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Morales-Durán N, León-Buitimea A, Morones-Ramírez JR. Unraveling resistance mechanisms in combination therapy: A comprehensive review of recent advances and future directions. Heliyon 2024; 10:e27984. [PMID: 38510041 PMCID: PMC10950705 DOI: 10.1016/j.heliyon.2024.e27984] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Antimicrobial resistance is a global health threat. Misuse and overuse of antimicrobials are the main drivers in developing drug-resistant bacteria. The emergence of the rapid global spread of multi-resistant bacteria requires urgent multisectoral action to generate novel treatment alternatives. Combination therapy offers the potential to exploit synergistic effects for enhanced antibacterial efficacy of drugs. Understanding the complex dynamics and kinetics of drug interactions in combination therapy is crucial. Therefore, this review outlines the current advances in antibiotic resistance's evolutionary and genetic dynamics in combination therapies-exposed bacteria. Moreover, we also discussed four pivotal future research areas to comprehend better the development of antibiotic resistance in bacteria treated with combination strategies.
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Affiliation(s)
- Nami Morales-Durán
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León (UANL), San Nicolás de los Garza, 66455, Mexico
- Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Parque de Investigación e Innovación Tecnológica, Apodaca, 66628, Mexico
| | - Angel León-Buitimea
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León (UANL), San Nicolás de los Garza, 66455, Mexico
- Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Parque de Investigación e Innovación Tecnológica, Apodaca, 66628, Mexico
| | - José R. Morones-Ramírez
- Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León (UANL), San Nicolás de los Garza, 66455, Mexico
- Centro de Investigación en Biotecnología y Nanotecnología, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, Parque de Investigación e Innovación Tecnológica, Apodaca, 66628, Mexico
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Salas-Orozco MF, Lorenzo-Leal AC, de Alba Montero I, Marín NP, Santana MAC, Bach H. Mechanism of escape from the antibacterial activity of metal-based nanoparticles in clinically relevant bacteria: A systematic review. Nanomedicine 2024; 55:102715. [PMID: 37907198 DOI: 10.1016/j.nano.2023.102715] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/05/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
The emergency of antibiotic-resistant bacteria in severe infections is increasing, especially in nosocomial environments. The ESKAPE group is of special importance in the groups of multi-resistant bacteria due to its high capacity to generate resistance to antibiotics and bactericides. Therefore, metal-based nanomaterials are an attractive alternative to combat them because they have been demonstrated to damage biomolecules in the bacterial cells. However, there is a concern about bacteria developing resistance to NPs and their harmful effects due to environmental accumulation. Therefore, this systematic review aims to report the clinically relevant bacteria that have developed resistance to the NPs. According to the results of this systematic review, various mechanisms to counteract the antimicrobial activity of various NP types have been proposed. These mechanisms can be grouped into the following categories: production of extracellular compounds, metal efflux pumps, ROS response, genetic changes, DNA repair, adaptative morphogenesis, and changes in the plasma membrane.
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Affiliation(s)
- Marco Felipe Salas-Orozco
- Facultad de Estomatología, Doctorado en Ciencias Odontológicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
| | - Ana Cecilia Lorenzo-Leal
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Nuria Patiño Marín
- Facultad de Estomatología, Laboratorio de Investigación Clinica, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Miguel Angel Casillas Santana
- Maestría en Estomatología con Opcion Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Horacio Bach
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Carlsen L, Büttner H, Christner M, Cordts L, Franke G, Hoffmann A, Knobling B, Lütgehetmann M, Nakel J, Werner T, Knobloch JK. Long time persistence and evolution of carbapenemase-producing Enterobacterales in the wastewater of a tertiary care hospital in Germany. J Infect Public Health 2023; 16:1142-1148. [PMID: 37267681 DOI: 10.1016/j.jiph.2023.05.029] [Citation(s) in RCA: 2] [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: 02/13/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Worldwide observations revealed increased frequencies of multi-resistant Enterobacterales and resistance genes in hospital wastewater compared to any other type of wastewater. Despite the description of clonal lineages possibly adapted to hospital wastewater, little is known about long term persistence as well as evolution of these lineages. METHODS In this study, wastewater isolates of different Enterobacterales species from a tertiary care hospital were investigated with 2.5 years distance. Whole Genome Sequencing (WGS) and resistance gene identification were performed for E. coli, C. freundii, S. marcescens, K. pneumoniae, K. oxytoca, and E. cloacae isolates (n = 59), isolated in 2022 and compared with strains isolated from the same wastewater pipeline in 2019 (n = 240). RESULTS Individual clonal lineages with highly related isolates could be identified in all species identified more than once in 2022 that appear to persist in the wastewater drainage. A common motif of all persistent clonal lineages was the carriage of mobile genetic elements encoding carbapenemase genes with hints for horizontal gene transfer in persistent clones in this environment observed over the 2.5-year period. Multiple plasmid replicons could be detected in both years. In 2022 isolates blaVIM-1 replaced blaOXA-48 as the most common carbapenemase gene compared to 2019. Interestingly, despite a similar abundance of carbapenemase genes (>80% of all isolates) at both time points genes encoding extended spectrum β-lactamases decreased over time. CONCLUSIONS This data indicates that hospital wastewater continuously releases genes encoding carbapenemases to the urban wastewater system. The evolution of the resident clones as well as the reasons for the selection advantage in this specific ecological niche needs to be further investigated in the future.
