/2022]
Abstract
Cystic fibrosis (CF) patients receive chronic treatment with macrolides for their antivirulence and anti-inflammatory properties. We, however, previously showed thatPseudomonas aeruginosa, considered as naturally resistant to macrolides, becomes susceptible when tested in a eukaryotic medium rather than a conventional broth.We therefore looked for specific macrolide resistance determinants in 333 CF isolates from four European CF centres in comparison with 48 isolates from patients suffering from hospital-acquired pneumonia (HAP).Minimum inhibitory concentrations (MICs) of macrolides and ketolides measured in eukaryotic medium (RPMI-1640) were higher towards CF than HAP isolates. Gene sequencing revealed mutations at three positions (2045, 2046 and 2598) in domain V of 23S rRNA of 43% of sequenced CF isolates, but none in HAP isolates. Enzymes degrading extracellular polymeric substances also reduced MICs, highlighting a role of the mucoid, biofilm-forming phenotype in resistance. An association between high MICs and chronic azithromycin administration was evidenced, which was statistically significant for patients infected by the Liverpool Epidemic Strain.Thus, ribosomal mutations are highly prevalent in CF isolates and may spread in epidemic clones, arguing for prudent use of oral macrolides in these patients. Measuring MICs in RPMI-1640 could be easily implemented in microbiology laboratories to phenotypically detect resistance.
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Chalhoub H, Pletzer D, Weingart H, Braun Y, Tunney MM, Elborn JS, Rodriguez-Villalobos H, Plésiat P, Kahl BC, Denis O, Winterhalter M, Tulkens PM, Van Bambeke F. Mechanisms of intrinsic resistance and acquired susceptibility of Pseudomonas aeruginosa isolated from cystic fibrosis patients to temocillin, a revived antibiotic. Sci Rep 2017; 7:40208. [PMID: 28091521 PMCID: PMC5238406 DOI: 10.1038/srep40208] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/01/2016] [Indexed: 12/29/2022] Open
Abstract
The β-lactam antibiotic temocillin (6-α-methoxy-ticarcillin) shows stability to most extended spectrum β-lactamases, but is considered inactive against Pseudomonas aeruginosa. Mutations in the MexAB-OprM efflux system, naturally occurring in cystic fibrosis (CF) isolates, have been previously shown to reverse this intrinsic resistance. In the present study, we measured temocillin activity in a large collection (n = 333) of P. aeruginosa CF isolates. 29% of the isolates had MICs ≤ 16 mg/L (proposed clinical breakpoint for temocillin). Mutations were observed in mexA or mexB in isolates for which temocillin MIC was ≤512 mg/L (nucleotide insertions or deletions, premature termination, tandem repeat, nonstop, and missense mutations). A correlation was observed between temocillin MICs and efflux rate of N-phenyl-1-naphthylamine (MexAB-OprM fluorescent substrate) and extracellular exopolysaccharide abundance (contributing to a mucoid phenotype). OpdK or OpdF anion-specific porins expression decreased temocillin MIC by ~1 two-fold dilution only. Contrarily to the common assumption that temocillin is inactive on P. aeruginosa, we show here clinically-exploitable MICs on a non-negligible proportion of CF isolates, explained by a wide diversity of mutations in mexA and/or mexB. In a broader context, this work contributes to increase our understanding of MexAB-OprM functionality and help delineating how antibiotics interact with MexA and MexB.
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Affiliation(s)
- Hussein Chalhoub
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Daniel Pletzer
- Life Sciences, School of Engineering and Science, Jacobs University, Bremen, Germany
| | - Helge Weingart
- Life Sciences, School of Engineering and Science, Jacobs University, Bremen, Germany
| | - Yvonne Braun
- Life Sciences, School of Engineering and Science, Jacobs University, Bremen, Germany
| | - Michael M Tunney
- CF &Airways Microbiology Research Group, Queen's University Belfast, Belfast, UK
| | - J Stuart Elborn
- CF &Airways Microbiology Research Group, Queen's University Belfast, Belfast, UK
| | - Hector Rodriguez-Villalobos
- Laboratoire de microbiologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Patrick Plésiat
- Laboratoire de bactériologie, Hôpital Jean Minjoz, Besançon, France
| | | | - Olivier Denis
- Laboratoire de microbiologie, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Mathias Winterhalter
- Life Sciences, School of Engineering and Science, Jacobs University, Bremen, Germany
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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Abrahamian FM, Aldape MJ, Aldasoro E, Allen UD, Al-Sum H, Anadkat MJ, Anders K, Angelakis E, Angus BJ, Antoniadou A, Arena F, Arends JE, Arribas JR, Artenstein AW, Atherton JC, Aucott JN, Aw TC, Babcock HM, Bailey R, Bailey TC, Banks AZ, Barillo DJ, Barrette EP, Bauer MP, Bayston R, Beard CB, Beardsley J, Beeching NJ, Bégué RE, Beldi G, Benson CA, Berbari EF, Berenger JM, Berger C, Bernardino JI, Bille J, Billioux AC, Bitnun A, Blair I, Blanche S, Bleck TP, Bleeker-Rovers CP, Bleijenberg G, Bloch KC, Blum J, Blumberg EA, Bonomo RA, Bonten MJ, Bourayou R, Bouza E, Brandt KA, Bretelle F, Brisse S, Britton WJ, Brook I, Brouwer MC, Browne SK, Bryant AE, Bühler S, Bulger EM, Buller RML, Burke LA, Burri C, Butler MW, Calandra T, Calfee DP, Calvo-Cano A, Cameron DW, Carcillo JA, Carson G, Chambers ST, Charrel RN, Nguyen VCV, Chevaliez S, Chiller TM, Christaki E, Chung KK, Clifford DB, Clumeck N, Cohen J, Collinge J, Conlon CP, Conrad C, Cooke FJ, Cope JR, Corey GR, Cross JH, Cunha BA, Cunha CB, D'Journo B, Daikos GL, Daniels JM, Davidson RN, Day NP, De Cock KM, de Silva TI, de Vries HJ, de Wit S, Delaloye J, Denning DW, Dennis DT, Dhanireddy S, Dielubanza EJ, Diemert DJ, Doganay M, Doherty T, Dolecek C, Dondorp