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Indian J Med Microbiol ; 47: 100528, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38228227


PURPOSE: Treatment of antibiotic-resistant Gram-positive infections (GPIs), including methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly difficult, particularly in patients with multiple co-morbidities who require antibiotics with greater safety and a consistent pharmacokinetic/pharmacodynamic (PK/PD) profile. Such difficult-to-treat GPIs are often associated with poor outcomes, extended hospital stay and increased expenditure. This can be partly attributed to the limited safety and aberrant PK/PD profile of existing anti-MRSA antibiotics. In this context, intravenous levonadifloxacin and its oral prodrug alalevonadifloxacin are novel anti-MRSA antibiotics that have significant advantages over conventional anti-Gram-positive antibiotics. The purpose of this paper was to generate a consensus on the optimal use of levonadifloxacin and alalevonadifloxacin for tackling resistant Gram-positive infections in patients with multiple co-morbidities. METHOD: Using a modified Delphi approach that combines critical appraisal of evidence and expert opinion, therapeutic use of levonadifloxacin and alalevonadifloxacin in various clinical scenarios and specific unmet conditions was deliberated. Fifteen expert members from medicine, critical-care, emergency, microbiology, and intensive-care disciplines participated and voted on 11 pre-conceived statements. When there was at least 70 % agreement, a consensus was reached. RESULTS: Following the voting, agreements were reached on 10 out of the 11 statements. Broadly, a consensus was reached in defining the therapeutic role of levonadifloxacin and alalevonadifloxacin in the treatment of various clinical indications involving resistant Gram-positive pathogens, including MRSA, in patients with co-morbidities, such as co-existing or increased risk for kidney dysfunction or hepatic disease and/or immunosuppression; also, in therapeutically challenging conditions caused by Gram-positive bacteria such as bacteraemia, bone and joint infection, diabetic foot infection, febrile neutropenia, and hospital-acquired pneumonia. CONCLUSIONS: This consensus supports the therapeutic use of levonadifloxacin and alalevonadifloxacin in the treatment of antibiotic-resistant GPIs, including those caused by MRSA and certain polymicrobial infections, in patients with multiple co-morbidities requiring drug with adequate safety and consistent efficacy.

Staphylococcus aureus Resistente a Meticilina , Quinolizinas , Quinolonas , Infecciones Estafilocócicas , Humanos , Antibacterianos/efectos adversos , Consenso , Fluoroquinolonas/uso terapéutico , Fluoroquinolonas/farmacología , Quinolonas/efectos adversos , Infecciones Estafilocócicas/microbiología
Clin Microbiol Infect ; 30(3): 368-374, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38081413


OBJECTIVES: To compare COVID-19-associated pulmonary mucormycosis (CAPM) with COVID-19-associated rhino-orbital mucormycosis (CAROM), ascertain factors associated with CAPM among patients with COVID-19, and identify factors associated with 12-week mortality in CAPM. METHODS: We performed a retrospective multicentre cohort study. All study participants had COVID-19. We enrolled CAPM, CAROM, and COVID-19 subjects without mucormycosis (controls; age-matched). We collected information on demography, predisposing factors, and details of COVID-19 illness. Univariable analysis was used to compare CAPM and CAROM. We used multivariable logistic regression to evaluate factors associated with CAPM (with hypoxemia during COVID-19 as the primary exposure) and at 12-week mortality. RESULTS: We included 1724 cases (CAPM [n = 122], CAROM [n = 1602]) and 3911 controls. Male sex, renal transplantation, multimorbidity, neutrophil-lymphocyte ratio, intensive care admission, and cumulative glucocorticoid dose for COVID-19 were significantly higher in CAPM than in CAROM. On multivariable analysis, COVID-19-related hypoxemia (aOR, 2.384; 95% CI, 1.209-4.700), male sex, rural residence, diabetes mellitus, serum C-reactive protein, glucocorticoid, and zinc use during COVID-19 were independently associated with CAPM. CAPM reported a higher 12-week mortality than CAROM (56 of the 107 [52.3%] vs. 413 of the 1356 [30.5%]; p = 0.0001). Hypoxemia during COVID-19 (aOR [95% CI], 3.70 [1.34-10.25]) and Aspergillus co-infection (aOR [95% CI], 5.40 [1.23-23.64]) were independently associated with mortality in CAPM, whereas surgery was associated with better survival. DISCUSSION: CAPM is a distinct entity with a higher mortality than CAROM. Hypoxemia during COVID-19 illness is associated with CAPM. COVID-19 hypoxemia and Aspergillus co-infection were associated with higher mortality in CAPM.

Aspergilosis , COVID-19 , Coinfección , Mucormicosis , Humanos , Masculino , Mucormicosis/complicaciones , Mucormicosis/epidemiología , Estudios Retrospectivos , Estudios de Cohortes , Glucocorticoides , COVID-19/complicaciones , COVID-19/terapia , Factores de Riesgo , India/epidemiología , Hipoxia/complicaciones
J Glob Infect Dis ; 15(1): 31-34, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37090149


Erysipelothrix rhusiopathiae is a Gram-positive bacillus, a zoonotic pathogen rarely causing human infections ranging from localized skin infections to invasive infections such as endocarditis. In this report, we present two cases of Erysipelothrix bacteremia. The first case is a native valve tricuspid endocarditis, which is a highly unusual valve to be involved. The second case is bacteremia, probably secondary to a minor skin breach, which did not involve heart valves. Erysipelothrix bacteremia is considered highly associated with infective endocarditis and a high mortality rate, which could be a bias due to underreporting of Erysipelothrix bacteremia without endocarditis. Erysipelothrix is intrinsically resistant to vancomycin, the first-line agent for Gram-positive bacteremia. Both the patients in this report were treated successfully with ceftriaxone.