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1.
Microbiol Spectr ; 12(4): e0272623, 2024 Apr 02.
Article in English | MEDLINE | ID: mdl-38415603

ABSTRACT

Antibiotic resistance is a recognized and concerning public health issue. Gram-negative bacilli, such as Pseudomonas aeruginosa (P. aeruginosa), are notorious for their rapid development of drug resistance, leading to treatment failures. TanReQing injection (TRQ) was chosen to explore its pharmacological mechanisms against clinical multidrug-resistant P. aeruginosa (MDR-PA), given its antibacterial and anti-inflammatory properties. We revealed the expression of proteins and genes in P. aeruginosa after co-culture with TRQ. This study developed an assessment method to evaluate clinical resistance of P. aeruginosa using MALDI-TOF MS identification and Biotyper database searching techniques. Additionally, it combined MIC determination to investigate changes in MDR-PA treated by TRQ. TRQ effectively reduced the MICs of ceftazidime and cefoperazone and enhanced the confidence scores of MDR-PA as identified by mass spectrometry. Using this evaluation method, the fingerprints of standard P. aeruginosa and MDR-PA were compared, and the characteristic peptide sequence (Seq-PA No. 1) associated with flagellum was found. The phenotypic experiments were conducted to confirm the effect of TRQ on the motility and adhesion of P. aeruginosa. A combination of co-immunoprecipitation and proteome analysis was employed, and 16 proteins were significantly differentially expressed and identified as potential candidates for investigating the mechanism of inhibiting resistance in P. aeruginosa treated by TRQ. The candidates were verified by quantitative real-time PCR analysis, and TRQ may affect these core proteins (MexA, MexB, OprM, OprF, OTCase, IDH, and ASL) that influence resistance of P. aeruginosa. The combination of multiple methods helps elucidate the synergistic mechanism of TRQ in overcoming resistance of P. aeruginosa.IMPORTANCEPseudomonas aeruginosa is an opportunistic pathogen closely associated with various life-threatening acute and chronic infections. The presence of antimicrobial resistance and multidrug resistance in P. aeruginosa infections significantly complicates antibiotic treatment. The expression of ß-lactamase, efflux systems such as MexAB-OprM, and outer membrane permeability are considered to have the greatest impact on the sensitivity of P. aeruginosa. The study used a method to assess the clinical resistance of P. aeruginosa using matrix-assisted laser desorption ionization time of flight mass spectrometry identification and Biotyper database search techniques. TanReQing injection (TRQ) effectively reduced the MICs of ceftazidime and cefoperazone in multidrug-resistant P. aeruginosa (MDR-PA) and improved the confidence scores for co-cultured MDR-PA. The study found a characteristic peptide sequence for distinguishing whether P. aeruginosa is resistant. Through co-immunoprecipitation and proteome analysis, we explored the mechanism of TRQ overcoming resistance of P. aeruginosa.


Subject(s)
Drugs, Chinese Herbal , Pseudomonas Infections , Pseudomonas aeruginosa , Humans , Ceftazidime/pharmacology , Cefoperazone/metabolism , Cefoperazone/pharmacology , Cefoperazone/therapeutic use , Proteome/metabolism , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/metabolism , Pseudomonas Infections/drug therapy , Pseudomonas Infections/microbiology , Peptides/pharmacology
2.
Altern Ther Health Med ; 30(9): 274-278, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38290444

ABSTRACT

Objective: To evaluate associations between patient characteristics and cefoperazone/sulbactam-associated coagulation dysfunction. Methods: Retrospective analysis was performed on 821 cases of bacterial infection treated with cefoperazone/sulbactam for more than three days in the Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, from January 2018 to June 2022. The patients were divided into normal coagulation function group (NCFG) (781 cases) and abnormal coagulation function group (ACFG) (40 cases) according to their coagulation function. Univariate and multivariate logistic regression analysis used the general data of the two groups of patients to investigate the risk factors of abnormal coagulation function caused by cefoperazone/sulbactam. Results: The incidence of abnormal coagulation function caused by cefoperazone/sulbactam was 4.87% (40/821). There was no significant difference in gender, body mass index (BMI), marriage, educational background, and concurrent medical conditions between the two groups (all P > .05). The patients in ACFG were older, the dosage and duration of cefoperazone/sulbactam were more prolonged, and the liver and kidney functions were more abnormal than those in NCFG, with significant differences (all P < .05). Univariate and multivariate logistic regression analysis showed that age (≥ 65 years old) (OR=1.293, 95%CI:0.897-1.287), duration of therapy (>10d) (OR=1.765, 95%CI:1.052-3.761), daily dosage (>6g) (OR=3.291, 95%CI:1.732-6.871), aspartate aminotransferase (AST) (≥ 23.98U/L) (OR=3.281, 95%CI:1.009-6.981), alanine aminotransferase (ALT) (≥ 24.03U/L) (OR=2.109, 95%CI:1.276-3.298), and serum creatinine (SCR) (>107 µ mol/L) (OR=2.716, 95%CI:1.023-4.398), prothrombin time (PT) (≥ 13.9U/L) (OR=1.571, 95%CI:1.287-1.945) were the risk factors (P < .05). Conclusion: Elderly patients, time of use, daily dose of use, liver and kidney function, and PT are the risk factors of cefoperazone/sulbactam leading to abnormal coagulation function.