AM, Douglas A, Drancourt M, Dubourg G, Dudley MN, Durand G, Eckhardt BJ, Efstratiou A, Ekkelenkamp MB, Eranki A, Erdem H, Escota GV, Evans HL, Eziefula AC, Fenollar F, Fenwick A, Fierer J, Finch RG, Fleckenstein JM, Forstner C, Foschi F, Fournier PE, French MA, Gage KL, Garcia LS, Gascon J, Gastañaduy AS, Gautret P, Geisler WM, Ghanem KG, Giani T, Giannella M, Gilliam BL, Gilliet M, Glaser CA, Glupczynski Y, Gnann JW, Goldstein EJ, Gottstein B, Gouriet F, Gravitt PE, Green MD, Green ST, Groll AH, Gulick RM, Gupta A, Habib G, Harbarth S, Harris M, Hayden FG, Hetem DJ, Hill PC, Hirschel B, Hodowanec AC, Hoffart L, Hoffmann C, Holland SM, Horby PW, Horne DJ, Hraiech S, Hull MW, Huttner A, Ingram RJ, Islam J, Ison MG, James SH, Jenkins C, Jenkins SG, Jensen JS, Johnston C, Jones TB, Jordan SJ, Julian KG, Kato Y, Kauffman CA, Kaye KS, Keane MP, Keeney J, Kelly P, Kent SJ, Kern WV, Keynan Y, Kim AA, Koné-Paut I, Kosmidis C, Kroes AC, Kroon FP, Ksiazek TG, Kuhlmann FM, Kuijper EJ, Kwon JH, Kyei GB, Lacombe K, Lagacé-Wiens P, Lagier JC, Lamagni T, Landraud L, Lanternier F, LaPlante KL, Lawn SD, Lawrence SJ, Leblebicioglu H, Lee N, Leggett JE, Lehours P, Levy PY, Leyh RG, Lillis RA, Limmathurotsakul D, Lin J, Lindquist HA, Lipsky BA, Liscynesky C, Looney D, Lortholary O, Lowy FD, Luft BJ, Mackowiak PA, MacPherson PA, Maghraoui-Slim V, Mallon PW, Mangino JE, Manuel O, Marchetti O, Marks KM, Marr KA, Marrazzo J, Marschall J, Martin DH, Matonti F, Matulewicz RS, Mayer KH, McCulloh RJ, McGready R, Mdodo R, Mead S, Mégraud F, Meintjes G, Metcalf SC, Michaels MG, Migliori GB, Miles MA, Miller A, Mimiaga MJ, Mingeot-Leclercq MP, Misch EA, Mitreva M, Montaner JS, Moore CB, Muñoz P, Muñoz J, Murray CK, Musso D, Mutengo M, Mutizwa MM, Naber KG, Natarajan P, Neme S, Newton PN, Nichols RA, Nicolle LE, Nosten F, Notarangelo LD, Nutman TB, Nyirjesy P, O'Connell PR, Opal SM, Ormerod LP, Osmon DR, Pankert MB, Pantaleo G, Papazian L, Parente DM, Parola P, Parsaei S, Pascual MA, Patel R, Patrozou E, Pawlotsky JM, Peacock SJ, Pechère JC, Pelegrin I, Peters BS, Peters EJ, Petersen JM, Petersen LR, Petraitis V, Pham LL, Picado A, Pilatz A, Pilmis B, Pinazo MJ, Pletz MW, Pogue JM, Polgreen EL, Polgreen PM, Posfay-Barbe KM, Powderly WG, Presti R, Prod'hom G, Puolakkainen M, Quinn TC, Raoult D, Razonable RR, Read RC, Redfield RR, Rentenaar RJ, Reynolds SJ, Ribi C, Richardson MD, Ritter ML, Roch A, Rockstroh JK, Rojek A, Romero JR, Rooijakkers SH, Rosenbluth D, Rosenzweig SD, Rossolini GM, Rubinstein E, Ryan G, Safren SA, Sahasrabuddhe VV, Saikku PA, Sajadi MM, Salvaggio MR, Santos CA, Satlin MJ, Schaeffer AJ, Schimmer C, Schooley RT, Schumacher RF, Sha BE, Shapiro DS, Sheehan G, Shlaes DM, Shoham S, Simmons CP, Simon DW, Simon MS, Simonsen KA, Slack MP, Smith TT, Sobel JD, Souli M, Sridhar S, Steckelberg JM, Stevens DL, Strah H, Sturm AW, Sungkanuparph S, Tabrizi SJ, Tacconelli E, Tan CS, Taplitz RA, Thomas G, Thomas LD, Thuny F, Thwaites G, Tissot F, Tønjum T, Torriani FJ, Toso C, Tulkens PM, Tunkel AR, Turner CE, Ustianowski AP, van Bambeke F, van Crevel R, van de Beek D, van Delden C, van der Eerden MM, van der Meer JW, van der Poll T, van Ingen J, van Putten J, Vaudaux BP, Vermund SH, Viscidi RP, Visvanathan K, Visvesvara GS, von Seidlein L, Wagenlehner FM, Wald A, Walsh TJ, Warhurst DC, Warnock DW, Warrell DA, Warrell MJ, Warris A, Watkins RR, Weatherall DJ, Weber R, Weidner W, White JR, White PJ, Whitehorn J, Whitley RJ, Whitty CJ, Wiersinga WJ, Wilcox MH, Williams TN, Wilson CC, Wilson ME, Wisplinghoff H, Wood R, Wunderink RG, Wyles D, Yang ZT, Yoder JS, Zaidi NA, Zimmer AJ, Zuckerman JN, Zumla A. List of Contributors. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00234-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Spinewine A, Dhillon S, Mallet L, Tulkens PM, Wilmotte L, Swine C. Implementation of Ward-Based Clinical Pharmacy Services in Belgium—Description of the Impact on a Geriatric Unit. Ann Pharmacother 2016; 40:720-8. [PMID: 16569792 DOI: 10.1345/aph.1g515] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Patient-centered clinical pharmacy services are still poorly developed in Europe, despite their demonstrated advantages in North America and the UK. Reporting European pilot experiences is, therefore, important to assess the usefulness of clinical pharmacy services in this specific context. Objective: To report the results of the first implementation of Belgian clinical pharmacy services targeting patients at high risk of drug-related problems. Methods: An intervention study was conducted by a trained clinical pharmacist providing pharmaceutical care to 101 patients (mean age 82.2 y; mean ± SD number of prescribed drugs 7.8 ± 3.5) admitted to an acute geriatric unit, over a 7 month period. All interventions to optimize prescribing, and their acceptance, were recorded. An external panel (2 geriatricians, 1 clinical pharmacist) assessed the interventions' clinical significance. Persistence of interventions after discharge was assessed through telephone calls. Results: A total of 1066 interventions were made over the 7 month period. The most frequent drug-related problems underlying interventions were: underuse (15.9%), wrong dose (11.9%), inappropriate duration of therapy (9.7%), and inappropriate choice of medicine (9.6%). The most prevalent consequences were to discontinue a drug (24.5%), add a drug (18.6%), and change dosage (13.7%). Acceptance rate by physicians was 87.8%. Among interventions with clinical impact, 68.3% and 28.6% had moderate and major clinical significance, respectively. Persistence of chronic treatment changes 3 months after discharge was 84%. Conclusions: Involving a trained clinical pharmacist in a geriatric team led to clinically relevant and well-accepted optimization of medicine use. This initiative may be a springboard for further development of clinical pharmacy services.