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Affiliation(s)
- Laura Carlsen
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Henning Büttner
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Lukas Cordts
- HAMBURG WASSER, Billhorner Deich 2, 20539 Hamburg, Germany
| | - Gefion Franke
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Armin Hoffmann
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Birte Knobling
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jacqueline Nakel
- Virus Genomics, Heinrich-Pette-Institute, Leibniz Institute for Experimental Biology, Martinistraße 52, 20251 Hamburg, Germany
| | - Thomas Werner
- HAMBURG WASSER, Billhorner Deich 2, 20539 Hamburg, Germany
| | - Johannes K Knobloch
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
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Carlsen L, Büttner H, Christner M, Franke G, Indenbirken D, Knobling B, Lütgehetmann M, Knobloch J. High burden and diversity of carbapenemase-producing Enterobacterales observed in wastewater of a tertiary care hospital in Germany. Int J Hyg Environ Health 2022; 242:113968. [PMID: 35390565 DOI: 10.1016/j.ijheh.2022.113968] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 12/20/2021] [Revised: 03/10/2022] [Accepted: 03/28/2022] [Indexed: 12/01/2022]
Abstract
Hospitals are one of the main reservoirs of multi-resistant Enterobacterales (MRE). As MRE are resistant to the most frequently used antibiotics, therapy for patients with MRE infections is challenging. It has been previously described that MRE from hospital wastewater can pass into municipal wastewater and even surface water. In this study, we investigated the diversity and epidemiology of MRE in the wastewater of a large tertiary care hospital. Wastewater samples were collected for a four-day period and tested for the presence of Enterobacterales resistant to 3rd gen. cephalosporins. Representative isolates were further characterized by whole genome sequencing. In 120 β-glucuronidase-producing isolates, 68 Escherichia coli and, interestingly, also 52 Citrobacter freundii were identified. In 120 β-glucosidase-producing isolates 45 Serratia marcescens, 34 Klebsiella oxytoca, 32 Enterobacter cloacae and 9 Klebsiella pneumoniae were observed. For all species various MLST sequence types and different clusters of resistance genes were determined, showing a great diversity within the different Enterobacterales, further corroborated by clonal analysis performed by cgMLST. The most prominent clone was wastewater associated E. coli ST635, which accounted for 47.1% of all E. coli isolates. Interestingly, 45.6% of E. coli, 88.5% of C. freundii, 95.6% of S. marcescens, 91.2% of K. oxytoca, 96.9% of E. cloacae and 88.9% of K. pneumoniae isolates carried a carbapenemase gene, indicating a high burden with carbapenemase-producing Enterobacterales. Comparison with clinical isolates from the same hospital displayed few clonal matches. One wastewater isolate of K. pneumoniae was identified to be closely related compared to a clone that had been introduced into the hospital during an outbreak four years earlier. One E. coli isolate was identified as identical to an isolate from a patient, with inpatient stay during the sampling period. The data obtained in this study highlight the problem of antibiotic resistance of Enterobacterales in hospital wastewater. In particular, the clustered occurrence of carbapenemase genes is of great concern and underscores the problem of increasingly scarce antibiotic options against these bacteria.
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Affiliation(s)
- Laura Carlsen
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Henning Büttner
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Gefion Franke
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Daniela Indenbirken
- Virus Genomics, Heinrich-Pette-Institute, Leibniz Institute for Experimental Biology, Martinistraße 52, 20251, Hamburg, Germany
| | - Birte Knobling
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Knobloch
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
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Pérez JI, Álvarez-Arroyo R, Arrieta J, Suescun JM, Paunero S, Gómez MA. Occurrence of antibiotics and antibiotic-resistant bacteria (ARB) in the Nervión river. Chemosphere 2022; 288:132479. [PMID: 34626662 DOI: 10.1016/j.chemosphere.2021.132479] [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] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
The main hydrometeorological, microbiological and physico-chemical characteristics of the Nervión river were monitored during a year, including 10 antibiotics and the presence of bacteria resistant to these antibiotics among faecal coliforms (FC) and total aerobic bacteria at 22 °C (TAB22). The characteristics of the river water were variable without a clear seasonal component, strongly influenced by rainfall, with a good quality for drinking water production throughout the year according to the physico-chemical parameters. The antibiotic resistant bacteria isolated from the water of the Nervión river were especially resistant to β-lactams and macrolide antibiotics, highlighting the absence of resistance to derivatives of tetracyclines among strains of TAB22. A third of the isolated strains were multi-resistant to antibiotics with a seasonal component in its presence, with multi-resistant FC more abundant during summer and multi-resistant TAB22 more abundant during winter. The presence of antibiotics in the waters of the Nervión river was not very significant, with total absence of β-lactams, minocycline and ciprofloxacin. Erythromycin and clarithromycin can be considered ubiquitous with mean concentrations of 2.5 ± 2.3 ngL-1 and 5.7 ± 4.6 ngL-1 respectively, and the presence of sulfamethoxazole and trimethoprim was also noticeable with maximum concentrations of 78.3 ngL-1 for sulfamethoxazole. Dilution due to the increase of rainfall was observed for several analysed antibiotics, but without significant seasonal differences.