Subject(s)
Anti-Bacterial Agents , Blood Coagulation Disorders , Cefoperazone , Sulbactam , Humans , Cefoperazone/adverse effects , Cefoperazone/therapeutic use , Sulbactam/adverse effects , Sulbactam/therapeutic use , Male , Female , Retrospective Studies , Middle Aged , Anti-Bacterial Agents/adverse effects , Aged , Adult , Blood Coagulation Disorders/chemically induced , Risk Factors
3.
Medicine (Baltimore) ; 102(28): e34284, 2023 Jul 14.
Article in English | MEDLINE | ID: mdl-37443505

ABSTRACT

The objective was to compare the clinical efficacy of cefoperazone-sulbactam with piperacillin-tazobactam in the treatment of severe community-acquired pneumonia (SCAP). The retrospective study was conducted from March 1, 2018 to May 30, 2019. Clinical outcomes were compared for patients who received either cefoperazone-sulbactam or piperacillin-tazobactam in the treatment of SCAP. A total of 815 SCAP patients were enrolled. Among them, 343 received cefoperazone-sulbactam, and 472 received piperacillin-tazobactam. Patients who received cefoperazone-sulbactam presented with higher Charlson Comorbidity Index scores. (6.20 ± 2.77 vs 5.72 ± 2.61; P = .009). The clinical cure rates and effectiveness for patients receiving cefoperazone-sulbactam and piperacillin-tazobactam were 84.2% versus 80.3% (P = .367) and 85.4% versus 83.3% (P = .258), respectively. In addition, the overall mortality rate of the cefoperazone-sulbactam group was 16% (n = 55), which was also comparable to the piperacillin-tazobactam group (17.8%, n = 84, P = .572). The primary clinical outcomes for patients receiving cefoperazone-sulbactam were superior compared to those receiving piperacillin-tazobactam after adjusting disease severity status. The clinical efficacy of cefoperazone-sulbactam in the treatment of adult patients with SCAP is comparable to that of piperacillin-tazobactam. After adjusting for disease severity, cefoperazone-sulbactam tended to be superior to piperacillin-tazobactam.


Subject(s)
Community-Acquired Infections , Pneumonia , Humans , Cefoperazone/therapeutic use , Sulbactam/therapeutic use , Anti-Bacterial Agents/therapeutic use , Piperacillin/therapeutic use , Retrospective Studies , Penicillanic Acid/therapeutic use , Piperacillin, Tazobactam Drug Combination/therapeutic use , Treatment Outcome , Microbial Sensitivity Tests , Community-Acquired Infections/drug therapy , Pneumonia/drug therapy
4.
Lett Appl Microbiol ; 76(3)2023 Mar 01.
Article in English | MEDLINE | ID: mdl-36918199

ABSTRACT

The prophylactic and therapeutic overuse of antimicrobials on the farm has contributed to the emergence of hard-to-fight bacterial strains causing bovine mastitis. Aiming at alternative therapies, this study evaluated the antimicrobial activity of 20 essential oils against clinical Staphylococcus aureus strains. Of them, five with strong activities were selected and evaluated for their minimum inhibitory concentrations (MIC) in culture medium and milk, cytotoxicity against bovine mammary cells (MAC-T), antiadhesive properties, and interactions among themselves and with cefoperazone. The oils remained active on milk, were not cytotoxic, and some concentrations stimulated MAC-T cells growth, suggesting healing potential. Subinhibitory concentrations of Coriandrum sativum, Origanum vulgare, Syzygium aromaticum, and Thymus vulgaris reduced biofilm formation by at least 80%. Several oil and cefoperazone combinations displayed additive interaction, with O. vulgare and C. sativum showing the most promising results. We developed formulations for being used as prophylactic postdipping solutions in the field, containing different concentrations (1% or 3%) of the active oils, alone or in combination, with 3% glycerin, 1% Tween 80, and water. The formulations showed strong antimicrobial activity in milk and enhanced antiadhesive properties, specially when two oils were combined in the formula, indicating promising biotechnological and therapeutical applications.


Subject(s)
Anti-Infective Agents , Mastitis, Bovine , Oils, Volatile , Staphylococcal Infections , Female , Cattle , Animals , Humans , Oils, Volatile/pharmacology , Staphylococcus aureus , Cefoperazone/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcal Infections/veterinary , Staphylococcal Infections/microbiology , Anti-Infective Agents/pharmacology , Plants , Condiments , Medicine, Traditional , Mastitis, Bovine/drug therapy , Mastitis, Bovine/microbiology , Microbial Sensitivity Tests , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use
5.
J Clin Pharm Ther ; 47(7): 1020-1027, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35285526