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Affiliation(s)
- Anne Spinewine
- School of Pharmacy, Université Catholique de Louvain, Brussels, Belgium.
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Mustafa MH, Chalhoub H, Denis O, Deplano A, Vergison A, Rodriguez-Villalobos H, Tunney MM, Elborn JS, Kahl BC, Traore H, Vanderbist F, Tulkens PM, Van Bambeke F. Antimicrobial Susceptibility of Pseudomonas aeruginosa Isolated from Cystic Fibrosis Patients in Northern Europe. Antimicrob Agents Chemother 2016; 60:6735-6741. [PMID: 27572406 PMCID: PMC5075080 DOI: 10.1128/aac.01046-16] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/23/2016] [Indexed: 12/23/2022] Open
Abstract
Pseudomonas aeruginosa is a major cause of morbidity and mortality in cystic fibrosis patients. This study compared the antimicrobial susceptibilities of 153 P. aeruginosa isolates from the United Kingdom (UK) (n = 58), Belgium (n = 44), and Germany (n = 51) collected from 118 patients during routine visits over the period from 2006 to 2012. MICs were measured by broth microdilution. Genes encoding extended-spectrum β-lactamases (ESBL), metallo-β-lactamases, and carbapenemases were detected by PCR. Pulsed-field gel electrophoresis and multilocus sequence typing were performed on isolates resistant to ≥3 antibiotic classes among the penicillins/cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and polymyxins. Based on EUCAST/CLSI breakpoints, susceptibility rates were ≤30%/≤40% (penicillins, ceftazidime, amikacin, and ciprofloxacin), 44 to 48%/48 to 63% (carbapenems), 72%/72% (tobramycin), and 92%/78% (colistin) independent of patient age. Sixty percent of strains were multidrug resistant (MDR; European Centre for Disease Prevention and Control criteria). Genes encoding the most prevalent ESBL (BEL, PER, GES, VEB, CTX-M, TEM, SHV, and OXA), metallo-β-lactamases (VIM, IMP, and NDM), or carbapenemases (OXA-48 and KPC) were not detected. The Liverpool epidemic strain (LES) was prevalent in UK isolates only (75% of MDR isolates). Four MDR sequence type 958 (ST958) isolates were found to be spread over the three countries. The other MDR clones were evidenced in ≤3 isolates and localized in a single country. A new sequence type (ST2254) was discovered in one MDR isolate in Germany. Clonal and nonclonal isolates with different susceptibility profiles were found in 20 patients. Thus, resistance and MDR are highly prevalent in routine isolates from 3 countries, with meropenem, tobramycin, and colistin remaining the most active drugs.
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Affiliation(s)
- Muhammad-Hariri Mustafa
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- SMB Laboratories, Brussels, Belgium
| | - Hussein Chalhoub
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Olivier Denis
- Hôpital Erasme/Hôpital des Enfants Malades, Université libre de Bruxelles, Brussels, Belgium
| | - Ariane Deplano
- Hôpital Erasme/Hôpital des Enfants Malades, Université libre de Bruxelles, Brussels, Belgium
| | - Anne Vergison
- Hôpital Erasme/Hôpital des Enfants Malades, Université libre de Bruxelles, Brussels, Belgium
| | - Hector Rodriguez-Villalobos
- Department of Microbiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | | | | | | | | | | | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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30
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Chalhoub H, Sáenz Y, Rodriguez-Villalobos H, Denis O, Kahl BC, Tulkens PM, Van Bambeke F. High-level resistance to meropenem in clinical isolates of Pseudomonas aeruginosa in the absence of carbapenemases: role of active efflux and porin alterations. Int J Antimicrob Agents 2016; 48:740-743. [PMID: 28128097 DOI: 10.1016/j.ijantimicag.2016.09.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/25/2016] [Accepted: 09/12/2016] [Indexed: 11/29/2022]
Abstract
High-level carbapenem resistance is worryingly increasing in clinical isolates and is often attributed to carbapenemase expression. This study aimed to determine the mechanisms leading to high-level meropenem resistance in six carbapenemase-negative Pseudomonas aeruginosa isolated from cystic fibrosis (CF) patients and seven carbapenemase-positive isolates from patients suffering from hospital-acquired pneumonia (HAP). MICs were determined in the absence or presence of l-arginine or glycine-glutamate as competitive substrates for OprD (OccD1) or OpdP (OccD3), respectively, or the efflux pump inhibitor Phe-Arg β-naphthylamide (PAβN). β-Lactamases were screened by phenotypic tests and/or PCR. The oprD gene and its promoter were sequenced; protein expression was evidenced by SDS-PAGE. mexA, mexX, mexC and mexE transcripts were evaluated by real-time and semiquantitative PCR. Meropenem/imipenem MICs were 64-128/16-32 mg/L and 128/128-256 mg/L in CF and HAP isolates, respectively; PAβN reduced meropenem MICs to 4-16 mg/L only and specifically in CF isolates; porin competitors had no effect on MICs. All isolates showed an increase in transcription levels of mexA, mexX and/or mexC and mutations in oprD leading to production of truncated proteins. AmpC-type cephalosporinases were overexpressed in CF isolates and VIM-2 was expressed in HAP isolates. Antibiotic exclusion from bacteria by concomitant efflux and reduced uptake is sufficient to confer high-level resistance to meropenem in isolates overexpressing AmpC-type cephalosporinases. As efflux is preponderant in these isolates, it confers a paradoxical phenotype where meropenem is less active than imipenem. Concomitant susceptibility testing of both carbapenems and rapid elucidation of the most probable resistance mechanisms is thus warranted.
