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Magallon J, Chiem K, Tran T, Ramirez MS, Jimenez V, Tolmasky ME. Restoration of susceptibility to amikacin by 8-hydroxyquinoline analogs complexed to zinc. PLoS One 2019; 14:e0217602. [PMID: 31141575 PMCID: PMC6541283 DOI: 10.1371/journal.pone.0217602] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 11/18/2022] Open
Abstract
Gram-negative pathogens resistant to amikacin and other aminoglycosides of clinical relevance usually harbor the 6’-N-acetyltransferase type Ib [AAC(6')-Ib], an enzyme that catalyzes inactivation of the antibiotic by acetylation using acetyl-CoA as donor substrate. Inhibition of the acetylating reaction could be a way to induce phenotypic conversion to susceptibility in these bacteria. We have previously observed that Zn2+ acts as an inhibitor of the enzymatic acetylation of aminoglycosides by AAC(6')-Ib, and in complex with ionophores it effectively reduced the levels of resistance in cellulo. We compared the activity of 8-hydroxyquinoline, three halogenated derivatives, and 5-[N-Methyl-N-Propargylaminomethyl]-8-Hydroxyquinoline in complex with Zn2+ to inhibit growth of amikacin-resistant Acinetobacter baumannii in the presence of the antibiotic. Two of the compounds, clioquinol (5-chloro-7-iodo-8-hydroxyquinoline) and 5,7-diiodo-8-hydroxyquinoline, showed robust inhibition of growth of the two A. baumannii clinical isolates that produce AAC(6')-Ib. However, none of the combinations had any activity on another amikacin-resistant A. baumannii strain that possesses a different, still unknown mechanism of resistance. Time-kill assays showed that the combination of clioquinol or 5,7-diiodo-8-hydroxyquinoline with Zn2+ and amikacin was bactericidal. Addition of 8-hydroxyquinoline, clioquinol, or 5,7-diiodo-8-hydroxyquinoline, alone or in combination with Zn2+, and amikacin to HEK293 cells did not result in significant toxicity. These results indicate that ionophores in complex with Zn2+ could be developed into potent adjuvants to be used in combination with aminoglycosides to treat Gram-negative pathogens in which resistance is mediated by AAC(6')-Ib and most probably other related aminoglycoside modifying enzymes.
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Affiliation(s)
- Jesus Magallon
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States of America
| | - Kevin Chiem
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States of America
| | - Tung Tran
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States of America
| | - Maria S. Ramirez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States of America
| | - Veronica Jimenez
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States of America
| | - Marcelo E. Tolmasky
- Center for Applied Biotechnology Studies, Department of Biological Science, College of Natural Sciences and Mathematics, California State University Fullerton, Fullerton, CA, United States of America
- * E-mail:
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Blumenthal KG, Shenoy ES, Huang M, Kuhlen JL, Ware WA, Parker RA, Walensky RP. The Impact of Reporting a Prior Penicillin Allergy on the Treatment of Methicillin-Sensitive Staphylococcus aureus Bacteremia. PLoS One 2016; 11:e0159406. [PMID: 27438379 PMCID: PMC4954694 DOI: 10.1371/journal.pone.0159406] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [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: 04/16/2016] [Accepted: 07/02/2016] [Indexed: 11/28/2022] Open
Abstract
Background Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia is a morbid infection with mortality benefit from receipt of parenteral β-lactam therapy. A substantial portion of MSSA bacteremia patients report penicillin allergy, but infrequently have true allergy. Objective To determine the frequency and predictors of optimal and adequate therapy in patients with MSSA bacteremia. Design Retrospective cohort. Participants Adult inpatients with MSSA bacteremia, January 2009 through October 2013. Main Measures The primary measure was a trial of optimal therapy (OT), defined as ≥3 inpatient days or discharge on any first-line agents (nafcillin, oxacillin, cefazolin, or penicillin G, if susceptible). The secondary measure was completion of adequate therapy (AT), defined as ≥10 inpatient days or discharge on an agent appropriate for MSSA bacteremia. Data were electronically gathered with key variables manually validated through chart review. Log-binomial regression models were used to determine the frequency and predictors of outcomes. Key Results Of 456 patients, 346 (76%) received a trial of OT. Patients reporting penicillin allergy (13%) were less likely to receive OT trial than those without penicillin allergy (47% vs. 80%, p <0.001). Adjusting for other factors, penicillin allergy was the largest negative predictor of OT trial (RR 0.64 [0.49, 0.83]). Infectious Disease (ID) consultation was the largest positive predictor of OT trial across all patients (RR 1.34 [1.14, 1.57]). Allergy/Immunology consultation was the single most important predictor of OT trial among patients reporting penicillin allergy (RR 2.33 [1.44, 3.77]). Of 440 patients, 391 (89%) completed AT, with ID consultation the largest positive predictor of the outcome (RR 1.28 [1.15, 1.43]). Conclusions Nearly 25% of patients with MSSA bacteremia did not receive OT trial and about 10% did not receive AT completion. Reported penicillin allergy reduced, and ID consult increased, the likelihood of OT. Allergy evaluation, coupled with ID consultation, may improve outcomes in MSSA bacteremic patients.