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Sulbactam and sulbactam-containing ß-lactam antibiotics are often used in the treatment of Acinetobacter baumannii. We aimed to further examine the clinical efficacy of a cefoperazone/sulbactam anti-infective regimen in multidrug-resistant A. baumannii (MDRAB) lung infections. METHODS: We conducted a retrospective analysis among patients with MDRAB lung infection and complete data who were treated at the geriatric intensive care unit of Jiangsu Province Hospital from January 2018 to December 2020. We collected general information, including age, sex, APACHE II score, anti-infective course, comorbid infections in other sites, other pathogens, cefoperazone/sulbactam regimen and concomitant medications, and adverse reactions. We used microbiological changes before and after treatment to assess microbiological efficacy, defined as microbial eradication and reduction. RESULTS AND DISCUSSION: 121 patients were included, among which 96 (79.34%) were men and 25 (20.66%) were women. The median age was 76 (interquartile range [IQR] 62.5-83) years, median APACHE II score was 22 (IQR 19-26), and median treatment course was 8 (IQR 5-12.5) days. Among these patients, tigecycline was concomitantly used in 52 patients and the sulbactam dose was increased to 4 g and above in 27 patients. The microbiological efficacy of conventional cefoperazone/sulbactam with/without tigecycline in MDRAB decreased with each consecutive year and a reduction in efficacy was linearly correlated with year, which was both statistically significant (p = 0.039, 0.030, respectively). In 2020, the microbiological efficacy of a higher sulbactam dose combined with tigecycline was 75%, which was a significant improvement over the conventional dose (p = 0.028). The 3-year data showed that the microbiological efficacy of conventional cefoperazone/sulbactam 3 g eight hourly (q8h) without tigecycline was 32% and efficacy increased to 57.9% when the sulbactam dose was increased. Hence, the increased sulbactam dose significantly improved efficacy in MDRAB lung infection (p = 0.049). Different doses of sulbactam combined with tigecycline increased the microbiological efficacy of MDRAB but the differences were not statistically significant. WHAT IS NEW AND CONCLUSION: A cefoperazone/sulbactam-based anti-infective regimen showed some efficacy in MDRAB lung infection, but the microbiological efficacy of a cefoperazone/sulbactam 3 g q8h regimen decreased over time. Increasing the sulbactam dose to 4 g or more can improve efficacy. Minimum inhibitory concentration (MIC)-guided personalized medicine may be a future research direction.


Subject(s)
Acinetobacter Infections , Acinetobacter baumannii , Acinetobacter Infections/drug therapy , Acinetobacter Infections/microbiology , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Cefoperazone/pharmacology , Cefoperazone/therapeutic use , Drug Resistance, Multiple, Bacterial , Female , Humans , Lung , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , Sulbactam/pharmacology , Sulbactam/therapeutic use , Tigecycline/therapeutic use , Treatment Outcome
6.
PLoS One ; 16(12): e0261264, 2021.
Article in English | MEDLINE | ID: mdl-34914757

ABSTRACT

BACKGROUND: The objectives of this study were; (I) to determine the proportion of pathogens isolated from patients with infected chronic wounds in the surgical ward of MRRH that are resistant to the third-generation cephalosporins and (II) to determine the factors associated with resistance to third-generation cephalosporins in the surgical ward of MRRH. METHOD(S): This study was a descriptive analytical survey of bacterial isolates from infected chronic wounds among patients admitted in the surgical ward of MRRH, Uganda. Seventy five (75) study participants were recruited in the study using convenient sampling technique. Bacterial culture and identification was performed using standard microbiology laboratory procedures whereas broth microdilution method was used to establish the susceptibility of the identified pathogens. Data for objective one (1) was summarized as proportions while the categorized variables were analyzed using logistic regression to determine whether they were associated with the resistance patterns. The level of significance was preset at 5% and p-values less than 0.05 were considered statistically significant. RESULTS: Generally, all isolates had complete susceptibility (100%) to Cefoperazone+Sulbactam 2g except 7.1% of proteus spp that were resistant. Of all the bacterial isolates studied, Staphylococcus aureus, Enterobacter agglomerans, providencia spp and pseudomonas earuginosa had complete resistance (100%) to Cefopodoxime 200mg while providencia spp and pseudomomas earuginosa had complete resistance (100%) to Cefixime 400mg and cefotaxime 1g. Finally, higher odds of bacterial resistance to more 2 brands of the third generation cephalosporins were observed among participants who had prior exposure to the third generation cephalosporins (OR, 2.22, 95% CI, 0.80-6.14), comorbidities (OR, 1.76, 95% CI, 0.62-4.96) and those who had more than two hospitalizations in a year (OR, 1.39, 95% CI 0.46-4.25). However, multivariate logistic regression was not performed since no factor was significantly associated with resistance to more than two brands of third generation cephalosporins (p >0.05). CONCLUSION: This study found that cefixime and cefpodoixme had high rates of resistance and should not be used in routine management of infected chronic wounds. In addition, the factors investigated in this study were not significantly associated with bacterial resistance to more than two brands of third generation cephalosporins.