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Affiliation(s)
- J I Pérez
- Technologies for Water Management and Treatment Research Group, University of Granada, Spain.
| | - R Álvarez-Arroyo
- Technologies for Water Management and Treatment Research Group, University of Granada, Spain.
| | - J Arrieta
- Department of Research and Development, CADAGUA S.A., Gran Vía 45, 7(a), 48011, Bilbao, Spain.
| | - J M Suescun
- Department of Research and Development, CADAGUA S.A., Gran Vía 45, 7(a), 48011, Bilbao, Spain.
| | - S Paunero
- Bilbao-Bizkaia Water Consortium, 48001, Bilbao, Spain.
| | - M A Gómez
- Technologies for Water Management and Treatment Research Group, University of Granada, Spain.
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Korichi W, Ibrahimi M, Loqman S, Ouhdouch Y, Younes K, Lemée L. Assessment of actinobacteria use in the elimination of multidrug-resistant bacteria of Ibn Tofail hospital wastewater (Marrakesh, Morocco): a chemometric data analysis approach. Environ Sci Pollut Res Int 2021; 28:26840-26848. [PMID: 33501577 DOI: 10.1007/s11356-021-12445-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
The efficiency of the treatment of hospital wastewater by actinobacteria was investigated using two chemometric data analysis methods. Six strains of multi-resistant bacteria isolated from Marrakesh hospital wastewater and four strains of antagonistic actinobacteria isolated from Moroccan marine environment were characterized by fatty acids released as methyl esters by thermochemolysis-GC/MS. The hierarchical cluster analysis (HCA) and the principal component analysis (PCA) were used to correlate fatty acids (FA) distributions within strains. HCA allowed to discriminate between bacteria and actinobacteria. A lower Euclidean distance is noted for bacteria. With PCA, linear and branched-chained FAs correlated with bacteria whereas mono unsaturated FAs correlated more specifically with Gram (-) bacteria. Terminally branched-chained FAs correlated most likely with actinobacteria. A co-culture of actinobacteria and bacteria monitored during 15 days demonstrated the efficiency of the biological treatment for 2 of the 4 studied actinobacteria. The effect is more important on Gram-negative bacteria. Antagonistic actinobacteria seem to be poorly efficient against Gram-positive bacteria.
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Affiliation(s)
- Wassila Korichi
- Laboratory of Microbial Biotechnologies, Agrosciences and Environment (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, PO Box 2390, Marrakesh, Morocco
- Laboratory of Microbiology and Virology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, PO Box 7010, Marrakesh, Morocco
- Institut de Chimie des Milieux et Matériaux de Poitiers (IC2MP - CNRS UMR 7285), Université de Poitiers, 4 rue Michel Brunet - TSA 51106, 86073, Poitiers Cedex 9, France
| | - Manar Ibrahimi
- Laboratoire de Chimie Organique et Analytique, FST, Université Sultan Moulay Slimane, Beni Mellal, Morocco
| | - Souad Loqman
- Laboratory of Microbiology and Virology, Faculty of Medicine and Pharmacy, Cadi Ayyad University, PO Box 7010, Marrakesh, Morocco
| | - Yedir Ouhdouch
- Laboratory of Microbial Biotechnologies, Agrosciences and Environment (BioMAgE), Faculty of Sciences Semlalia, Cadi Ayyad University, PO Box 2390, Marrakesh, Morocco
- Agro Bio Sciences Program, Mohammed VI Polytechnic University (UM6P), 43150, Benguerir, Morocco
| | - Khaled Younes
- Institut de Chimie des Milieux et Matériaux de Poitiers (IC2MP - CNRS UMR 7285), Université de Poitiers, 4 rue Michel Brunet - TSA 51106, 86073, Poitiers Cedex 9, France.
- College of Engineering and Technology, American University of the Middle East (AUM), Kuwait, Kuwait.
| | - Laurent Lemée
- Institut de Chimie des Milieux et Matériaux de Poitiers (IC2MP - CNRS UMR 7285), Université de Poitiers, 4 rue Michel Brunet - TSA 51106, 86073, Poitiers Cedex 9, France.
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De-Las-Casas-Cámara G, Collados-Arroyo V, García-Torrejón MC, Muñoz-Egea MC, Martín-Ríos MD. Impact of sink removal from intensive care unit rooms on the consumption of antibiotics and on results of Zero Resistance Project. Med Clin (Barc) 2021:S0025-7753(20)30872-1. [PMID: 33593639 DOI: 10.1016/j.medcli.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Due to the favourable impact of removing the sinks on isolations in bronchoaspirate samples of patients with mechanical ventilation, we now evaluate the impact on the consumption of antibiotics as well as on the results of the Zero Resistance Project (ZRP). PATIENTS AND METHODS All the patients admitted to the unit in a quasi-experimental before-after study with a pre-intervention period between 2014 and 2016 and a post-intervention period from 2016 to 2017, to evaluate antibiotic consumption in defined daily doses, and until 2018, to evaluate the ZRP indicators. The intervention was the removal of the sinks from the rooms of the ICU. We evaluated antibiotic consumption densities and their ratios, grouped as Enterobacteriaceae and non-fermenting gram-negative bacilli (NFGNB) according to their antibiograms; the absolute number of 'antibiotic days', 'hospitalised days', 'isolation days', and 'multi-resistant bacteria (MRB) days'; as well as their incidence densities per 1000 hospitalised days and the ratio between the two years prior to and the two years after the intervention. RESULTS Post-intervention antibiotic use was 1.61-fold (1.60-1.62) and 2.24-fold (2.10-2.37) lower for antibiotics used against Enterobacteriaceae and NFGNB, respectively. There were also reductions in the number of days of antibiotic use by 1.29-fold (1.22-1.36), number of MRB days by 1.84-fold (1.63-2.08), and number of patient isolation days by 1.51-fold (1.38-1.66). DISCUSSION The results suggest that the intervention had a favourable impact on the consumption of antibiotics, as well as on the number of days on antibiotics, MRB, and isolation.