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Affiliation(s)
- Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Erica S. Shenoy
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Infection Control Unit, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mingshu Huang
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James L. Kuhlen
- Acadia Allergy and Immunology, Department of Medicine, University of South Carolina School of Medicine, Greenville, South Carolina, United States of America
| | - Winston A. Ware
- Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Robert A. Parker
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Rochelle P. Walensky
- Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Flores-García A, Velarde-Félix JS, Garibaldi-Becerra V, Rangel-Villalobos H, Torres-Bugarín O, Zepeda-Carrillo EA, Ruíz-Bernés S, Ochoa-Ramírez LA. Recombinant murine IL-12 promotes a protective Th1/cellular response in Mongolian gerbils infected with Sporothrix schenckii. J Chemother 2014; 27:87-93. [PMID: 24548095 DOI: 10.1179/1973947814y.0000000174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Sporotrichosis is a cutaneous fungal infection caused by Sporothrix schenckii. It is known to be mainly contained by Th1 responses. As IL-12 is crucial for Th1 response, we investigated if treatment with recombinant murine IL-12 (rmIL-12) promoted Th1 immunity and/or clinical improvement in an experimental sporotrichosis gerbil model. Gerbils were inoculated with S. schenckii in the footpad and treated with rmIL-12. Seven days post infection there was a significant increase in macrophage phagocytosis and oxidative burst, and in delayed-type hypersensitivity (DTH) reaction in rmIL-12 treated gerbils, as well as a ∼10-fold increase of serum IFN-gamma and a decrease of IL-4 and IL-10. Moreover, rmIL-12 substantially decreased (∼70%) S. schenckii burden in liver and spleen and improved the clinical outcome preventing footpad ulcer and tail nodules observed in untreated gerbils. Our study demonstrates that rmIL-12 promotes Th1 immune response against S. schenckii favouring its clearance and preventing clinical symptoms.
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Koliscak LP, Johnson JW, Beardsley JR, Miller DP, Williamson JC, Luther VP, Ohl CA. Optimizing empiric antibiotic therapy in patients with severe β-lactam allergy. Antimicrob Agents Chemother 2013; 57:5918-23. [PMID: 24041892 PMCID: PMC3837866 DOI: 10.1128/aac.01202-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 06/12/2013] [Accepted: 09/06/2013] [Indexed: 11/20/2022] Open
Abstract
Antibiotic selection is challenging in patients with severe β-lactam allergy due to declining reliability of alternate antibiotics. Organisms isolated from these patients may exhibit unique resistance phenotypes. The objective of this study was to determine which alternate antibiotics or combinations provide adequate empirical therapy for patients with β-lactam allergy who develop Gram-negative infections at our institution. We further sought to determine the effects of risk factors for drug resistance on empirical adequacy. A retrospective analysis was conducted for adult patients hospitalized from September 2009 to May 2010 who had a severe β-lactam allergy and a urine, blood, or respiratory culture positive for a Gram-negative organism and who met predefined criteria for infection. Patient characteristics, culture and susceptibility data, and predefined risk factors for antibiotic resistance were collected. Adequacies of β-lactam and alternate antibiotics were compared for all infections and selected subsets. The primary outcome was adequacy of each alternate antibiotic or combination for all infections. One hundred sixteen infections (40 pneumonias, 67 urinary tract infections, and 9 bacteremias) were identified. Single alternate agents were adequate less frequently than β-lactams and combination regimens. Only in cases without risk factors for resistance did single-agent regimens demonstrate acceptable adequacy rates; each factor conferred a doubling of risk for resistance. Resistance risk factors should be considered in selecting empirical antibiotics for Gram-negative pathogens in patients unable to take β-lactams due to severe allergy.