Subject(s)
Cephalosporins/therapeutic use , Drug Resistance, Bacterial/physiology , Wound Infection/drug therapy , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Cefixime/pharmacology , Cefoperazone/therapeutic use , Ceftizoxime/analogs & derivatives , Ceftizoxime/pharmacology , Chronic Disease/drug therapy , Drug Resistance, Bacterial/drug effects , Female , Hospitals , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Sulbactam/therapeutic use , Uganda/epidemiology , Wound Infection/microbiology , Cefpodoxime
8.
J Postgrad Med ; 67(1): 36-38, 2021.
Article in English | MEDLINE | ID: mdl-33533750

ABSTRACT

Glyphosate is the most commonly used broad-spectrum, non-selective herbicide in the world. The toxicity is supposed to be due to uncoupling of oxidative phosphorylation and the surfactant polyoxyethylene amine (POEA)- mediated cardiotoxicity. Clinical features of this herbicide poisoning are varied, ranging from asymptomatic to even death. There is no antidote and aggressive supportive therapy is the mainstay of treatment for glyphosate poisoning. We present a 69-year-old female patient with suicidal consumption of around 500 ml of Glycel®. Initially, gastric lavage was done and intravenous fluids were given. Within two hours of presentation, the patient developed respiratory distress needing intubation, hypotension needing vasopressor support, and severe lactic acidosis. She also developed acute respiratory distress syndrome, hypokalemia, hypernatremia, and aspiration pneumonia. Our patient was critically ill with multiple poor prognostic factors, but with timely aggressive supportive management, the patient gradually recovered.


Subject(s)
Glycine/analogs & derivatives , Herbicides/poisoning , Hypernatremia/etiology , Hypokalemia/etiology , Pneumonia, Aspiration/etiology , Respiratory Distress Syndrome/etiology , Aged , Cefamandole/administration & dosage , Cefamandole/analogs & derivatives , Cefamandole/therapeutic use , Cefoperazone/administration & dosage , Cefoperazone/therapeutic use , Clindamycin/administration & dosage , Clindamycin/therapeutic use , Dietary Supplements , Female , Glycine/poisoning , Humans , Hypernatremia/drug therapy , Hypokalemia/drug therapy , Pneumonia, Aspiration/drug therapy , Potassium/administration & dosage , Potassium/therapeutic use , Respiratory Distress Syndrome/drug therapy , Suicide, Attempted , Sulbactam/administration & dosage , Sulbactam/therapeutic use , Treatment Outcome , Glyphosate
9.
J Chemother ; 32(3): 118-123, 2020 May.
Article in English | MEDLINE | ID: mdl-32096456

ABSTRACT

Cefoperazone-sulbactam (CS) and piperacillin-tazobactam (TZP) are used in the treatment of Gram-negative nosocomial infections (NIs). We aimed to compare the effects of these two antibiotics on mortality and treatment success. Patients treated with CS or TZP empirically for at least three days with suspicion of NI were included in this retrospective study. In total, 308 (154 patients in both treatment arms) patients were analyzed. Treatment success rate in CS and TZP group respectively (50% vs 51.2%, p = 0.18), 28-day mortality rate (46.1% vs 42.8%, p = 0.56) and antibiotic-related side effects (50.6% vs 46.1%, p = 0.42) were similar except prolonged prothrombin time (19.4% vs 6.4%; p = 0.001). According to this study results, CS and TZP have equal effectivity and safety for the empirical treatment of Gram-negative NIs. CS may be an appropriate alternative to TZP for antibiotic cycling or mixing strategy to reduce antibiotic resistance.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cefoperazone/therapeutic use , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/mortality , Piperacillin, Tazobactam Drug Combination/therapeutic use , Sulbactam/therapeutic use , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Cefoperazone/administration & dosage , Cefoperazone/adverse effects , Cross Infection , Drug Combinations , Drug Resistance, Multiple, Bacterial , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Piperacillin, Tazobactam Drug Combination/administration & dosage , Piperacillin, Tazobactam Drug Combination/adverse effects , Retrospective Studies , Sulbactam/administration & dosage , Sulbactam/adverse effects
10.
mSphere ; 5(1)2020 01 08.
Article in English | MEDLINE | ID: mdl-31915217