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Ciotti C, Ferrao B, Garrigues I, Nérome S. Bacteria which are highly resistant to antibiotics are not resistant hydro-alcoholic products. Infect Dis Now 2020; 51:77-80. [PMID: 33039552 DOI: 10.1016/j.medmal.2020.10.002] [Citation(s) in RCA: 1] [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: 11/13/2019] [Revised: 03/12/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preventing the emergence of antibiotic-resistant bacteria requires strict adherence to standard precautions, including hand hygiene by hydro-alcoholic friction, a technique now recommended. Our study evaluates the in vitro efficacy of an hydro-alcoholic product on four emerging resistant bacteria. METHODS AND MATERIALS The product was tested using the dilution-neutralization method using the NF/EN 13727+A2 standard on Staphylococcus epidermidis which is resistant to methicillin and has a reduced reaction to glycopeptide antibiotics, on Enterococcus faecium which is resistant to glycopeptides, as well as on Klebsiella pneumoniae and Pseudomonas aeruginosa which produce carbapenemases. Each of the steps was performed as a blind test on the test product as on the comparator. The surviving bacteria count was measured after 24 and 48 hours' incubation and the rate of reduction was calculated. RESULTS A reduction which was higher than 5 decimal logarithms was observed 30seconds after contact. The test product had an 80% bactericidal concentration on Pseudomonas aeruginosa and 40% on the three other germs. The bactericidal concentration of the comparator was 80% on the four micro-organisms. DISCUSSION The present study confirms the effect of hydro-alcoholic products on emerging resistant bacteria. The results make it possible to answer questions from healthcare professionals who often confuse antibiotics and antiseptics and question whether using hydro-alcoholic hand sanitizer is worth it. Proof of efficacy at 30seconds is reassuring since this time is close to that observed when evaluating practices. The data could be completed by performing in vitro tests using the NF/EN 1500 standard.
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Affiliation(s)
- C Ciotti
- Unité de lutte contre les infections nosocomiales, hôpital Beaujon - hôpitaux de Paris Nord - université de Paris, Assistance publique-Hôpitaux de Paris, 100, boulevard Général-Leclerc, 92110 Clichy, France
| | - B Ferrao
- Laboratoire de microbiologie de l'environnement, hôpital Beaujon - hôpitaux de Paris Nord - université de Paris, Assistance publique-Hôpitaux de Paris, 100, boulevard Général-Leclerc, 92110 Clichy, France
| | - I Garrigues
- Unité de lutte contre les infections nosocomiales, hôpital Beaujon - hôpitaux de Paris Nord - université de Paris, Assistance publique-Hôpitaux de Paris, 100, boulevard Général-Leclerc, 92110 Clichy, France
| | - S Nérome
- Unité de lutte contre les infections nosocomiales, hôpital Beaujon - hôpitaux de Paris Nord - université de Paris, Assistance publique-Hôpitaux de Paris, 100, boulevard Général-Leclerc, 92110 Clichy, France; Laboratoire de microbiologie de l'environnement, hôpital Beaujon - hôpitaux de Paris Nord - université de Paris, Assistance publique-Hôpitaux de Paris, 100, boulevard Général-Leclerc, 92110 Clichy, France.
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Li N, Chai Y, Ying GG, Jones KC, Deng WJ. Airborne antibiotic resistance genes in Hong Kong kindergartens. Environ Pollut 2020; 260:114009. [PMID: 32041021 DOI: 10.1016/j.envpol.2020.114009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 05/23/2023]
Abstract
Antibiotic resistance genes (ARGs) and antibiotic resistant bacteria (ARB) have become a critical global public health issue in this century. There is increasing evidence for the presence and transmission of ARGs by air transmission. In this research, ARGs and ARB in air conditioner filter dust (AC dust) and urine samples from 55 kindergarten children in 17 kindergartens and nearby 10 soil samples in Hong Kong were analyzed. The results showed the presence of 16 ARG subtypes and the mobile genetic element (MGE) intI1 in AC dust, and 12 ARG subtypes in the soil samples. ARGs presenting resistance to sulfonamide (6.9 × 10-3-0.17) (expressed as relative abundance of the 16 S rRNA genes) were most abundant followed by macrolides (1.8 × 10-3-3.3 × 10-2), sul1, sul2 (sulfonamide), ermF (macrolides) and intI1 genes in AC dust in 17 kindergartens. For soil samples, 12 ARG subtypes and the intI1 were detected, and the genes providing resistance to sulfonamide (1.6 × 10-3-2.7 × 10-1) were the most abundant ARGs in the 10 soil samples, followed by tetracycline (ND-1.4 × 10-2). Multi-resistant bacteria with sul1, sul2, intI1, or tetQ were detected in all AC dust samples and some urine samples. Based on bacterial genera and ARG co-occurrence network analysis and Hong Kong's special geographical location and cultural environment, there might be two origins for the ARGs detected in the kindergartens: β-lactam/macrolide ARGs mainly derived from human medicine use and tetracycline/sulfonamide ARGs mainly from other areas, as well as IntI1 may play a role in the spread of ARGs in Hong Kong. The widely detection of ARGs in AC dust in kindergartens in Hong Kong highlights the need for the improvement of management measures.
