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Gil Romero Y, Gómez-Garcés JL. In vitro activity of ceftaroline in combination with other antimicrobials active against Staphylococcus spp. Enferm Infecc Microbiol Clin 2020; 38:25-27. [PMID: 31072712 DOI: 10.1016/j.eimc.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 11/07/2018] [Revised: 03/03/2019] [Accepted: 03/12/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We evaluated the in vitro activity of the combination of ceftaroline with daptomycin, linezolid and vancomycin against methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus (CNS). MATERIAL AND METHODS We analysed 70 staphylococcal strains (31 S. aureus and 39 CNS) with the Etest using the MIC:MIC ratio method and calculation of fractional inhibitory concentration indexes. RESULTS The combination of ceftaroline with daptomycin showed an additive effect (53.2%) and synergy (6.6%) against methicillin-susceptible S. aureus, and an additive effect (81.2%) against methicillin-resistant S. aureus (MRSA). This combination also showed an additive effect against 33% of linezolid-susceptible CNS and was not synergistic against linezolid-resistant CNS. The combination of ceftaroline with vancomycin was synergistic (87%) and ceftaroline with linezolid was additive (37%) against MRSA. CONCLUSIONS The combinations of ceftaroline with daptomycin, vancomycin or linezolid showed additive and/or synergistic effects against methicillin-resistant Staphylococcus.
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Affiliation(s)
- Yolanda Gil Romero
- Servicio de Microbiología, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
| | - José-Luis Gómez-Garcés
- Instituto de Investigación Biomédica, Hospital Universitario de Móstoles, Móstoles, Madrid, España
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Tenorio-Abreu A, Gil Tomás J, Bratos Pérez MÁ, de la Iglesia Salgado A, Borrás Máñez M, Ortiz de Lejarazu Leonardo R, Ávila Alonso A, Colomina Rodríguez J, Pérez Cáceres JA, Saavedra Martín JM, Márquez Sanabria A, Domínguez Castaño A, de la Iglesia Salgado M. [In vitro activity of ceftaroline against Spanish isolates of Staphylococcus aureus: a multicenter study]. Enferm Infecc Microbiol Clin 2015; 33:101-4. [PMID: 25091384 DOI: 10.1016/j.eimc.2014.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 09/27/2013] [Revised: 01/20/2014] [Accepted: 02/24/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Ceftaroline fosamil is a new-generation antimicrobial agent of cephalosporins subgroup. It is the first commercially available beta-lactam antibiotic that exhibits activity against methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study is to determine the in vitro Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of ceftaroline against S.aureus strains (including MRSA). MATERIAL AND METHODS A multicenter study involving four hospitals representative of the Spanish geography was performed. MIC and MBC values against both the methicillin-resistant and sensitive strains of S.aureus (MRSA and methicillin-sensitive S.aureus [MSSA]) were determined using a broth microdilution method. RESULTS A total of 266 S.aureus strains were analyzed (95 MRSA and 171 MSSA). Ceftaroline bacterial sensitivity showed a mean MIC of 0.227 μg/ml (SD=0.146; range, 0.06 to 1 μg/ml). All MIC values of the 266 strains tested belonged to the sensitive category (value ≤ 1 μg/ml). Intermediate or resistant strains were not detected. MIC50 and MIC90 values for MRSA were 0.25 and 0.5 μg/ml, respectively (range=0.125-1 μg/ml). MSSA strains showed MIC50 and MIC90 values of 0.125 and 0.25 μg/ml, respectively (range=0.125-0.5 μg/ml). MBC50 and MBC90 values for MRSA were 0.5 and 1 μg/ml, respectively (range=0.125-1 μg/ml). MSSA strains showed MBC50 and MBC90 values of 0.25 and 0.25 μg/ml, respectively (range=0.125-0.5 μg/ml). CONCLUSION Ceftaroline shows excellent in vitro activity against S.aureus, including MRSA strains. Therefore, this antibiotic may be a promising alternative for the treatment of infections caused by this bacterium.
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Affiliation(s)
- Alberto Tenorio-Abreu
- Unidad de Gestión Clínica de Microbiología, Complejo Hospitalario de Huelva, Huelva, España.