ABSTRACT

Dietary fiber provides a variety of microbiota-mediated benefits ranging from anti-inflammatory metabolites to pathogen colonization resistance. A healthy gut microbiota protects against Clostridioides difficile colonization. Manipulation of these microbes through diet may increase colonization resistance to improve clinical outcomes. The primary objective of this study was to identify how the dietary fiber xanthan gum affects the microbiota and C. difficile colonization. We added 5% xanthan gum to the diet of C57BL/6 mice and examined its effect on the microbiota through 16S rRNA gene amplicon sequencing and short-chain fatty acid analysis. Following either cefoperazone or an antibiotic cocktail administration, we challenged mice with C. difficile and measured colonization by monitoring the CFU. Xanthan gum administration is associated with increases in fiber-degrading taxa and short-chain fatty acid concentrations. However, by maintaining both the diversity and absolute abundance of the microbiota during antibiotic treatment, the protective effects of xanthan gum administration on the microbiota were more prominent than the enrichment of these fiber-degrading taxa. As a result, mice that were on the xanthan gum diet experienced limited to no C. difficile colonization. Xanthan gum administration alters mouse susceptibility to C. difficile colonization by maintaining the microbiota during antibiotic treatment. While antibiotic-xanthan gum interactions are not well understood, xanthan gum has previously been used to bind drugs and alter their pharmacokinetics. Thus, xanthan gum may alter the activity of the oral antibiotics used to make the microbiota susceptible. Future research should further characterize how this and other common dietary fibers interact with drugs.IMPORTANCE A healthy gut bacterial community benefits the host by breaking down dietary nutrients and protecting against pathogens. Clostridioides difficile capitalizes on the absence of this community to cause diarrhea and inflammation. Thus, a major clinical goal is to find ways to increase resistance to C. difficile colonization by either supplementing with bacteria that promote resistance or a diet to enrich for those already present in the gut. In this study, we describe an interaction between xanthan gum, a human dietary additive, and the microbiota resulting in an altered gut environment that is protective against C. difficile colonization.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Clostridioides difficile/drug effects , Clostridium Infections/prevention & control , Dietary Fiber/administration & dosage , Gastrointestinal Microbiome/drug effects , Polysaccharides, Bacterial/administration & dosage , Animals , Cefoperazone/therapeutic use , Clostridium Infections/microbiology , Dietary Supplements , Disease Susceptibility , Feces/microbiology , Female , Male , Mice , Mice, Inbred C57BL , Specific Pathogen-Free Organisms
11.
Lett Appl Microbiol ; 69(3): 198-203, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31236975

ABSTRACT

Pseudomonas aeruginosa is related to nosocomial infections, and it tends to become resistant during or after antimicrobial treatment. The ability to develop carbapenems resistance makes it difficult to treat. P. aeruginosa infections are often associated with high mortality, morbidity and treatment costs. A group of Chinese experts drafted a consensus for treatment of extensively drug-resistant Gram-negative bacilli (XDR-GNB) including extensively drug-resistant P. aeruginosa (XDR-PA). In this study, we studied the antibacterial activities of different antibiotic combinations against six carbapenems-resistant P. aeruginosa (CRPA) strains in vitro, and the results indicated that the combination of ceftazidime with cefoperazone-sulbatam was the best combination with excellent synergistic rate (100%). Besides, some combinations exhibited better effects than using antibiotics alone, reducing the MICs of both drugs significantly, such as ceftazidime/piperacillin-tazobactam and ceftazidime/aztreonam etc. However, there are also some combinations that showed no additional or synergistic effects, suggesting that not all combinations recommended by the guideline have the same effect against resistant P. aeruginosa. Our study screened out some effective combinations against six CRPA strains which might help to prevent the spread of antibiotic resistance through improving antibiotic effectiveness. SIGNIFICANCE AND IMPACT OF THE STUDY: This study measured the synergistic interactions between various antibiotics in vitro recommended by Chinese consensus statement against carbapenems-resistant Pseudomonas aeruginosa. The results of this study provide valuable evidence that some combinations may be a promising option for clinical treatment.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/drug effects , Aztreonam/therapeutic use , Carbapenems/therapeutic use , Cefoperazone/therapeutic use , Ceftazidime/therapeutic use , China , Cross Infection/microbiology , Drug Resistance, Bacterial , Drug Therapy, Combination , Humans , Microbial Sensitivity Tests , Piperacillin/therapeutic use , Pseudomonas Infections/microbiology , Tazobactam/therapeutic use
12.
Article in English | MEDLINE | ID: mdl-30886705

ABSTRACT

Background: We retrospectively analyzed the effect of tigecycline and cefoperazone/sulbactam therapies on the prognosis of patients with carbapenem-resistant Acinetobacter baumannii bloodstream infection (CRAB-BSI). Methods: CRAB-BSI patients receiving tigecycline therapy or cefoperazone/sulbactam therapy between January 2012 and December 2017 was enrolled, and strict exclusion criteria were followed. The 28-day mortality of patients was analyzed. The impact of cefoperazone/sulbactam therapy on prognosis was evaluated using Cox multivariate regression analysis. The 28-day mortality of patients receiving cefoperazone/sulbactam monotherapy and cefoperazone/sulbactam-based combination therapy was also compared. Results: Three hundred forty eight patients with CRAB-BSI were enrolled in the study. Two hundred ten patients were included after applying the exclusion criteria. Of these, 135 patients received tigecycline therapy and 75 patients received cefoperazone/sulbactam therapy. The 28-day mortality of patients in the latter group was, significantly lower than that of the tigecycline group [29.3% vs. 51.9%; P = 0.001]. Cox multivariate regression analysis revealed that cefoperazone/sulbactam therapy exerted a protective effect on the prognosis of patients [hazard ratio 0.566, 95% confidence interval (0.342-0.940); P = 0.028]. Kaplan-Meier survival curve analysis indicated that the 28-day mortality of patients receiving cefoperazone/sulbactam therapy was lower than that of patients receiving cefoperazone/sulbactam monotherapy, but the difference was not significant (22.2% vs. 40%; P = 0.074). However, the mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin was significantly lower than that of patients receiving cefoperazone/sulbactam monotherapy (P = 0.048). Conclusions: Patients treated with cefoperazone/sulbactam therapy had a better clinical outcome. The mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin seems to be the lowest.