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Affiliation(s)
- Hussein Chalhoub
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Yolanda Sáenz
- Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | | | - Olivier Denis
- Laboratoire de microbiologie, Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | | | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
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31
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Denamur S, Boland L, Beyaert M, Verstraeten SL, Fillet M, Tulkens PM, Bontemps F, Mingeot-Leclercq MP. Subcellular mechanisms involved in apoptosis induced by aminoglycoside antibiotics: Insights on p53, proteasome and endoplasmic reticulum. Toxicol Appl Pharmacol 2016; 309:24-36. [DOI: 10.1016/j.taap.2016.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 12/21/2022]
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32
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Anantharajah A, Faure E, Buyck JM, Sundin C, Lindmark T, Mecsas J, Yahr TL, Tulkens PM, Mingeot-Leclercq MP, Guery B, Van Bambeke F. Inhibition of the Injectisome and Flagellar Type III Secretion Systems by INP1855 Impairs Pseudomonas aeruginosa Pathogenicity and Inflammasome Activation. J Infect Dis 2016; 214:1105-16. [PMID: 27412581 DOI: 10.1093/infdis/jiw295] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 07/06/2016] [Indexed: 11/13/2022] Open
Abstract
With the rise of multidrug resistance, Pseudomonas aeruginosa infections require alternative therapeutics. The injectisome (iT3SS) and flagellar (fT3SS) type III secretion systems are 2 virulence factors associated with poor clinical outcomes. iT3SS translocates toxins, rod, needle, or regulator proteins, and flagellin into the host cell cytoplasm and causes cytotoxicity and NLRC4-dependent inflammasome activation, which induces interleukin 1β (IL-1β) release and reduces interleukin 17 (IL-17) production and bacterial clearance. fT3SS ensures bacterial motility, attachment to the host cells, and triggers inflammation. INP1855 is an iT3SS inhibitor identified by in vitro screening, using Yersinia pseudotuberculosis Using a mouse model of P. aeruginosa pulmonary infection, we show that INP1855 improves survival after infection with an iT3SS-positive strain, reduces bacterial pathogenicity and dissemination and IL-1β secretion, and increases IL-17 secretion. INP1855 also modified the cytokine balance in mice infected with an iT3SS-negative, fT3SS-positive strain. In vitro, INP1855 impaired iT3SS and fT3SS functionality, as evidenced by a reduction in secretory activity and flagellar motility and an increase in adenosine triphosphate levels. As a result, INP1855 decreased cytotoxicity mediated by toxins and by inflammasome activation induced by both laboratory strains and clinical isolates. We conclude that INP1855 acts by dual inhibition of iT3SS and fT3SS and represents a promising therapeutic approach.
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Affiliation(s)
- Ahalieyah Anantharajah
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Emmanuel Faure
- EA7366, Host-Pathogen Translational Research Group, Faculté de Médecine, Université Lille Nord de France, Lille, France
| | - Julien M Buyck
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | | | | | - Joan Mecsas
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, Massachusetts
| | - Timothy L Yahr
- Department of Microbiology, University of Iowa, Iowa City
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Marie-Paule Mingeot-Leclercq
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Benoît Guery
- EA7366, Host-Pathogen Translational Research Group, Faculté de Médecine, Université Lille Nord de France, Lille, France
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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33
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Ceyssens PJ, Van Bambeke F, Mattheus W, Bertrand S, Fux F, Van Bossuyt E, Damée S, Nyssen HJ, De Craeye S, Verhaegen J, Tulkens PM, Vanhoof R. Molecular Analysis of Rising Fluoroquinolone Resistance in Belgian Non-Invasive Streptococcus pneumoniae Isolates (1995-2014). PLoS One 2016; 11:e0154816. [PMID: 27227336 PMCID: PMC4881901 DOI: 10.1371/journal.pone.0154816] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/19/2016] [Indexed: 11/25/2022] Open
Abstract
We present the results of a longitudinal surveillance study (1995–2014) on fluoroquinolone resistance (FQ-R) among Belgian non-invasive Streptococcus pneumoniae isolates (n = 5,602). For many years, the switch to respiratory fluoroquinolones for the treatment of (a)typical pneumonia had no impact on FQ-R levels. However, since 2011 we observed a significant decrease in susceptibility towards ciprofloxacin, ofloxacin and levofloxacin with peaks of 9.0%, 6.6% and 3.1% resistant isolates, respectively. Resistance to moxifloxacin arised sporadically, and remained <1% throughout the entire study period. We observed classical topoisomerase mutations in gyrA (n = 25), parC (n = 46) and parE (n = 3) in varying combinations, arguing against clonal expansion of FQ-R. The impact of recombination with co-habiting commensal streptococci on FQ-R remains marginal (10.4%). Notably, we observed that a rare combination of DNA Gyrase mutations (GyrA_S81L/GyrB_P454S) suffices for high-level moxifloxacin resistance, contrasting current model. Interestingly, 85/422 pneumococcal strains display MICCIP values which were lowered by at least four dilutions by reserpine, pointing at involvement of efflux pumps in FQ-R. In contrast to susceptible strains, isolates resistant to ciprofloxacin significantly overexpressed the ABC pump PatAB in comparison to reference strain S. pneumoniae ATCC 49619, but this could only be linked to disruptive terminator mutations in a fraction of these. Conversely, no difference in expression of the Major Facilitator PmrA, unaffected by reserpine, was noted between susceptible and resistant S. pneumoniae strains. Finally, we observed that four isolates displayed intermediate to high-level ciprofloxacin resistance without any known molecular resistance mechanism. Focusing future molecular studies on these isolates, which are also commonly found in other studies, might greatly assist in the battle against rising pneumococcal drug resistance.