| | - Jesús Gil Tomás
- Servicio de Microbiología, Hospital Universitario de la Ribera, Alcira, Valencia, España
| | | | | | - María Borrás Máñez
- Servicio de Microbiología, Hospital Universitario de la Ribera, Alcira, Valencia, España
| | | | - Ana Ávila Alonso
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | | | | | | | | | - Ana Domínguez Castaño
- Unidad de Gestión Clínica de Microbiología, Complejo Hospitalario de Huelva, Huelva, España
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Abstract
Ceftaroline is administered intravenously in the form of a prodrug, ceftaroline fosamil, which is rapidly hydrolyzed by plasma phosphatases to its active form, ceftaroline. In general, the pharmacokinetics of ceftaroline differ little from those of other cephalosporins. A proportional increase in both the peak plasma concentration (Cmax) and the area under the curve (AUC) have been observed when the drug is administered in increasing doses, which demonstrates its linear pharmacokinetics. Half the dose of ceftaroline is excreted actively through the kidneys. The pharmacokinetic parameters of ceftaroline administered through the intramuscular route in diverse animal species were similar to those observed when the drug was administered intravenously and consequently clinical research into ceftaroline administered through this alternative route would be appropriate. Patients with moderate-severe alterations of renal function and those undergoing hemodialysis require dose adjustments. There is limited experience of the pharmacokinetics of ceftaroline in children, which has given rise to several schedules stratified by age groups. The pharmacodynamics of the drug have been studied in models of animal infection and in in vitro infections caused mainly by Staphylococcus aureus (including methicillin-resistant S. aureus [MRSA], strains with intermediate vancomycin sensitivity [hVISA or hGISA]) and by Streptococcus pneumoniae strains with distinct sensitivities to penicillin. Because ceftaroline is a time-dependent antibiotic, the most widely studied pharmacokinetic/pharmacodynamic (PK/PD) indicator is the time interval during which drug concentrations are maintained above the minimum inhibitory concentration (MIC), calculated both as total drug (T > MIC) and as free fraction of the drug (fT > MIC). The PK/PD simulations carried out in these models, developed on the basis of the concentrations obtained with routine doses in humans, have shown that ceftaroline has a good PK/PD profile against these microorganisms, including strains with reduced sensitivity to vancomycin, linezolid, and daptomycin.
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Affiliation(s)
- Santiago Grau
- Servicio de Farmacia, Hospital del Mar, Barcelona, España.
| | - Luisa Sorlí
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, España
| | - Sonia Luque
- Servicio de Farmacia, Hospital del Mar, Barcelona, España
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Abstract
Antimicrobial resistance has increased during the last few years, representing a public health concern. Among Gram-positive organisms, methicillin-resistant Staphylococcus aureus (MRSA) and Streptococcus pneumoniae are paradigms of resistance and of the dispersion of multiresistant clones. Ceftaroline, a broad-spectrum cephalosporin that includes MRSA and penicillin-resistant S. pneumoniae, is the first β-lactam antibiotic useful in infections due to MRSA. Phase-III clinical trials have demonstrated its efficacy in the treatment of community-acquired pneumonia and in skin and soft tissue infections, which are the current indications for ceftaroline. Due to its microbiological and pharmacological (PK/PD) profiles, these indications could be expanded to include bacteremia, endocarditis, and even osteoarticular infections. Another notable feature is the activity of this drug against Gram-negative bacilli susceptible to third generation cephalosporins, indicating that ceftaroline could be useful when these organisms are suspected or demonstrated in polymicrobial infections. Clinical follow-up of ceftaroline use will more clearly define future ceftaroline indications.
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Affiliation(s)
- Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital Universitario del Mar, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Barcelona, España
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España.
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Cisneros JM, Barberán J. [Role of ceftaroline in skin and soft tissue infections]. Enferm Infecc Microbiol Clin 2014; 32 Suppl 2:27-31. [PMID: 24702976 DOI: 10.1016/s0213-005x(14)70155-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Skin and soft tissue infections (SSTI) are relatively common. Although most of these infections are mild, a few are severe, requiring hospital admission for intravenous antimicrobial therapy and, fairly frequently, surgery. These infections can be produced by any microorganism, but the most frequent is Staphylococcus aureus. Traditionally, the bacteria causing community-acquired SSTI have been sensitive to antimicrobial agents but this situation has changed with the dissemination of community-acquired microbial resistance, as has occurred in many countries with the increase in methicillin-resistant S. aureus (MRSA). These changes complicate empirical therapy and increase the risk of monotherapy being insufficient to cover all the diagnostic possibilities of SSTI. Within this epidemiological framework, ceftaroline, because of its activity against MRSA, can be used as empirical monotherapy for SSTI.