Subject(s)
Acinetobacter Infections/drug therapy , Acinetobacter baumannii/drug effects , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Drug Resistance, Bacterial/drug effects , Acinetobacter baumannii/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Carbapenems , Cefoperazone/pharmacology , Cefoperazone/therapeutic use , Child , Child, Preschool , Drug Synergism , Drug Therapy, Combination , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Prognosis , Retrospective Studies , Sulbactam/pharmacology , Sulbactam/therapeutic use , Survival Analysis , Tigecycline/pharmacology , Tigecycline/therapeutic use , Treatment Outcome , Young Adult
13.
J Glob Antimicrob Resist ; 18: 47-51, 2019 09.
Article in English | MEDLINE | ID: mdl-30710647

ABSTRACT

BACKGROUND AND OBJECTIVE: Macrolides are the recommended antibiotics for treating pertussis and preventing transmission. The causative bacterium, Bordetella pertussis, has high macrolide resistance and has recently circulated in China. The objective of this study was to find effective alternative antibiotics for treatment by assessing the in vitro activity and clinical efficacy of antibiotics against Bordetella pertussis. METHODS: Bordetella pertussis was confirmed by agglutination with specific antisera and mass spectrometry. The MICs of antibiotics against isolates were determined using the Etest method. Treatment outcomes were clinically and microbiologically evaluated. RESULTS: A total of 126 pertussis patients were diagnosed based on culture, 69.8% of whom were aged ≤6 months and 72.1% were treated with previous macrolides. Leucocytosis and lymphocytosis were observed in 29.4% and 54.8% of all patients, respectively. Both MIC50 and MIC90 of erythromycin, azithromycin, and clindamycin were >256mg/L, and 75.4% were highly macrolide resistant. The MIC90 of trimethoprim-sulfamethoxazole, ampicillin, ampicillin-sulbactam, cefuroxime, ceftriaxone and cefoperazone-sulbactam were 0.38mg/L, 0.25mg/L, 0.19mg/L, 12mg/L, 0.19mg/L and 0.047mg/L, respectively. The MICs of piperacillin in all of the isolations were <0.016mg/L. Of the patients treated with single cefoperazone-sulbactam or piperacillin-tazobactam, 30 of 32 (93.8%) had significantly improved clinical symptoms and 24 of 25 (96%) had negative culture results after 2 weeks of therapy. CONCLUSION: Macrolide resistance in Bordetella pertussis is a serious problem in Zhejiang Province, China. Piperacillin/piperacillin-tazobactam and cefoperazone-sulbactam have potent antibacterial activity in vitro and in vivo, and may become the alternative choice for treating pertussis caused by macrolide-resistant isolates.


Subject(s)
Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bordetella pertussis/drug effects , Macrolides/pharmacology , Macrolides/therapeutic use , Whooping Cough/drug therapy , Adolescent , Cefoperazone/pharmacology , Cefoperazone/therapeutic use , Child , Child, Preschool , China , Drug Resistance, Bacterial , Female , Humans , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Piperacillin, Tazobactam Drug Combination/pharmacology , Piperacillin, Tazobactam Drug Combination/therapeutic use , Sulbactam/pharmacology , Sulbactam/therapeutic use , Treatment Outcome
14.
J Antimicrob Chemother ; 73(11): 3176-3180, 2018 11 01.
Article in English | MEDLINE | ID: mdl-30099554

ABSTRACT

Objectives: Carbapenems are widely recommended for the treatment of infections caused by ESBL producers however, non-carbapenem ß-lactams such as ß-lactam/ß-lactamase inhibitor combinations (BLBLIs) deserve consideration for the treatment of ESBL infections. Cefoperazone/sulbactam is one of the most commonly used BLBLIs in China; however, few outcome studies have been reported. In this study, we evaluated and compared the clinical efficacy of cefoperazone/sulbactam with that of a carbapenem in the treatment of bloodstream infections (BSIs) caused by ESBL-producing Enterobacteriaceae. Methods: Patients with monomicrobial ESBL-producing Enterobacteriaceae BSIs empirically treated with cefoperazone/sulbactam or a carbapenem were included. Outcomes of interest were clinical response and 14 day mortality. To make a comparison of the efficacy of cefoperazone/sulbactam and a carbapenem more accurate, propensity score analysis was performed. Results: No statistically significant differences in success rates or 14 day mortality were found between the cefoperazone/sulbactam (n = 17) and carbapenem (n = 46) groups. In the propensity score analysis with 17 case-control pairs, the success rate in the cefoperazone/sulbactam group (70.6%, 12/17) was lower than that in the carbapenem group (94.1%, 16/17), but the difference was not significant (P = 0.175). Sepsis-related mortality and 14 day mortality rates did not significantly differ either (P = 1.000 for both). In the cefoperazone/sulbactam group, 66.7% (2/3) of the patients with a Pitt bacteraemia score ≥5 died within 14 days, whereas none (0/14) of the patients with a Pitt bacteraemia score <5 died within 14 days (P = 0.022). Conclusions: This study showed that cefoperazone/sulbactam had a lower success rate and a higher 14 day mortality rate compared with carbapenems, although the differences were not statistically significant because of the small patient numbers. Further evaluation of cefoperazone/sulbactam is needed.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Carbapenems/therapeutic use , Cefoperazone/therapeutic use , Enterobacteriaceae Infections/drug therapy , Sulbactam/therapeutic use , Aged , Aged, 80 and over , Case-Control Studies , China , Enterobacteriaceae/drug effects , Enterobacteriaceae/enzymology , Enterobacteriaceae Infections/blood , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Retrospective Studies , beta-Lactamase Inhibitors/therapeutic use , beta-Lactamases , beta-Lactams/therapeutic use
15.
Indian J Med Microbiol ; 36(1): 127-130, 2018.
Article in English | MEDLINE | ID: mdl-29735843

