Should tigecycline be considered for urinary tract infections? A pharmacokinetic re-evaluation

Nix, David E.; Matthias, Kathryn R.

doi:10.1093/jac/dkq116

Cited by 41 publications

(24 citation statements)

References 6 publications

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“…In this cohort, combination therapy with tigecycline was used for all three patients who developed fosfomycin resistance. The lack of a protective effect against resistance development may be due to the limited urinary excretion of tigecycline; however, this was recently challenged (3,15). An in vitro study showed that the use of combination therapy with meropenem, colistin, or gentamicin reduced the development of resistance for KPC-producing K. pneumoniae (21).…”

Section: Discussionmentioning

confidence: 99%

Experience with Fosfomycin for Treatment of Urinary Tract Infections Due to Multidrug-Resistant Organisms

Neuner

Sekeres

Hall

et al. 2012

Antimicrob Agents Chemother

175

153

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c Fosfomycin has shown promising in vitro activity against multidrug-resistant (MDR) urinary pathogens; however, clinical data are lacking. We conducted a retrospective chart review to describe the microbiological and clinical outcomes of urinary tract infections (UTIs) with MDR pathogens treated with fosfomycin tromethamine. Charts for 41 hospitalized patients with a urine culture for an MDR pathogen who received fosfomycin tromethamine from 2006 to 2010 were reviewed. Forty-one patients had 44 urinary pathogens, including 13 carbapenem-resistant Klebsiella pneumoniae (CR-Kp), 8 Pseudomonas aeruginosa, and 7 vancomycin-resistant Enterococcus faecium (VRE) isolates, 7 extended-spectrum beta-lactamase (ESBL) producers, and 9 others. In vitro fosfomycin susceptibility was 86% (median MIC, 16 g/ml; range, 0.25 to 1,024 g/ml). Patients received an average of 2.9 fosfomycin doses per treatment course. The overall microbiological cure was 59%; failure was due to either relapse (24%) or reinfection UTI (17%). Microbiological cure rates by pathogen were 46% for CR-Kp, 38% for P. aeruginosa, 71% for VRE, 57% for ESBL producers, and 100% for others. Microbiological cure (n ‫؍‬ 24) was compared to microbiological failure (n ‫؍‬ 17). There were significantly more solid organ transplant recipients in the microbiological failure group (59% versus 21%; P ‫؍‬ 0.02). None of the patients in the microbiological cure group had a ureteral stent, compared to 24% of patients within the microbiological failure group (P ‫؍‬ 0.02). Fosfomycin demonstrated in vitro activity against UTIs due to MDR pathogens. For CR-KP, there was a divergence between in vitro susceptibility (92%) and microbiological cure (46%). Multiple confounding factors may have contributed to microbiological failures, and further data regarding the use of fosfomycin for UTIs due to MDR pathogens are needed.

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Section: Discussionmentioning

confidence: 99%

Experience with Fosfomycin for Treatment of Urinary Tract Infections Due to Multidrug-Resistant Organisms

Neuner

Sekeres

Hall

et al. 2012

Antimicrob Agents Chemother

175

153

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“…The broad-spectrum parenteral glycylcycline tigecycline, a tetracycline derivative, showed potent in vitro activity against gonococci, including tetracycline-resistant strains (308,309). Worryingly, tigecycline is mostly eliminated through the bile, and a limited proportion of the given antimicrobial is excreted unchanged in the urine, which calls into question the use of tigecycline to treat urinary tract infections (310)(311)(312). Another novel and fully synthetic tetracycline analog (fluorocycline), eravacycline (TP-434), was recently shown to have a high in vitro activity against tetracycline-, penicillin-, and ciprofloxacinresistant gonococcal isolates (313).…”

Section: Future Perspectives For Treatmentmentioning

confidence: 99%

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

2014

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SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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“…Since the initial description of hypervirulent ribotype O27, there have been repeated descriptions of transfer of the strain with the inter-country patient [160,161]. A retrospective study in 2007…”

Section: Hyper Virulent Clostridium Difficilementioning

confidence: 99%

“…identified the transfer of a patient infected with the hypervirulent strain from the UK to Ireland very soon after the initial descriptions in 2005; fortunately no outbreak occurred [160]. Introduction of the strain into France in 2006, which now has sustained transmission, was speculated to be due to transfer with patients from neighbouring Belgium [162].…”

Section: Hyper Virulent Clostridium Difficilementioning

confidence: 99%

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Antimicrobial resistant Escherichia coli. Clinical, epidemiological and molecular characteristics in the Australian region

Rogers¹

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BackgroundEscherichia coli is the most common gram-negative bacteria to cause human infection. The pathological manifestations range from minor disease to severe life threatening sepsis. Urinary tract infection, most often caused by E. coli, is also the most common bacterial infection in humans. Since the inception of antimicrobial therapy in the early 20 th century, E. coli has systematically developed resistance to almost all known antimicrobials, posing a challenge for the treatment of such infections.From a global perspective, the first decade of the 21 st century heralded a change in the epidemiology and tempo of resistance amongst E. coli. Previously, resistance to third generation cephalosporins (3GC) was primarily associated with current or previous healthcare exposure. In the past decade however, expandedspectrum cephalosporin resistant E. coli (ESC-R-EC), usually mediated by Extended Spectrum betalactamase (ESBL) genes has spread widely within the communities of many regions, independent of healthcare associated acquisition.The latter half of this decade has led to the delineation of two further challenges amongst resistant E. coli.The first is the identification of Sequence Type 131 E. coli (ST131), a global 'pandemic' clone fine-tuned for resistance and virulence. This clone is now implicated in a significant proportion of community ESBL E. coli infections globally. The second challenge is the emergence of E. coli harbouring carbapenemase genes, conferring resistance to carbapenem antimicrobials used to treat severe ESBL producing E. coli infection. MethodsThrough several studies we have aimed to better define global and local aspects of antimicrobial resistant E.coli, in particular ESC-R-EC. The studies have included clinical and laboratory based research. Clinical research included a multi-centre case-control study of community onset ESC-R-EC infection inAustralia and New Zealand, and a national survey of health services' infection control practices pertaining to multi-resistant gram-negative bacilli and patients at risk of harbouring these.Laboratory research included molecular epidemiological investigation of E. coli from two sources. The first was isolates from the 182 participants in the case-control study, comprising a broad sample of community onset 3GC resistant and susceptible E. coli from Australia and New Zealand. The second was a collection of isolates from a previously conducted study on carriage of resistant E. coli in overseas travellers returning to Australia.Results 182 patients (91 cases and 91 controls) were recruited across six tertiary hospitals in Australia andNew Zealand for the case-control study. Multivariate logistic regression identified risk factors for 3GCR-EC III including birth on the Indian subcontinent (OR=11. 13, 2.17-56.98, p=0.003) being of the recently defined fimH 30 sub-clone variant. Whilst patients with ST131 were significantly more likely to have an upper rather than lower urinary tract infection (relative risk 1.8, p=0.040), they were otherwise rel...

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Should tigecycline be considered for urinary tract infections? A pharmacokinetic re-evaluation

Cited by 41 publications

References 6 publications

Experience with Fosfomycin for Treatment of Urinary Tract Infections Due to Multidrug-Resistant Organisms

Experience with Fosfomycin for Treatment of Urinary Tract Infections Due to Multidrug-Resistant Organisms

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

Antimicrobial resistant Escherichia coli. Clinical, epidemiological and molecular characteristics in the Australian region

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