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Affiliation(s)
- Na Li
- Department of Science and Environmental Studies, The Education University of Hong Kong, Tai Po, N.T, Hong Kong
| | - Yemao Chai
- Department of Science and Environmental Studies, The Education University of Hong Kong, Tai Po, N.T, Hong Kong
| | - Guang-Guo Ying
- a SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China; School of Environment, South China Normal University, University Town, Guangzhou, 510006, China
| | - Kevin C Jones
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ, UK
| | - Wen-Jing Deng
- Department of Science and Environmental Studies, The Education University of Hong Kong, Tai Po, N.T, Hong Kong; a SCNU Environmental Research Institute, Guangdong Provincial Key Laboratory of Chemical Pollution and Environmental Safety & MOE Key Laboratory of Theoretical Chemistry of Environment, South China Normal University, Guangzhou, 510006, China.
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Paulsen MH, Ausbacher D, Bayer A, Engqvist M, Hansen T, Haug T, Anderssen T, Andersen JH, Sollid JUE, Strøm MB. Antimicrobial activity of amphipathic α,α-disubstituted β-amino amide derivatives against ESBL - CARBA producing multi-resistant bacteria; effect of halogenation, lipophilicity and cationic character. Eur J Med Chem 2019; 183:111671. [PMID: 31536892 DOI: 10.1016/j.ejmech.2019.111671] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/27/2019] [Accepted: 08/30/2019] [Indexed: 02/06/2023]
Abstract
The rapid emergence and spread of multi-resistant bacteria have created an urgent need for new antimicrobial agents. We report here a series of amphipathic α,α-disubstituted β-amino amide derivatives with activity against 30 multi-resistant clinical isolates of Gram-positive and Gram-negative bacteria, including isolates with extended spectrum β-lactamase - carbapenemase (ESBL-CARBA) production. A variety of halogenated aromatic side-chains were investigated to improve antimicrobial potency and minimize formation of Phase I metabolites. Net positive charge and cationic character of the derivatives had an important effect on toxicity against human cell lines. The most potent and selective derivative was the diguanidine derivative 4e with 3,5-di-brominated benzylic side-chains. Derivative 4e displayed minimum inhibitory concentrations (MIC) of 0.25-8 μg/mL against Gram-positive and Gram-negative reference strains, and 2-32 μg/mL against multi-resistant clinical isolates. Derivative 4e showed also low toxicity against human red blood cells (EC50 > 200 μg/mL), human hepatocyte carcinoma cells (HepG2: EC50 > 64 μg/mL), and human lung fibroblast cells (MRC-5: EC50 > 64 μg/mL). The broad-spectrum antimicrobial activity and low toxicity of diguanylated derivatives such as 4e make them attractive as lead compounds for development of novel antimicrobial drugs.
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Skjøt-Arkil H, Mogensen CB, Lassen AT, Johansen IS, Chen M, Petersen P, Andersen KV, Ellermann-Eriksen S, Møller JM, Ludwig M, Fuglsang-Damgaard D, Nielsen FE, Petersen DB, Jensen US, Rosenvinge FS. Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments - evaluation of national screening guidelines. J Hosp Infect 2019; 104:27-32. [PMID: 31494129 DOI: 10.1016/j.jhin.2019.08.024] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multi-resistant bacteria (MRB) are an emerging problem. Early identification of patients colonized with MRB is mandatory to avoid in-hospital transmission and to target antibiotic treatment. Since most patients pass through specialized emergency departments (EDs), these departments are crucial in early identification. The Danish National Board of Health (DNBH) has developed exposure-based targeted screening tools to identify and isolate carriers of meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE). AIM To assess the national screening tools for detection of MRSA and CPE carriage in a cohort of acute patients. The objectives were to investigate: (i) if the colonized patients were detected; and (ii) if the colonized patients were isolated. METHODS This was a multi-centre cross-sectional survey of adults visiting EDs. The patients answered the DNBH questions, and swabs were taken from the nose, throat and rectum. The collected samples were examined for MRSA and CPE. Screening performances were calculated. FINDINGS Of the 5117 included patients, 16 were colonized with MRSA and four were colonized with CPE. The MRSA screening tool had sensitivity of 50% [95% confidence interval (CI) 25-75%] for carrier detection and 25% (95% CI 7-52%) for carrier isolation. The CPE screening tool had sensitivity of 25% (95% CI 1-81%) and none of the CPE carriers were isolated. CONCLUSION The national screening tools were of limited use as the majority of MRSA and CPE carriers passed unidentified through the EDs, and many patients were isolated unnecessarily.