ABSTRACT

Ceftolozane/tazobactam is a novel antimicrobial agent with activity against Pseudomonas aeruginosa and other common Gram-negative pathogens. In this study, we determined the antimicrobial susceptibility for a total of 149 clinical isolates of P. aeruginosa for the most commonly used antimicrobials including the new agent ceftolozane/tazobactam (C/T). Broth microdilution was performed to determine the minimum inhibitory concentration against various antimicrobials including C/T. Among the ß-lactam/ß-lactamase inhibitor, overall susceptibility was 67%, 55% and 51% for C/T, Piperacillin/Tazobactam (P/T) and Cefoperazone/Sulbactam, respectively. The variations in the susceptibility rates were noted among the three different ß-lactam/ß-lactamase inhibitors. Interestingly, 33% susceptibility was noted for C/T against isolates that were resistant to P/T, indicating the higher activity of C/T. This finding suggests about 33% of the P/T-resistant isolates can still be treated effectively with C/T. C/T could be a better alternative for the treatment of ESBL-producing organism, and thereby usage of higher antimicrobials can be minimised.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Cefoperazone/therapeutic use , Cephalosporins/therapeutic use , Penicillanic Acid/analogs & derivatives , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/drug effects , Sulbactam/therapeutic use , beta-Lactamase Inhibitors/therapeutic use , Cross Infection/drug therapy , Cross Infection/microbiology , Drug Combinations , Drug Resistance, Multiple, Bacterial , Humans , India , Microbial Sensitivity Tests , Penicillanic Acid/therapeutic use , Piperacillin/therapeutic use , Piperacillin, Tazobactam Drug Combination , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/isolation & purification , Tazobactam , Treatment Outcome
16.
Int J Infect Dis ; 23: 90-3, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24726664

ABSTRACT

BACKGROUND: Acinetobacter baumannii has been reported increasingly as a significant causative organism of various nosocomial infections, including hospital-acquired pneumonia (HAP). The aim of this study was to investigate the clinical characteristics of HAP induced by carbapenem-resistant A. baumannii (CRAB) in elderly patients and the in vitro antimicrobial effects of cefoperazone/sulbactam combination therapy. METHODS: Seventy-one elderly patients in the geriatric ward of the General Hospital of the People's Liberation Army (PLAGH) with CRAB-induced HAP were analyzed retrospectively. The checkerboard method was used to determine the in vitro drug sensitivity of 60 CRAB strains to antimicrobial combinations (cefoperazone/sulbactam with meropenem, minocycline, or levofloxacin). The occurrence of carbapenemase genes was detected by PCR. RESULTS: CRAB-induced HAP occurred mostly in patients with underlying diseases. Prior to onset, most patients had received antimicrobial therapies including broad-spectrum ß-lactams, invasive mechanical ventilation, and catheterization. The 30-day survival rate was 95.1% in patients using cefoperazone/sulbactam, with or without combination with antimicrobial drugs, and 73.3% in patients not using cefoperazone/sulbactam (p<0.05). When cefoperazone/sulbactam was used in combination with minocycline, levofloxacin, and meropenem, minimum inhibitory concentrations MIC50 and MIC90 were reduced for each drug. The genes OXA-23 and OXA-51 were amplified in 96.7% of the strains, but the genes OXA-24, OXA-58, SIM, VIM, and IMP were not amplified. CONCLUSIONS: CRAB-induced HAP occurred mostly in patients with anemia or decreased levels of serum albumin, but with elevated levels of C-reactive protein and creatinine. Cefoperazone/sulbactam in combination with minocycline, meropenem, and levofloxacin had a synergistic and additive in vitro bacteriostatic action on CRAB.