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Affiliation(s)
- Lindsey P. Koliscak
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wingate University, School of Pharmacy, Wingate, North Carolina, USA
| | - James W. Johnson
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - James R. Beardsley
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
| | - David P. Miller
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - John C. Williamson
- Wake Forest Baptist Health, Department of Pharmacy, Winston-Salem, North Carolina, USA
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vera P. Luther
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christopher A. Ohl
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Fukushima C, Matsuse H, Tomari S, Obase Y, Miyazaki Y, Shimoda T, Kohno S. Oral candidiasis associated with inhaled corticosteroid use: comparison of fluticasone and beclomethasone. Ann Allergy Asthma Immunol 2003; 90:646-51. [PMID: 12839324 DOI: 10.1016/s1081-1206(10)61870-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [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: 10/19/2022]
Abstract
BACKGROUND Inhaled steroids such as fluticasone propionate and beclomethasone dipropionate play a central role in the treatment of bronchial asthma. Fluticasone exhibits excellent clinical effectiveness; however, oral adverse effects can occur. OBJECTIVE To compare the frequency of oral candidiasis in asthmatic patients treated with fluticasone and beclomethasone, to evaluate the effect of gargling with amphotericin B, and to measure the inhalation flow rate on candidiasis. METHODS The study consisted of 143 asthmatic patients who were treated with inhaled steroids, 11 asthmatic patients not treated with inhaled steroids, and 86 healthy volunteers. Quantitative fungal culture was performed by aseptically obtaining a retropharyngeal wall swab from these patients. Patients with positive results were treated with gargling using a 1:50 dilution amphotericin B solution. In asthmatic patients treated with fluticasone, the inhalation flow rate was measured using an inspiratory flow meter. RESULTS The amount of Candida spp. was significantly greater in asthmatic patients taking inhaled steroids compared with those who were not. It was also significantly greater in patients with oral symptoms than asymptomatic patients and significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Although the presence of Candida did not correlate with the inhaled dose of beclomethasone, it did increase with the dose of fluticasone. Gargling with amphotericin B was effective in most asthmatic patients with candidiasis. Candidiasis was not due to inappropriate flow rates during inhalation of steroids. CONCLUSIONS Fungal culture of a retropharyngeal wall swab may be useful for predicting the risk of developing oral candidiasis in asthmatic patients treated with inhaled steroids. The amount of isolated Candida was significantly greater in asthmatic patients treated with fluticasone than in those treated with beclomethasone. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:50 dilution of amphotericin B is effective in treating oral candidiasis of asthmatic patients treated with inhaled steroids.
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Affiliation(s)
- Chizu Fukushima
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
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Zdziarski P. [Role of bacterial infection in the pathophysiology of benzylpenicillin allergy]. Pol Merkur Lekarski 2003; 14:50-4. [PMID: 12712830] [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: 03/02/2023]
Abstract
In this paper current data on the pathogenesis of benzylpenicillin allergy is presented. Individual allergic reaction and susceptibility for the drug perhaps is not related to chemical properties of benzylpenicillin. An association between bacterial infection and allergy to benzylpenicillin is reviewed.
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Chapman JA. Stachybotrys chartarum (chartarum = atra = alternans) and other problems caused by allergenic fungi. Allergy Asthma Proc 2003; 24:1-7. [PMID: 12635571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Stachybotrys chartarum is a cellulose-decaying fungus with worldwide distribution. It grows well at room temperature and with humidity above 93%. S. chatarum requires special media high in cellulose and low in sugar and nitrogen to compete with Penicillium and Aspergillus. Ninety percent of field-collected spores are not culturable. S. chartarum can produce macrocyclic trichothecenes but is highly dependent on strain and environmental conditions. In strains implicated in mycotoxicosis, not all produce detectable trichothecenes. Therefore, the presence of S. chartarum is not proof of toxin presence. Trichothecenes are potent inhibitors of protein and DNA synthesis. By the inhalation route, occupational stachybotrytoxicosis causes chest and upper airway symptoms, fever, leucopenia, dermatitis; starts in 2-3 days of exposure; and lasts 3 weeks. Investigation of the environment of the cluster of pulmonary hemorrhage in 10 infants in Cleveland, Ohio, and similar cases elsewhere are presented. The Centers for Disease Control and Prevention considers S. chartarum a serious health threat. However, even though there are now techniques of measuring S. chartarum conidia and estimating trichothecene mycotoxin in indoor air samples, no standards exist that relate to health effects. Those standards available are numerical or comparison of indoor/outdoor counts or both. Upper limit of noncontaminated indoor environment is 100-1000 colony-forming units (CFU) m3. There is no compelling evidence that exposures expected in most mold-contaminated indoor environments are likely to result in measurable health effects. However, when the health care worker suspects a problem in the home environment, a questionnaire and home visit may be helpful. High indoor exposures are associated with infrequent ventilation or vacuuming, pets, visible mold, and old carpets. To screen the indoor air, an experienced pollen and mold counter could use a Burkard personal air sampler. Health-based exposure standards for molds and mycotoxins do not exist. When available data indicate extremely high mold levels, cleanup consisting of removal of all contaminated material, cleaning accessible heating, ventilation, and airconditioning parts and filters, and preventive maintenance are indicated. There is a brief summary of the diseases of plants, animals, and humans caused by several common allergenic fungi and the mycotoxins they produce.
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Affiliation(s)
- J W Chow
- Department of Veterans Affairs Medical Center, Detroit, Michigan, USA
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Pedersen M. Histamine release from basophil leukocytes from HIV infected patients. In vitro studies of type I hypersensitivity reactions to microbial antigens, cytokines, and environmental antigens. Dan Med Bull 1993; 40:286-94. [PMID: 7687946] [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] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- M Pedersen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen
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