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Affiliation(s)
- Pieter-Jan Ceyssens
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Wesley Mattheus
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Sophie Bertrand
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Frédéric Fux
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Eddie Van Bossuyt
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Sabrina Damée
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Henry-Jean Nyssen
- Unit of Foodborne Pathogens, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Stéphane De Craeye
- Unit of Foodborne Pathogens, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
| | - Jan Verhaegen
- Laboratory of Clinical Bacteriology and Mycology, KULeuven, 3000 Leuven, Belgium
| | | | - Paul M. Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Raymond Vanhoof
- Unit of Bacterial Diseases, Scientific Institute of Public Health (WIV-ISP), 1050 Brussels, Belgium
- * E-mail:
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34
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Vandevelde NM, Tulkens PM, Van Bambeke F. Modulating antibiotic activity towards respiratory bacterial pathogens by co-medications: a multi-target approach. Drug Discov Today 2016; 21:1114-29. [PMID: 27094105 DOI: 10.1016/j.drudis.2016.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/01/2023]
Abstract
Non-antibiotic drugs can modulate bacterial physiology and/or antibiotic activity, opening perspectives for innovative therapeutic strategies. Focusing on respiratory pathogens and considering in vitro, in vivo, and clinical data, here we examine the effect of these drugs on the expression of resistance mechanisms, biofilm formation, and intracellular survival, as well as their influence on the activity of antibiotics on bacteria. Beyond the description of the effects observed, we also comment on concentrations that are active and discuss the mechanisms of drug-drug or drug-target interactions. This discussion should be helpful in defining useful targets for adjuvant therapy and establishing the corresponding pharmacophores for further drug fine-tuning.
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Affiliation(s)
- Nathalie M Vandevelde
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
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35
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Van Bambeke F, Tulkens PM. Editorial Commentary: Colistin and a New Paradigm in Drug Development. Clin Infect Dis 2016; 62:559-60. [PMID: 26607423 DOI: 10.1093/cid/civ968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 11/13/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire and Centre of Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire and Centre of Clinical Pharmacy, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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36
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Van Bambeke F, Tulkens PM. The role of solithromycin in the management of bacterial community-acquired pneumonia. Expert Rev Anti Infect Ther 2016; 14:311-24. [DOI: 10.1586/14787210.2016.1138857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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37
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Buyck JM, Lemaire S, Seral C, Anantharajah A, Peyrusson F, Tulkens PM, Van Bambeke F. In Vitro Models for the Study of the Intracellular Activity of Antibiotics. Methods Mol Biol 2016; 1333:147-157. [PMID: 26468107 DOI: 10.1007/978-1-4939-2854-5_13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intracellular bacteria are poorly responsive to antibiotic treatment. Pharmacological studies are thus needed to determine which antibiotics are most potent or effective against intracellular bacteria as well as to explore the reasons for poor bacterial responsiveness. An in vitro pharmacodynamic model is described, consisting of (1) phagocytosis of pre-opsonized bacteria by eukaryotic cells; (2) elimination of non-internalized bacteria with gentamicin; (3) incubation of infected cells with antibiotics; and (4) determination of surviving bacteria by viable cell counting and normalization of the counts based on sample protein content.
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Affiliation(s)
- Julien M Buyck
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Focal Area Infection Biology, Biozentrum, University of Basel, Basel, Switzerland
| | - Sandrine Lemaire
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- GSK Biologicals, Rixensart, Belgium
| | - Cristina Seral
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Department of Microbiology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Ahalieyah Anantharajah
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Frédéric Peyrusson
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
- Pharmacologie cellulaire et molÕculaire, Louvain Drug Research Institute, Avenue E. Mounier 73 B1.73.05, Brussels, 1200, Belgium.
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38
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Riou M, Avrain L, Carbonnelle S, El Garch F, Pirnay JP, De Vos D, Plésiat P, Tulkens PM, Van Bambeke F. Increase of efflux-mediated resistance in Pseudomonas aeruginosa during antibiotic treatment in patients suffering from nosocomial pneumonia. Int J Antimicrob Agents 2015; 47:77-83. [PMID: 26691019 DOI: 10.1016/j.ijantimicag.2015.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/17/2022]
Abstract
Increases in antibiotic minimum inhibitory concentrations (MICs) for Pseudomonas aeruginosa during treatment are commonly observed but their relationship to efflux overexpression remains poorly documented. In this study, pairs of first [at time of diagnosis (D0)] and last [during treatment (DL)] P. aeruginosa isolates were obtained from patients treated for suspicion of nosocomial pneumonia. Pair clonality was determined by repetitive extragenic palindromic PCR. Overexpression of mexA and mexX was assessed by real-time PCR, and expression of mexC and mexE was assessed by PCR. Antibiotics received by patients before and during treatment were determined from clinical charts. For D0 isolates, 24% were from patients without antibiotics for 1 month and 64% were negative for mexA/mexX overexpression and mexC/mexE expression. For DL isolates, approximately one-half of the patients had received piperacillin/tazobactam, amikacin, meropenem and/or cefepime, and 17% had received ciprofloxacin (alone or in combination); 38% did not show changes in expression of the four genes, whereas 38% showed increased expression for one gene (mainly mexA or mexX), 19% for two genes (mainly mexA and mexX) and 5% for three or four genes. Isolates overexpressing mexA or mexX had median MICs above EUCAST clinical resistance breakpoints for ciprofloxacin, cefepime and meropenem, or for ciprofloxacin, amikacin, cefepime and meropenem, respectively. mexA or mexX overexpression was statistically significantly associated with patients' exposure to ciprofloxacin and meropenem or cefepime and meropenem, respectively. Overexpression of genes encoding antibiotic transporters in P. aeruginosa during treatment is frequent and is associated with increases in MICs above EUCAST clinical susceptibility breakpoints.
