A Monte Carlo pharmacokinetic/pharmacodynamic simulation to evaluate the efficacy of minocycline, tigecycline, moxifloxacin, and levofloxacin in the treatment of hospital-acquired pneumonia caused by<i>Stenotrophomonas maltophilia</i>

Wei, Chuanqi; Ni, Wentao; Cai, Xuejiu; Cui, Jiayue

doi:10.3109/23744235.2015.1064542

Cited by 33 publications

(26 citation statements)

References 32 publications

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“…Florokinolon grubu antibiyotikler, özellikle S.maltophilia gibi çoklu ilaç direnci geliştiren nonfermentatif bakterilere bağlı enfeksiyonlarda önemli tedavi alternatifleri arasında sayılmaktadır. Trovafloksasin, klinafloksasin, grepafloksasin, gatifloksasin, moksifloksasin, levofloksasin gibi yeni kuşak kinolonların tedavide siprofloksasinden 4-8 kat daha etkili oldukları bildirilmektedir (23) . Corlouer ve ark.…”

Section: Discussionunclassified

Antibiotic Susceptibility of Stenotrophomonas maltophilia Isolated from Various Clinical Specimens

Arabacı¹,

Yanılmaz²,

Uzun³

2019

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Tigesiklin minimum inhibitör konsantrasyon (MİK) değeri 2 mg/l'nin üzerinde dirençli kabul edildiğinde tigesikline % 83 duyarlılık saptanmıştır. Çalışmamızda, seftazidime karşı saptanan direnç nedeniyle, üçüncü kuşak sefalosporinlerin hastanemizde S.maltophilia'nın ampirik tedavisinde kullanılamayacağı sonucuna varılmıştır. TMP-SXT ve levofloksasin direncimiz henüz korkulacak boyutlarda olmamasına rağmen artan direnç oranları açısından dikkat edilmesi gerektiği görülmüştür.

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Section: Discussionunclassified

Antibiotic Susceptibility of Stenotrophomonas maltophilia Isolated from Various Clinical Specimens

Arabacı¹,

Yanılmaz²,

Uzun³

2019

Ankem Derg

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“…Çin'de yapılan başka bir çalışmada, klinik izo-latlardan izole edilen S. maltophilia suşlarında levofloksasin direncinin %49'a ulaştığı bildirilmektedir (27) . S. maltophilia'nın neden olduğu sağlık hizmetleri ile ilişkili pnömonilerin araştırıldığı çalışmada, levofloksasin direnci %30.4 olarak bulunmuştur (28) .…”

Section: Discussionunclassified

Attention ! There is a Significant Increase in Trimetoprim-sulfomethoxazole and Levofloxacin Resistance of Stenotrophomanas maltophilia Strains Isolated from Clinical Samples (2008-2016)

Hazırolan¹,

Araz²,

Çelikbaş³

et al. 2018

TMCD

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ÖZ Amaç: Stenotrophomonas maltophilia sağlık hizmetleri ile ilişkili enfeksiyon etkeni olarak yoğun bakımlarda ve immünsüprese hastalarda sıklığı ve önemi gittikçe artan fırsatçı bir patojendir. Hastaların ağırlıklı olarak solunum yolu örneklerinde, kan ve idrarlarında izole edilmektedir. Birçok antibiyotiğe karşı gösterdiği intrensek direnç nedeniyle tedavisi zordur. Bu çalışmada, sekiz yıllık bir dönemde çeşitli klinik örneklerden izole edilen S. maltophilia suşlarının trimetoprim-sulfametoksazol ve levofloksasin direnç oranlarının ve bu oranların yıllara göre değişiminin saptanması amaçlanmıştır. Artan trimetoprimsulfametoksazol direnci nedeniyle yalnızca trimetoprimsulfametoksazol direncinin bildirilmesinin klinik takip ve tedavide yeterli olup olmayacağı tartışılmıştır. Gereç ve Yöntem: Çalışmamızda, sekiz yıllık süreçte izole edilmiş olan 195 S. maltophilia suşunun dağılımı ve antimikrobiyal duyarlılığı retrospektif olarak incelenmiştir. Suşların tanımlama ve antibiyotik duyarlılıklarına, Vitek2 Compact (BioMérieux, Fransa), Matrix-Assisted Laser Desorption/Ionization time-of-flight, Mass Spectrometry (MALDI TOF MS, Bruker, Almanya) sistemi ve Phoenix (Becton Dickinson, ABD) otomatik cihazları ile bakılmıştır. Bulgular: Suşlar en sık yoğun bakım kliniğinden gönderilen (n=63) solunum yolu örneklerinden (n=25) izole edilmişlerdir. Trimetoprim sulfametoksazol direnci ortalama %4.08 (0-13.58), levofloksasin direnci %11.71 (0-17.39) olarak belirlenmiştir. Levofloksasine orta derecede duyarlı yedi suş saptanmıştır. Sonuç: Yıllar içinde artan direnç göz önüne alındığında, antibiyotik duyarlılığında kısıtlı bildirim yapılması zaten tedavi seçenekleri az olan bir mikroorganizma için klinisyenin işini zorlaştırmaktadır. Bu nedenle suşlar gereğinde daha geniş antibiyotik duyarlılığı çalışılmak üzere saklanmalıdır. Anahtar kelimeler: Stenotrophomanas maltophilia, antibiyotik direnci, trimetoprim sulfametoksazol, levofloksasin ABSTRACT Attention! Objective:As an health services-related infectious agent Stenotrophomonas maltophilia, is an opportunistic pathogen whose frequency and importance increase in intensive care units and immunocompromised patients. It is predominantly isolated from the blood, urine and respiratory tract specimens of the patients. Due to its intrinsic resistance to many antimicrobials, the treatment of the patients infected with S. maltophilia is very difficult. The aim of this study is to determine the resistance rates of trimethoprim sulfamethoxazole and levofloxacin of S. maltophilia strains isolated from various clinical samples within a period of eight years and the variation of these rates with respect to years. We discussed if it is sufficient to report only trimethoprim sulfamethoxazole resistance in terms of clinical follow-up and treatment as there is an increasing resistance to trimethoprim sulfamethoxazole. Material and Methods:In our study, the distribution and antimicrobial susceptibility of 195 S. maltophilia isolates that were collected over an eight-year period were examined retros...

