Comparative in vitro susceptibility of Burkholderia pseudomallei to doripenem, ertapenem, tigecycline and moxifloxacin

Harris, Patrick N A; Engler, Cathy; Norton, Robert

doi:10.1016/j.ijantimicag.2011.02.001

Cited by 18 publications

(12 citation statements)

References 19 publications

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“…129 Doripenem has minimum inhibitory concentrations similar to meropenem but ertapenem, tigecycline, and moxifloxacin appear to have limited in vitro activity. 159 Other potential novel therapeutic approaches for melioidosis have recently been extensively reviewed. [160][161][162] Development of a melioidosis vaccine has been heavily funded in recent years because of the biothreat potential of B. pseudomallei and for military purposes.…”

Section: Other Therapeutic Aspectsmentioning

confidence: 99%

Melioidosis: Evolving Concepts in Epidemiology, Pathogenesis, and Treatment

Currie

2015

Semin Respir Crit Care Med

284

347

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Infection with Burkholderia pseudomallei can result in asymptomatic seroconversion, a single skin lesion that may or may not heal spontaneously, a pneumonia which can be subacute or chronic and mimic tuberculosis or rapidly progressive resulting in fatal overwhelming sepsis. Latency with subsequent activation of disease is well recognized, but very uncommon. Melioidosis also has a myriad of other clinical presentations and diagnosis is often delayed because of this and because of difficulties with laboratory diagnosis and lack of recognition outside melioidosis-endemic regions. The perception of B. pseudomallei as a top tier biothreat agent has driven large funding for research, yet resources for diagnosis and therapy of melioidosis in many endemic locations remain extremely limited, with mortality as high as 50% in comparison to around 10% in regions where state-of-the-art intensive care therapy for sepsis is available. Fatal melioidosis is extremely unlikely from natural infection in a healthy person, provided the diagnosis is made early, ceftazidime or meropenem is commenced and intensive care therapy is available. While biothreat research is directed toward potential aerosol exposure to B. pseudomallei, the overall proportion of melioidosis cases resulting from inhalation rather than from percutaneous inoculation remains entirely uncertain, although the epidemiology supports a shift to inhalation during severe weather events such as cyclones and typhoons. What makes B. pseudomallei such a dangerous organism for patients with diabetes and other selective risk factors remains unclear, but microbial genome-wide association studies linking clinical aspects of melioidosis cases to nonubiquitous or polymorphic B. pseudomallei genes or genomic islands are beginning to uncover specific virulence signatures. Finally, what also remains uncertain is the global phylogeography of B. pseudomallei and whether melioidosis is spreading beyond historical locations or is just being unmasked in Africa and the Americas by better recognition and increased surveillance.

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Section: Other Therapeutic Aspectsmentioning

confidence: 99%

Melioidosis: Evolving Concepts in Epidemiology, Pathogenesis, and Treatment

Currie

2015

Semin Respir Crit Care Med

284

347

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“…Although it may have a role in empirical treatment for sepsis of unknown etiology, co-amoxiclav was not determined to have a role in the intravenous treatment for suspected or confirmed melioidosis unless no other appropriate agents are available. Other antimicrobial drugs such as ertapenem ( 28 , 29 ), doripenem ( 29 ), ticarcillin/clavulanate ( 30 ), and piperacillin/tazobactam ( 31 ) have good in vitro efficacy, but their clinical use has yet to be established. Ceftriaxone has moderate in vitro activity ( 32 ), but there is some evidence that it is less effective than ceftazidime and co-amoxiclav for treating melioidosis ( 33 ).…”

Section: Review Of Current Knowledgementioning

confidence: 99%

Workshop on Treatment of and Postexposure Prophylaxis forBurkholderia pseudomalleiandB. malleiInfection, 2010

Lipsitz¹,

Garges²,

Aurigemma³

et al. 2012

Emerg. Infect. Dis.

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190

214

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The US Public Health Emergency Medical Countermeasures Enterprise convened subject matter experts at the 2010 HHS Burkholderia Workshop to develop consensus recommendations for postexposure prophylaxis against and treatment for Burkholderia pseudomallei and B. mallei infections, which cause melioidosis and glanders, respectively. Drugs recommended by consensus of the participants are ceftazidime or meropenem for initial intensive therapy, and trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid for eradication therapy. For postexposure prophylaxis, recommended drugs are trimethoprim/sulfamethoxazole or co-amoxiclav. To improve the timely diagnosis of melioidosis and glanders, further development and wide distribution of rapid diagnostic assays were also recommended. Standardized animal models and B. pseudomallei strains are needed for further development of therapeutic options. Training for laboratory technicians and physicians would facilitate better diagnosis and treatment options.

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“…Of the newer antibiotics, ertapenem, tigecycline, and moxifloxacin have limited in vitro activity against clinical isolates of B. pseudomallei, and the minimum inhibitory concentration for doripenem is similar to that for meropenem. 92 Various mechanisms of acquired antibiotic resistance have been identified, including efflux pumps, enzymatic inactivation, bacterial-cell-membrane impermeability, alterations in the antibiotic target site, and amino acid changes in penA, the gene encoding the highly conserved class A â-lactamase. 93,94 Treatment is divided into intravenous and oral phases.…”

Section: How It Is Treated?mentioning

confidence: 99%