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Affiliation(s)
- Mickaël Riou
- Pharmacologie cellulaire et moléculaire & Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | | | - Sylviane Carbonnelle
- Pharmacologie cellulaire et moléculaire & Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Farid El Garch
- Pharmacologie cellulaire et moléculaire & Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Laboratoire de microbiologie, CHU Dinant-Godinne UCL Namur, Yvoir, Belgium
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Neder-over-Heembeek, Brussels, Belgium
| | - Daniel De Vos
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, Neder-over-Heembeek, Brussels, Belgium
| | - Patrick Plésiat
- Laboratoire de bactériologie, Faculté de médecine, Université de Franche-Comté, Besançon, France
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire & Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire & Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
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39
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Anantharajah A, Buyck JM, Faure E, Glupczynski Y, Rodriguez-Villalobos H, De Vos D, Pirnay JP, Bilocq F, Guery B, Tulkens PM, Mingeot-Leclercq MP, Van Bambeke F. Correlation between cytotoxicity induced by Pseudomonas aeruginosa clinical isolates from acute infections and IL-1β secretion in a model of human THP-1 monocytes. Pathog Dis 2015. [PMID: 26203053 DOI: 10.1093/femspd/ftv049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Type III secretion system (T3SS) in Pseudomonas aeruginosa is associated with poor clinical outcome in acute infections. T3SS allows for injection of bacterial exotoxins (e.g. ExoU or ExoS) into the host cell, causing cytotoxicity. It also activates the cytosolic NLRC4 inflammasome, activating caspase-1, inducing cytotoxicity and release of mature IL-1β, which impairs bacterial clearance. In addition, flagellum-mediated motility has been suggested to also modulate inflammasome response and IL-1β release. Yet the capacity of clinical isolates to induce IL-1β release and its relation with cytotoxicity have never been investigated. Using 20 clinical isolates from acute infections with variable T3SS expression levels and human monocytes, our aim was to correlate IL-1β release with toxin expression, flagellar motility and cytotoxicity. ExoU-producing isolates caused massive cell death but minimal release of IL-1β, while those expressing T3SS but not ExoU (i.e. expressing ExoS or no toxins) induced caspase-1 activation and IL-1β release, the level of which was correlated with cytotoxicity. Both effects were prevented by a specific caspase-1 inhibitor. Flagellar motility was not correlated with cytotoxicity or IL-1β release. No apoptosis was detected. Thus, T3SS cytotoxicity is accompanied by a modification in cytokine balance for P. aeruginosa clinical isolates that do not express ExoU.
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Affiliation(s)
- Ahalieyah Anantharajah
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Julien M Buyck
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Emmanuel Faure
- Host-Pathogen Translational Research Group, Université Droit et Santé de Lille, Faculté de Médecine, CHRU Lille, 59000 Lille, France
| | - Youri Glupczynski
- Centre National de Référence de la résistance chez Pseudomonas aeruginosa, CHU Dinant-Godinne UCL Namur, Université catholique de Louvain, 5530 Yvoir, Belgium
| | - Hector Rodriguez-Villalobos
- Laboratoire de microbiologie, Cliniques universitaires Saint Luc, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Daniel De Vos
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Neder-over-Heembeek, Belgium
| | - Jean-Paul Pirnay
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Neder-over-Heembeek, Belgium
| | - Florence Bilocq
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Neder-over-Heembeek, Belgium
| | - Benoît Guery
- Host-Pathogen Translational Research Group, Université Droit et Santé de Lille, Faculté de Médecine, CHRU Lille, 59000 Lille, France
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Marie-Paule Mingeot-Leclercq
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, 1200 Brussels, Belgium
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Kishore BK, Van Schepdael A, Laurent G, Lambricht P, Claes PJ, Piret J, Tulkens PM, Maldague P. Co-oxydextran as a protectant against gentamicin-induced renal lysosomal phospholipidosis and focal tubular necrosis. Perspectives and limitations. Contrib Nephrol 2015; 101:213-9. [PMID: 7682169 DOI: 10.1159/000422134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- B K Kishore
- Laboratoire de Chimie Physiologique, Université Catholique de Louvain, Belgium
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Kishore BK, Lambricht P, Ibrahim S, Laurent G, Tulkens PM, Maldague P. Inhibition of aminoglycoside-induced nephrotoxicity in rats by polyanionic peptides. Contrib Nephrol 2015; 83:191-201. [PMID: 1713134 DOI: 10.1159/000418798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In the present study, we compared poly-L-Asp with poly-L-Glu and poly-D-Glu in vitro and in vivo for their ability to inhibit the GM-induced nephrotoxicity. In vitro, all three polyanions (i) bound GM over a wide range of pH; (ii) displaced GM previously bound to negatively charged phospholipid bilayers at acid pH (i.e. under the conditions prevailing in lysosomes in vivo), and thereby (iii) decreased the inhibitory potency of GM towards lysosomal phospholipase A1. Thus, one was tempted to predict that all three polyanions would have the potential of protecting against AG-induced nephrotoxicity. However, when co-administered to rats with GM, poly-L-Asp and poly-D-Glu completely suppressed the development of lysosomal phospholipidosis, as assessed by biochemical criteria and increased drug accumulation, whereas poly-L-Glu did not offer such protection despite a relatively lower increase in drug accumulation levels. Histoautoradiography also confirmed that poly-L-Asp, but not poly-L-Glu, was a nephroprotectant against the tissue proliferative response induced by GM. Morphologically, poly-L-Asp almost completely and poly-D-Glu totally prevented the accumulation of myeloid bodies in lysosomes. In vitro incubation in the presence of purified lysosomal extracts revealed marked differences in the hydrolysis rate of these peptides (poly-D-Glu:poly-L-Asp:poly-L-Glu = 1:1.2:16.9). Assuming that all three polyanionic peptides are transported and accumulated in lysosomes to the same extent, these results not only suggest that their stability in lysosomes is an essential requisite for protection against lysosomal phospholipidosis, but also strengthen our hypothesis that the site of action of poly-L-Asp is inside the lysosomes but not at the level of the renal membranes. In addition, poly-D-Glu alone or combined with GM induced another type of morphological lesion, not related to AG-induced nephrotoxicity which, to our knowledge, has not yet been described.