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Affiliation(s)
- H Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
| | - C B Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - A T Lassen
- Emergency Department, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - I S Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - M Chen
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark; Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark
| | - P Petersen
- Emergency Department, Regional Hospital West Jutland, Herning, Denmark
| | - K V Andersen
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - J M Møller
- Emergency Department, Aalborg University Hospital, Aalborg, Denmark
| | - M Ludwig
- Emergency Department, North Denmark Regional Hospital, Hjørring, Denmark
| | - D Fuglsang-Damgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - F E Nielsen
- Emergency Department, Slagelse Hospital, Slagelse, Denmark
| | - D B Petersen
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | - U S Jensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - F S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
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12
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Teare L, Martin N, Elamin W, Pilgrim K, Tredoux T, Swanson J, Hoffman P. Acinetobacter - the trojan horse of infection control? J Hosp Infect 2018; 102:45-53. [PMID: 30594610 DOI: 10.1016/j.jhin.2018.12.013] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Five cases of multi-resistant Acinetobacter baumanii (MRA) producing OXA-23 and OXA-51 occurred in a regional burn intensive care unit (BICU). Three were repatriated from other parts of the world (Dubai and Mumbai) and colonized on admission. Despite optimal precautions, two patients acquired MRA. Both had been nursed in the same room. METHODS Multi-disciplinary outbreak investigation of MRA in a regional BICU. FINDINGS The mechanism of transfer for the first case is thought to have been contaminated air from theatre activity releasing MRA bacteria into the communal corridor. No MRA patients went to theatre between the first and second acquired cases. The mechanism of transfer for the second case is thought to have been via a shower unit that was decontaminated inadequately between patients. CONCLUSION In an outbreak where contact precautions and environmental cleaning are optimal, it is important to give careful consideration to other mechanisms of spread. If there is a failure to do this, it is likely that the true causes of transmission will not be addressed and the problem will recur. It is recommended that burn theatres within burn facilities should be designed to operate at negative pressure; this is the opposite of normal operating theatre ventilation. Where showers are used, both the shower head and the hose should be changed after a patient with a resistant organism. The role of non-contact disinfection (e.g. hydrogen peroxide dispersal) should be reconsidered, and constant vigilance should be given to any 'trojan horse' item in the room.
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Affiliation(s)
- L Teare
- Department of Microbiology, Broomfield Hospital, Chelmsford, UK.
| | - N Martin
- St Andrew's Burn Service, Broomfield Hospital, Chelmsford, UK; Centre for Trauma Sciences, Queen Mary University of London, London, UK; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - W Elamin
- Department of Microbiology, Broomfield Hospital, Chelmsford, UK
| | - K Pilgrim
- Department of Microbiology, Broomfield Hospital, Chelmsford, UK
| | - T Tredoux
- St Andrew's Burn Service, Broomfield Hospital, Chelmsford, UK
| | - J Swanson
- Infection Prevention and Control Department, Broomfield Hospital, Chelmsford, UK
| | - P Hoffman
- HCAI & AMR Division, National Infection Service, Public Health England, London, UK
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13
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Igumnova EM, Mishchenko E, Haug T, Blencke HM, Sollid JUE, Fredheim EGA, Lauksund S, Stensvåg K, Strøm MB. Amphipathic sulfonamidobenzamides mimicking small antimicrobial marine natural products; investigation of antibacterial and anti-biofilm activity against antibiotic resistant clinical isolates. Bioorg Med Chem 2018; 26:4930-4941. [PMID: 30185388 DOI: 10.1016/j.bmc.2018.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/09/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 01/20/2023]
Abstract
There is an urgent need for novel antimicrobial agents to address the threat of bacterial resistance to modern society. We have used a structural motif found in antimicrobial marine hit compounds as a basis for synthesizing a library of antimicrobial sulfonamidobenzamide lead compounds. Potent in vitro antimicrobial activity against clinically relevant bacterial strains was demonstrated for two compounds, G6 and J18, with minimal inhibitory concentrations (MIC) of 4-16 μg/ml against clinical methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE). The two compounds G6 and J18, together with several other compounds of this library, also caused ≥90% eradication of pre-established biofilm of methicillin-resistant S. epidermidis (MRSE) at 40 μg/ml. Using a luciferase assay, the mechanism of action of G6 was shown to resemble the biocide chlorhexidine by targeting the bacterial cell membrane.
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Affiliation(s)
- Elizaveta M Igumnova
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Ekaterina Mishchenko
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Tor Haug
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Hans-Matti Blencke
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Johanna U Ericson Sollid
- Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Elizabeth G Aarag Fredheim
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Silje Lauksund
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Klara Stensvåg
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Morten B Strøm
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway.
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14
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Abstract
Introduction Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods This review focuses on the best management strategies for patients with ACLF and infections. Using the following terms, an extensive literature research on the Medline database was performed: 'acute-on-chronic liver failure', 'infection', 'ACLF', 'bacteria', 'multi-resistance'. Results Analysis of the literature confirmed that delayed diagnosis and treatment of infections in patients with ACLF results in a poor prognosis. Patients with ACLF should be considered as having a potential infection and should undergo a complete screening for sepsis. Once biochemical analysis indicates a potential infection, such as abnormal levels of C-reactive protein and procalcitonin, antibiotic treatment should be initiated immediately without microbiological culture results. For community-acquired infections third-generation cephalosporins are still the first choice, whereas in the nosocomial setting antibiotics with broader spectrum, such as piperacillin/combactam or carbapenems ± glycopeptides, are preferred. The patient should be re-assessed 48 h after treatment initiation in order to tailor the treatment. Non-response is suspicious, likely due to bacterial resistance or fungal infection, which should be considered when choosing further treatment strategies. Albumin substitution to prevent hepatorenal syndrome and to improve patients' outcome is mandatory in patients with spontaneous bacterial peritonitis. Prophylactic antibiotic therapy is suitable to prevent infections in high-risk patients. Conclusion The screening for infections and its treatment is an essential part of managing patients with ACLF. In order to improve patients' prognosis, antibiotic treatment should be initiated once an infection is suspected. However, preventive strategies are already established and should be applied according to the guidelines.