Subject(s)
Acinetobacter baumannii/drug effects , Carbapenems/pharmacology , Cefoperazone/therapeutic use , Cross Infection/drug therapy , Pneumonia, Bacterial/drug therapy , Sulbactam/therapeutic use , Acinetobacter baumannii/isolation & purification , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , C-Reactive Protein/metabolism , Drug Combinations , Drug Resistance, Multiple, Bacterial , Drug Synergism , Female , Humans , Levofloxacin/therapeutic use , Male , Meropenem , Microbial Sensitivity Tests , Middle Aged , Minocycline/therapeutic use , Retrospective Studies , Thienamycins/therapeutic use
17.
Pediatr Int ; 54(1): 60-3, 2012 Feb.
Article in English | MEDLINE | ID: mdl-21883691

ABSTRACT

BACKGROUND: Neonates are at high risk for nosocomial infections due to multidrug-resistant pathogens. The use of ß-lactamase inhibitors in combination with ß-lactam antibiotics broadens the antimicrobial spectrum. Cefoperazone/sulbactam is used in children but there are limited data on its usage in neonates. The purpose of the present study was therefore to evaluate the use of cefoperazone/sulbactam in the treatment of neonatal infections caused by multidrug-resistant pathogens. METHODS: The records of neonates who were hospitalized and who received cefoperazone/sulbactam were reviewed. RESULTS: There were 90 infants who received cefoperazone/sulbactam. A pathogen could be isolated in 41 (45.6%) of the infants. In total, 17.1% of isolated pathogens were resistant to cefoperazone/sulbactam. Side-effects were seen in four of the infants. Two infants had cholestasis, one infant had neutropenia and one had superinfection with candida. CONCLUSION: Cefoperazone/sulbactam can be used in the treatment of nosocomial infections caused by multidrug-resistant pathogens in neonates.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Cefoperazone/therapeutic use , Cross Infection/drug therapy , Sulbactam/therapeutic use , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Female , Humans , Infant, Newborn , Male , Microbial Sensitivity Tests
19.
Article in English | MEDLINE | ID: mdl-17120738

ABSTRACT

To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia (CAP) in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group (n = 20) and a control group (n = 20), which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin (Avelox) once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy (90% for moxifloxacin, 95% for cefoperazone plus azithromycin) (P > 0.05). The bacteriologic eradication rate at the end of treatment was 90% in the moxifloxacin group and 80% in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups (P > 0.05). In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the commonly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.


Subject(s)
Aza Compounds/therapeutic use , Community-Acquired Infections/drug therapy , Pneumonia, Bacterial/drug therapy , Quinolines/therapeutic use , Adolescent , Adult , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/therapeutic use , Aza Compounds/administration & dosage , Azithromycin/administration & dosage , Azithromycin/therapeutic use , Cefoperazone/administration & dosage , Cefoperazone/therapeutic use , Female , Fluoroquinolones , Humans , Infusions, Intravenous , Male , Middle Aged , Moxifloxacin , Quinolines/administration & dosage , Treatment Outcome
20.
Oral Microbiol Immunol ; 17(5): 285-9, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12354209

ABSTRACT

In this study, we evaluated the current effectiveness of 11 beta-lactam antibiotics for treatment of orofacial odontogenic infections by determining the antimicrobial susceptibility of the major pathogens. The antimicrobial susceptibilities of viridans streptococci (n = 47), Peptostreptococcus (n = 67), Porphyromonas (n = 18), Fusobacterium (n = 57), black-pigmented Prevotella (n = 59) and non-pigmented Prevotella (n = 47) isolated from pus specimens of 93 orofacial odontogenic infections to penicillin G, cefmetazole, flomoxef, cefoperazone, cefoperazone/sulbactam, ceftazidime, cefpirome, cefepime, cefoselis, imipenem and faropenem were determined using the agar dilution method. Penicillin G, most cephalosporins, imipenem and faropenem worked well against viridans streptococci, Peptostreptococcus, Porphyromonas and Fusobacterium. Penicillin G and most cephalosporins, including fourth-generation agents, were not effective against beta-lactamase-positive Prevotella, though they were effective against beta-lactamase-negative strains. Cefmetazole, cefoperazone/sulbactam, imipenem and faropenem expressed powerful antimicrobial activity against beta-lactamase-positive Prevotella. In conclusion, penicillins have the potential to be first-line agents in the treatment of orofacial odontogenic infections. Most of the other beta-lactam antibiotics, including fourth-generation cephalosporins, were not found to have greater effectiveness than penicillins. In contrast, cefmetazole, cefoperazone/sulbactam, imipenem and faropenem were found to have greater effectiveness than penicillins.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria/drug effects , Bacterial Infections/drug therapy , Ceftizoxime/analogs & derivatives , Lactams , Mouth Diseases/microbiology , beta-Lactams , Bacteroidaceae Infections/drug therapy , Cefepime , Cefmetazole/therapeutic use , Cefoperazone/administration & dosage , Cefoperazone/therapeutic use , Ceftazidime/therapeutic use , Ceftizoxime/therapeutic use , Cephalosporins/therapeutic use , Drug Resistance, Bacterial , Drug Therapy, Combination/therapeutic use , Fusobacterium/drug effects , Fusobacterium Infections/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Humans , Imipenem/therapeutic use , Microbial Sensitivity Tests , Mouth Diseases/drug therapy , Penicillin G/therapeutic use , Penicillins/therapeutic use , Peptostreptococcus/drug effects , Porphyromonas gingivalis/drug effects , Prevotella/drug effects , Streptococcal Infections/drug therapy , Streptococcus/drug effects , Sulbactam/administration & dosage , Sulbactam/therapeutic use , Cefpirome
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