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Affiliation(s)
- B K Kishore
- Laboratoire de Chimie Physiologique, Université Catholique de Louvain, Bruxelles, Belgium
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Claeys C, Dufrasne M, De Vriese C, Nève J, Tulkens PM, Spinewine A. [Information transmission to the community pharmacist after a patient's discharge from the hospital: setting up of a written medication discharge form, prospective evaluation of its impact, and survey of the information needs of the pharmacists]. J Pharm Belg 2015:42-54. [PMID: 26571796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Discharge from the hospital is a period at risk for the continuity of patient's medication (seamless pharmaceutical care). The community pharmacist is often the first health care professional seen by the patient after hospital discharge. The clinical pharmacist has potentially a key role in establishing an efficient information transfer from the hospital to the community pharmacy. OBJECTIVE (1) To develop and, (2) to evaluate the impact of a structured discharge medication form prepared at hospital discharge by the clinical pharmacist and containing information items related to the medication regimen for the community pharmacist, and (3) to survey the information needs of the Belgian community pharmacists to ensure continuity of care after hospitalization. METHODS (1) A structured discharge medication form has been developed based on a Literature review and on opinions expressed by community and clinical pharmacists, members of the Belgian Pharmaceutical Union (Association Pharmaceutique Belge) and an ethical committee. (2) A prospective study has been conducted with patients from geriatrics and orthopaedics wards of the University Hospital Dinant-Godinne returning home after hospital discharge with the discharge medication form to be given to their commuiity pharmacist; its use, the reasons for non-use, the perceived impact and the satisfaction of the community pharmacist have been assessed. (3) An on-line survey addressed to all Belgian community pharmacists evaluated their information needs. RESULTS (1) The final version of the discharge medication form included key information items concerning the hospital, the patient, the discharge treatment (including the type of modifications made as compared to medications taken before admission), and on medication management at home. Some items were excluded because of Lack of perceived utility by pharmacists, confidentiality issues, and respect of patient's freedom of choice. (2) From the 71 medication forms given to patients, 48 were received by the community pharmacist. One quarter of respondents stated that they did not use the form, the main reason being that it was received after dispensing of the discharge treatment (n=6/11). The majority of the community pharmacists considered most of the information items as useful and the discharge medication form as being valuable for continuity of care. Requests for additional information were made (e.g., reason of admission and of treatment modifications, etc.). (3) The utility, benefits, and need for additional information items beyond what was included in the discharge medication form were highlighted by the respondents (n=309) of the national survey. Most of these respondents confirmed the value of the different information items included in the discharge medication form. CONCLUSION The transmission of a structured medication form containing information about the medication regimen upon hospital discharge is of real interest and value for the community pharmacist because it goes beyond what is usually provided on a medical prescription. However, this discharge medication form should include more information items for effective pharmaceutical care.
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Vandevelde NM, Tulkens PM, Muccioli GG, Van Bambeke F. Modulation of the activity of moxifloxacin and solithromycin in an in vitro pharmacodynamic model of Streptococcus pneumoniae naive and induced biofilms. J Antimicrob Chemother 2015; 70:1713-26. [PMID: 25712316 DOI: 10.1093/jac/dkv032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Bacterial biofilms developing in the bronchial tree of patients experiencing acute exacerbations of chronic bronchitis (AECBs) are suggested to cause relapses and recurrences of the disease because the matrix barrier impairs antibiotic access to the offending organisms. We examined whether bronchodilators could modulate pneumococcal biofilm development and antibiotic action using an in vitro model. METHODS Streptococcus pneumoniae strains from patients hospitalized for AECBs and two reference strains (ATCC 49619 and R6) were screened for biofilm formation (multi-well plates; 2-11 days of growth). Ipratropium and salbutamol (alone or in combination) were added at concentrations of 1.45 and 7.25 mg/L, respectively (mimicking those in the bronchial tree), and their effects were measured on biofilm formation and modulation of the activity of antibiotics [full antibiotic concentration-dependent effects (pharmacodynamic model)] with a focus on moxifloxacin and solithromycin. Bacterial viability and biomass were measured by the reduction of resazurin and crystal violet staining, respectively. Release of sialic acid (from biofilm) and neuraminidase activity were measured using enzymatic and HPLC-MS detection of sialic acid. RESULTS All clinical isolates produced biofilms, but with fast disassembly if from patients who had received muscarinic antagonists. Ipratropium caused: (i) reduced biomass formation and faster biofilm disassembly with free sialic acid release; and (ii) a marked improvement of antibiotic activity (bacterial killing and biomass reduction). Salbutamol stimulated neuraminidase activity associated with improved antibiotic killing activity (reversed by zanamivir) but modest biomass reduction. CONCLUSIONS Ipratropium and, to a lesser extent, salbutamol may cooperate with antibiotics for bacterial clearance and disassembly of pneumococcal biofilms.
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Affiliation(s)
- Nathalie M Vandevelde
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Giulio G Muccioli
- Bioanalysis and Pharmacology of Bioactive Lipids, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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Chalhoub H, Tunney M, Elborn JS, Vergison A, Denis O, Plésiat P, Kahl BC, Van Bambeke F, Tulkens PM. Avibactam confers susceptibility to a large proportion of ceftazidime-resistant Pseudomonas aeruginosa isolates recovered from cystic fibrosis patients. J Antimicrob Chemother 2015; 70:1596-8. [PMID: 25587996 DOI: 10.1093/jac/dku551] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hussein Chalhoub
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Michael Tunney
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, UK
| | - J Stuart Elborn
- CF & Airways Microbiology Research Group, Queen's University Belfast, Belfast, UK
| | - Anne Vergison
- Unité des maladies infectieuses, Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Olivier Denis
- Laboratoire de microbiologie, Hôpital Erasme, Brussels, Belgium
| | - Patrick Plésiat
- Laboratoire de bactériologie, Hôpital Jean Minjoz, Besançon, France
| | - Barbara C Kahl
- Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
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Flanagan S, McKee EE, Das D, Tulkens PM, Hosako H, Fiedler-Kelly J, Passarell J, Radovsky A, Prokocimer P. Nonclinical and pharmacokinetic assessments to evaluate the potential of tedizolid and linezolid to affect mitochondrial function. Antimicrob Agents Chemother 2015; 59:178-85. [PMID: 25331703 PMCID: PMC4291347 DOI: 10.1128/aac.03684-14] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022] Open
Abstract
Prolonged treatment with the oxazolidinone linezolid is associated with myelosuppression, lactic acidosis, and neuropathies, toxicities likely caused by impairment of mitochondrial protein synthesis (MPS). To evaluate the potential of the novel oxazolidinone tedizolid to cause similar side effects, nonclinical and pharmacokinetic assessments were conducted. In isolated rat heart mitochondria, tedizolid inhibited MPS more potently than did linezolid (average [± standard error of the mean] 50% inhibitory concentration [IC50] for MPS of 0.31 ± 0.02 μM versus 6.4 ± 1.2 μM). However, a rigorous 9-month rat study comparing placebo and high-dose tedizolid (resulting in steady-state area under the plasma concentration-time curve values about 8-fold greater than those with the standard therapeutic dose in humans) showed no evidence of neuropathy. Additional studies explored why prolonged, high-dose tedizolid did not cause these mitochondriopathic side effects despite potent MPS inhibition by tedizolid. Murine macrophage (J774) cell fractionation studies found no evidence of a stable association of tedizolid with eukaryotic mitochondria. Monte Carlo simulations based on population pharmacokinetic models showed that over the course of a dosing interval using standard therapeutic doses, free plasma concentrations fell below the respective MPS IC50 in 84% of tedizolid-treated patients (for a median duration of 7.94 h) and 38% of linezolid-treated patients (for a median duration of 0 h). Therapeutic doses of tedizolid, but not linezolid, may therefore allow for mitochondrial recovery during antibacterial therapy. The overall results suggest that tedizolid has less potential to cause myelosuppression and neuropathy than that of linezolid during prolonged treatment courses. This, however, remains a hypothesis that must be confirmed in clinical studies.