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Affiliation(s)
- Cornelius Engelmann
- Section Hepatology, Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Berg
- Section Hepatology, Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
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15
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Imbernón-Moya A, Ortiz-de Frutos FJ, Sanjuan-Alvarez M, Portero-Sanchez I, Merinero-Palomares R, Alcazar V. Topical sevoflurane for chronic venous ulcers infected by multi-drug-resistant organisms. Int Wound J 2017; 14:1388-1390. [PMID: 28736974 DOI: 10.1111/iwj.12794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 06/18/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022] Open
Abstract
Several anaesthetic drugs have demonstrated antibacterial properties in vitro. Anaesthetics can primarily affect the cell wall of both susceptible and multi-resistant bacteria. They may also have a synergistic effect with conventional antibiotics through an unknown mechanism. We present three cases of a chronic venous ulcer infected by multi-resistant bacteria refractory to conventional systemic antibiotics, including Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). Treatment with topical sevoflurane was performed for 1 month without systemic antibiotics. Patients with an MRSA infection showed progressive improvement with negative culture at the end of the treatment. Multi-drug-resistant P. aeruginosa infection persisted at the end of treatment with positive culture. The local adverse events were mild and transient, including heat, pruritus and erythema. Topical sevoflurane may have an antibacterial effect on sensitive and multi-resistant strains. It can allow more complete surgical cleaning, leaving a cleaner wound with less fibrin and necrotic tissue. This decreases the bacterial colonisation and therefore the infectious risk, the bad smell and the exudation. The simultaneous use of conventional antibiotics and topical sevoflurane can have a synergistic antimicrobial effect.
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Affiliation(s)
| | | | | | | | - Raúl Merinero-Palomares
- Department of Crystallography and Mineralogy, Complutense University of Madrid, Madrid, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Leganés, Madrid, Spain
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16
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Igumnova EM, Mishchenko E, Haug T, Blencke HM, Sollid JUE, Fredheim EGA, Lauksund S, Stensvåg K, Strøm MB. Synthesis and antimicrobial activity of small cationic amphipathic aminobenzamide marine natural product mimics and evaluation of relevance against clinical isolates including ESBL-CARBA producing multi-resistant bacteria. Bioorg Med Chem 2016; 24:5884-5894. [PMID: 27692769 DOI: 10.1016/j.bmc.2016.09.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 06/17/2016] [Revised: 09/15/2016] [Accepted: 09/18/2016] [Indexed: 11/29/2022]
Abstract
A library of small aminobenzamide derivatives was synthesised to explore a cationic amphipathic motif found in marine natural antimicrobials. The most potent compound E23 displayed minimal inhibitory concentrations (MICs) of 0.5-2μg/ml against several Gram-positive bacterial strains, including methicillin resistant Staphylococcus epidermidis (MRSE).E23 was also potent against 275 clinical isolates including Staphylococcus aureus, Enterococcus spp., Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae, as well as methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), and ESBL-CARBA producing multi-resistant Gram-negative bacteria. The study demonstrates how structural motifs found in marine natural antimicrobials can be a valuable source for making novel antimicrobial lead-compounds.
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Affiliation(s)
- Elizaveta M Igumnova
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Ekaterina Mishchenko
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Tor Haug
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Hans-Matti Blencke
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Johanna U Ericson Sollid
- Department of Medical Biology, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Elizabeth G Aarag Fredheim
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Silje Lauksund
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Klara Stensvåg
- The Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
| | - Morten B Strøm
- Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, NO-9037 Tromsø, Norway
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17
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Tsitsopoulos PP, Iosifidis E, Antachopoulos C, Anestis DM, Karantani E, Karyoti A, Papaevangelou G, Kyriazidis E, Roilides E, Tsonidis C. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence. Acta Neurochir (Wien) 2016; 158:1647-54. [PMID: 27452903 DOI: 10.1007/s00701-016-2890-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Received: 04/27/2016] [Accepted: 06/22/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Data on nosocomial bloodstream infections (NBSI) in neurosurgery is limited. This study aimed to analyze the epidemiology, microbiology, outcome, and risk factors for death in neurosurgical patients with NBSI in a multidrug resistant setting. METHODS Neurosurgical patients with a confirmed NBSI within the period 2003-2012 were retrospectively analyzed. NBSI was diagnosed when a pathogen was isolated from a blood sample obtained after the first 48 h of hospitalization. Patients' demographic, clinical, and microbiological data were recorded and analyzed using univariate and multivariate analysis. RESULTS A total of 236 patients with NBSI were identified and 378 isolates were recovered from blood cultures. Incidence of NBSI was 4.3 infections/1000 bed-days. Gram-negative bacteria slightly predominated (54.5 %). The commonest bacteria were coagulase-negative staphylococci (CoNS, 26 %), Klebsiella pneumoniae (15.3 %), Pseudomonas aeruginosa (14.8 %), and Acinetobacter baumannii (13.2 %). Carbapenem resistance was found in 90 % of A. baumannii, in 66 % of P. aeruginosa, and in 22 % (2003-2007) to 77 % (2008-2012) of K. pneumoniae isolates (p < 0.05). Most CoNS and Staphylococcus aureus isolates (94 and 80 %, respectively) were methicillin-resistant. All Gram-negative isolates were sensitive to colistin and all Gram-positive isolates were sensitive to vancomycin and linezolid. Antimicrobial consumption decreased after 2007 (p < 0.05). Overall mortality was 50.4 %. In multivariate analysis, advanced age and stay in an Intermediate Care Unit (IMCU) were independent risk factors for in-hospital mortality (p < 0.05). CONCLUSIONS Overall, high incidence of NBSI and considerable resistance of Gram-positive and particularly Gram-negative bacteria were noted in neurosurgical patients. Mortality was high with advanced age and stay in IMCU being the most important death-related factors.