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Affiliation(s)
- José Miguel Cisneros
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España.
| | - José Barberán
- Servicio de Enfermedades Infecciosas, Hospital Universitario Montepríncipe, Universidad CEU-San Pablo, Madrid, España
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Abstract
Osteoarticular infections (OAI) include a wide-usually complex-spectrum of clinical scenarios. The approach is usually medical-surgical. In addition to this complexity, there is a low grade of evidence in the medical literature on these infections. Nevertheless, it is possible-and necessary-to integrate microbiological, pharmacological, experimental and clinical information to achieve the best possible clinical results. The most appropriate choice of antibiotic therapy largely depends on the clinical scenario and, obviously, on the microorganisms involved. Given the protagonism of staphylococci in OAI, it is appropriate to elucidate the role that could be played by a new antistaphylococcic agent in these infections. For clinicians who manage OAI, the incorporation of ceftaroline represents the recovery of a beta-lactam to treat methicillin-resistant staphylococci. This perspective can be used to guide the potential role of this new antibiotic for the management of OAI in various scenarios and the clinical research required for its introduction in clinical practice.
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Affiliation(s)
- Javier Cobo Reinoso
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, IRYCIS, Madrid, España.
| | - Javier Ariza Cardenal
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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Cercenado E, Morosini MI. [Antimicrobial spectrum of ceftaroline. In vitro activity against methicillin-resistant staphylococci]. Enferm Infecc Microbiol Clin 2014; 32 Suppl 2:8-14. [PMID: 24702973 DOI: 10.1016/s0213-005x(14)70152-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Because of the increase in bacterial resistance, there is a need for new antimicrobial agents. In particular, Staphylococcus aureus is a frequent cause of severe infections and has an extraordinary capacity to develop antibiotic multiresistance, including resistance to glycopeptides, linezolid, and daptomycin. Although the incidence of methicillin-resistant S. aureus (MRSA) seems to have stabilized in the last few years, its wide dissemination in healthcare settings and in the community is a cause of concern. Ceftaroline is a new broad-spectrum cephalosporin with bactericidal activity against Gram-positive bacteria, including MRSA and multidrug-resistant Streptococcus pneumoniae. In addition, this drug is active against staphylococci showing resistance to glycopeptides, linezolid, and daptomycin. The ceftaroline MIC90 against MRSA ranges from 0.5-2mg/L and that against methicillin-resistant coagulase-negative staphylococci is 0.5mg/L. Ceftaroline has also good activity against respiratory pathogens including Haemophilus influenzae and Moraxella catarrhalis. Although this drug is active against Enterobacteriaceae, it does not retain activity when these isolates produce extended-spectrum beta-lactamases, carbapenemases or hyperproduce AmpC. Ceftaroline is not active against nonfermentative Gram-negative bacilli. Ceftaroline is an interesting addition to the therapeutic armamentarium against MRSA and constitutes an important option for the treatment of polymicrobial infections caused by multidrug-resistant Gram-positive microorganisms.
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Affiliation(s)
- Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España.
| | - María Isabel Morosini
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, Madrid, España
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Abstract
Ceftaroline fosamil is a new subclass of cephalosporins with high intrinsic activity against various multi-resistant Gram-positive organisms, including Staphylococcus aureus and Streptococcus pneumoniae, as well as against Enterobacteriaceae causing bacteremia and infective endocarditis. Because of its pharmacokinetic profile and pharmacodynamic characteristics, this drug is a good therapeutic option for these infections. Experimental studies have shown good clinical efficacy for the treatment of endocarditis caused by S. aureus, regardless of their sensitivity to methicillin or vancomycin. Clinical experience is limited, although clinical trials and case series have reported a favorable clinical response in patients with bacteremia associated with skin and soft tissue infections, pneumonia, or infective endocarditis. Future studies should define more precisely the role of this new antibiotic in the treatment of these infections.
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Affiliation(s)
- Benito Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - Juan M Pericás
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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Canut A, Martínez-Martínez L. [Ceftaroline breakpoints]. Enferm Infecc Microbiol Clin 2014; 32 Suppl 2:21-6. [PMID: 24702975 DOI: 10.1016/s0213-005x(14)70154-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ceftaroline is a new cephalosporin for parenteral use. Notable among its microbiological properties is its ability to inhibit penicillin-binding protein 2a of methicillin-resistant Staphylococcus aureus and its good in vitro activity against several microorganisms of clinical interest. The European Committee of Antimicrobial Susceptibility Testing (EUCAST) has defined both epidemiological breakpoints (defining wild-type populations that lack known acquired mechanisms of resistance) and clinical breakpoints for this compound. The Clinical and Laboratory Standards Institute (CLSI) has also defined clinical breakpoints. Based on the microbiological activity of ceftaroline, clinical categories have been defined for enterobacteria, S. aureus, Haemophilus influenzae, Streptococcus pneumoniae, and beta-hemolytic Streptococcus. EUCAST has also established breakpoints based on pharmacokinetic-pharmacodynamic criteria.
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Affiliation(s)
- Andrés Canut
- Servicio de Microbiología, Hospital Universitario de Álava, Vitoria, España
| | - Luis Martínez-Martínez
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Departamento de Biología Molecular, Universidad de Cantabria, Santander, España.
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