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Affiliation(s)
| | - Edward E McKee
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Debaditya Das
- Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
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Laterre PF, Wittebole X, Van de Velde S, Muller AE, Mouton JW, Carryn S, Tulkens PM, Dugernier T. Temocillin (6 g daily) in critically ill patients: continuous infusion versus three times daily administration. J Antimicrob Chemother 2014; 70:891-8. [PMID: 25433006 DOI: 10.1093/jac/dku465] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The growing incidence of infections caused by Enterobacteriaceae producing ESBLs has led to increased use of carbapenems. Temocillin, which resists most β-lactamases, may be a useful alternative. The aim of this study was to assess the pharmacokinetics and target attainment rates of 6 g of temocillin daily divided into three administrations every 8 h (three times daily) or administered by continuous infusion in critically ill patients. PATIENTS AND METHODS This was a prospective, two-centre, randomized, controlled study in patients with intra-abdominal or lower respiratory tract infections caused by Enterobacteriaceae. RESULTS Thirty-two patients were included and analysed for clinical efficacy, and pharmacokinetics were measured in 29 of them. Four patients undergoing continuous veno-venous haemofiltration (CVVH) were analysed separately. Mean, median and range of percentages of the dosing interval during which the free drug concentration remained >16 mg/L were 76.4, 98 and 18.7-98.9 in patients treated three times daily and 98.9, 89.7 and 36.4-99.9 in patients with continuous infusion, respectively. Clinical cure rates were 79% and 93% in each of these groups, respectively (not significant). Patients with CVVH received a daily dose of 750 mg given by continuous infusion and had a mean free drug concentration of only 13.8 ± 1.9 mg/L. No adverse event attributable to temocillin was observed. CONCLUSIONS Temocillin (6 g daily) given by continuous infusion allows a larger proportion of critically ill patients to have free drug serum concentrations covering infections caused by Enterobacteriaceae with an MIC of 16 mg/L compared with administration three times daily. Clinical efficacy compared with carbapenems in documented severe infections needs to be further studied.
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Affiliation(s)
- Pierre-François Laterre
- Department of Critical Care Medicine, St Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Xavier Wittebole
- Department of Critical Care Medicine, St Luc University Hospital, Université catholique de Louvain, Brussels, Belgium
| | - Sebastien Van de Velde
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Anouk E Muller
- Department of Medical Microbiology, Medical Centre Haaglanden (MCH), Den Haag, The Netherlands
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Stéphane Carryn
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Dugernier
- Department of Critical Care Medicine, St Luc University Hospital, Université catholique de Louvain, Brussels, Belgium Department of Critical Care Medicine, St Pierre Hospital, Ottignies, Belgium
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Miranda Bastos AC, Vandecasteele SJ, Tulkens PM, Spinewine A, Van Bambeke F. Development and validation of a high performance liquid chromatography assay for the determination of temocillin in serum of haemodialysis patients. J Pharm Biomed Anal 2013; 90:192-7. [PMID: 24389461 DOI: 10.1016/j.jpba.2013.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/04/2013] [Indexed: 11/29/2022]
Abstract
Therapeutic drug monitoring of β-lactams can be useful for the optimization of therapy, especially when little reference data exist on actual pharmacokinetic profiles such as in patients undergoing haemodialysis. There is no reported validated method for temocillin assay in serum samples, and preliminary studies evidenced potential for interferences by acidic metabolites and co-administered drugs in patients with advanced kidney failure. This paper describes a fully validated method for the determination of temocillin in human serum, and its applicability in haemodialysis patients. Temocillin was extracted from human serum by a solid phase extraction methodology, and then assayed by reversed-phase HPLC with UV-detection. The method was validated according to the accuracy profile methodology, using total error to verify the trueness, precision and overall accuracy. It showed high specificity and precision and was accurate in the concentration range of 5-400 mg/L. LOD and LOQ were 1.2 and 5 mg/L, respectively. No interference with 30 co-administered drugs was evidenced. The method was successfully applied to clinical samples from haemodialysis patients, showing a high degree of dialysability of temocillin.
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Affiliation(s)
- Ana C Miranda Bastos
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Center for Clinical Pharmacy, Université catholique de Louvain, Brussels, Belgium
| | - Stefaan J Vandecasteele
- Department Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Center for Clinical Pharmacy, Université catholique de Louvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Center for Clinical Pharmacy, Université catholique de Louvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; Center for Clinical Pharmacy, Université catholique de Louvain, Brussels, Belgium.
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Marquez B, Pourcelle V, Vallet CM, Mingeot-Leclercq MP, Tulkens PM, Marchand-Bruynaert J, Van Bambeke F. Pharmacological Characterization of 7-(4-(Piperazin-1-yl)) Ciprofloxacin Derivatives: Antibacterial Activity, Cellular Accumulation, Susceptibility to Efflux Transporters, and Intracellular Activity. Pharm Res 2013; 31:1290-301. [DOI: 10.1007/s11095-013-1250-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 11/10/2013] [Indexed: 01/16/2023]
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Ampe E, Delaere B, Hecq JD, Tulkens PM, Glupczynski Y. Implementation of a protocol for administration of vancomycin by continuous infusion: pharmacokinetic, pharmacodynamic and toxicological aspects. Int J Antimicrob Agents 2013; 41:439-46. [DOI: 10.1016/j.ijantimicag.2013.01.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/28/2012] [Accepted: 01/03/2013] [Indexed: 10/27/2022]
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