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“…Because of its intrinsic and acquired resistance to most commonly clinical used antibiotics, its treatment is extremely difficult, and SXT is the only first-line drug recommended (Looney et al, 2009; Chang et al, 2015), with an overall susceptibility rate of higher than 90% (Abbott et al, 2011; Wu et al, 2012; Chang et al, 2015; Wei et al, 2015). Resistance to SXT in S. maltophilia will lead to more treatment failure and higher mortality, and the global emergence of an increasing tendency toward SXT resistance mediated by the dissemination of sul genes has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Since S. maltophilia shows a high level of intrinsic resistance to most commonly used antimicrobial agents, including most cephalosporins, carbapenems, aminoglycosides, and quinolones, its treatment is extremely difficult. Sulfamethoxazole/trimethoprim (SXT) is the only first-line antimicrobial recommended for treatment because of its good antibacterial activity in vitro and low incidence of resistance (Abbott et al, 2011; Wu et al, 2012; Wei et al, 2015). Although other mechanisms, such as dfrA and SmeDEF genes, might influence the minimal inhibitory concentration (MIC), the sul genes have generally been recognized as the predominant resistance mechanism (Toleman et al, 2007; Hu et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Surveillance of Dihydropteroate Synthase Genes in Stenotrophomonas maltophilia by LAMP: Implications for Infection Control and Initial Therapy

et al. 2016

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Stenotrophomonas maltophilia is a common nosocomial pathogen that causes high morbidity and mortality. Because of its inherent extended antibiotic resistance, therapeutic options for S. maltophilia are limited, and sulfamethoxazole/trimethoprim (SXT) is the only first-line antimicrobial recommended. However, with the spread of dihydropteroate synthase (sul1 and sul2) genes, global emergence of SXT resistance has been reported. There is an urgent need to develop a rapid and sensitive but cost-efficient method to monitor the dissemination of sul genes. In this study, we developed loop-mediated isothermal amplification (LAMP) assays for sul1 and sul2 using real-time turbidity and hydroxy naphthol blue coloration methods. The assays could quickly detect sul genes with high sensitivity and specificity. The LAMP detection limit was 0.74 pg/reaction of extracted genomic DNA for sul1 and 2.6 pg/reaction for sul2, which were both 10-fold more sensitive than the corresponding traditional PCR assays. Additionally, the LAMP assays could positively amplify DNA from sul1-producing strains, but not from the negative controls. We then used the LAMP assays to investigate the dissemination of sul genes among S. maltophilia isolates from patients in three hospitals in Beijing, China. Among 450 non-duplicated samples collected during 2012–2014, 56 (12.4%) strains were SXT-resistant. All these SXT-resistant strains were positive for sul genes, with 35 (62.5%) carrying sul1, 17 (30.4%) carrying sul2, and 4 (7.1%) carrying both sul1 and sul2, which indicated that sul genes were the predominant resistance mechanism. Of 394 SXT-susceptible strains, 16 were also sul-positive. To provide epidemiological data for the appropriate choice of antimicrobials for treatment of sul-positive S. maltophilia, we further tested the susceptibility to 18 antimicrobials. Among these, sul-positive strains showed the highest susceptibility to tetracycline derivatives, especially minocycline (MIC50/MIC90, 0.5/4; susceptibility rate, 95.4%). Ticarcillin-clavulanate and new fluoroquinolones (moxifloxacin and levofloxacin) also showed some in vitro activity. Apart from these three kinds of antimicrobials, other agents showed poor activity against sul-positive strains.

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A Monte Carlo pharmacokinetic/pharmacodynamic simulation to evaluate the efficacy of minocycline, tigecycline, moxifloxacin, and levofloxacin in the treatment of hospital-acquired pneumonia caused byStenotrophomonas maltophilia

Abstract: The simulation results suggest that minocycline may be a proper choice for treatment of HAP caused by S. maltophilia, while tigecycline, moxifloxacin, and levofloxacin may not be optimal as monotherapy.

Cited by 33 publications

References 32 publications

Antibiotic Susceptibility of Stenotrophomonas maltophilia Isolated from Various Clinical Specimens

Antibiotic Susceptibility of Stenotrophomonas maltophilia Isolated from Various Clinical Specimens

Attention ! There is a Significant Increase in Trimetoprim-sulfomethoxazole and Levofloxacin Resistance of Stenotrophomanas maltophilia Strains Isolated from Clinical Samples (2008-2016)

Surveillance of Dihydropteroate Synthase Genes in Stenotrophomonas maltophilia by LAMP: Implications for Infection Control and Initial Therapy

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