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Affiliation(s)
- Parmenion P Tsitsopoulos
- 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
| | - Elias Iosifidis
- Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece
- 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Charalampos Antachopoulos
- Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece
- 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Dimitrios M Anestis
- 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Ekaterini Karantani
- Department of Microbiology, Hippokration General Hospital, Thessaloniki, Greece
| | - Angeliki Karyoti
- Department of Microbiology, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgios Papaevangelou
- 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Eftychios Kyriazidis
- 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece
- 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Christos Tsonidis
- 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
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Lefébure A, Papy E, Rioux C, Diamantis S, Armand-Lefèvre L, Longuet P, Lescure FX, Wolff M, Arnaud P, Lucet JC. Audit of carbapenem prescriptions comparing 2 assessment periods. Med Mal Infect 2015; 45:273-8. [PMID: 26047686 DOI: 10.1016/j.medmal.2015.04.008] [Citation(s) in RCA: 6] [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] [Received: 12/18/2014] [Revised: 04/08/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The emergence of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae has resulted in the increase of carbapenem prescriptions. The objective of our study was to determine the appropriateness of carbapenem prescriptions from initiation to reassessment of treatment, between 2009 and 2011. PATIENTS AND METHOD A questionnaire drafted by infectious diseases specialists (IDS) and microbiologists was used to collect clinical and microbiological data concerning carbapenem prescriptions in 2009 and 2011. An IDS then compared the results to assess carbapenem prescription compliance with our hospital's local recommendations. RESULTS Seventy-one prescriptions were included in 2009 and 32 in 2011. The carbapenem treatment had been most frequently probabilistic to treat nosocomial infections. The microbiological data revealed that the number of multidrug-resistant (MDR) infections had increased between 2009 and 2011, especially infections involving ESBL-producing Enterobacteriaceae. At treatment reassessment, in 2009 and 2011, 15 (21%) and 12 (38%) carbapenem prescriptions were appropriate and continued. Overall, when comparing the 2 periods, prescriptions complied with local guidelines from initiation to reassessment of treatment without any statistically significant difference (68% in 2009 and 75% in 2011). CONCLUSION Our study results showed that MDR infections had increased and especially infections due to ESBL-producing Enterobacteriaceae; this was consistent with epidemiological data. We also proved that most carbapenem prescriptions were compliant with recommendations. The increased mobile IDS interventions in medical and surgical departments helped reach this rate of compliance. Carbapenem stewardship may be promoted even in a difficult epidemiological context, especially with IDS interventions for the duration of treatment or at treatment reassessment.
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Affiliation(s)
- A Lefébure
- Service de pharmacie, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
| | - E Papy
- Service de pharmacie, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - C Rioux
- Service des maladies infectieuses et tropicales, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - S Diamantis
- Service des maladies infectieuses et tropicales, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France; Unité de lutte contre les infections nosocomiales, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - L Armand-Lefèvre
- Laboratoire de microbiologie, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Longuet
- Service des maladies infectieuses et tropicales, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - F X Lescure
- Service des maladies infectieuses et tropicales, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - M Wolff
- Service de réanimation médicale et infectieuse, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Arnaud
- Service de pharmacie, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - J C Lucet
- Unité de lutte contre les infections nosocomiales, centre hospitalier Bichat - Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
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19
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Mattos AAD, Costabeber AM, Lionço LC, Tovo CV. Multi-resistant bacteria in spontaneous bacterial peritonitis: A new step in management? World J Gastroenterol 2014; 20:14079-14086. [PMID: 25339797 PMCID: PMC4202339 DOI: 10.3748/wjg.v20.i39.14079] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/04/2014] [Accepted: 06/26/2014] [Indexed: 02/06/2023] Open
Abstract
Spontaneous bacterial peritonitis (SBP) is the most typical infection observed in cirrhosis patients. SBP is responsible for an in-hospital mortality rate of approximately 32%. Recently, pattern changes in the bacterial flora of cirrhosis patients have been observed, and an increase in the prevalence of infections caused by multi-resistant bacteria has been noted. The wide-scale use of quinolones in the prophylaxis of SBP has promoted flora modifications and resulted in the development of bacterial resistance. The efficacy of traditionally recommended therapy has been low in nosocomial infections (up to 40%), and multi-resistance has been observed in up to 22% of isolated germs in nosocomial SBP. For this reason, the use of a broad empirical spectrum antibiotic has been suggested in these situations. The distinction between community-acquired infectious episodes, healthcare-associated infections, or nosocomial infections, and the identification of risk factors for multi-resistant germs can aid in the decision-making process regarding the empirical choice of antibiotic therapy. Broad-spectrum antimicrobial agents, such as carbapenems with or without glycopeptides or piperacillin-tazobactam, should be considered for the initial treatment not only of nosocomial infections but also of healthcare-associated infections when the risk factors or severity signs for multi-resistant bacteria are apparent. The use of cephalosporins should be restricted to community-acquired infections.
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