Febrile neutropenia in a bone marrow transplantation unit

A total of 119 strains of coagulase-negative staphylococci isolated from clinical specimens were speciated and tested for sensitivity to methicillin and four fluoroquinolones (ciprofloxacin, sparfloxacin, levofloxacin and ofloxacin). Resistance to fluoroquinolones was significantly more common in Staphylococcus haemolyticus (43%) than in Staphylococcus epidermidis (11%). Methicillin-resistant strains of S. haemolyticus were more often resistant to ciprofloxacin than were methicillin-resistant strains of S. epidermidis (P < 0.05). Sparfloxacin was the most active against fluoroquinolone-sensitive strains, and levofloxacin was twice as active as ofloxacin. There was cross-resistance between the four fluoroquinolones. Levofloxacin was the most active against resistant strains, but MICs obtained for all the compounds seemed to be outside the clinically useful range for the treatment of systemic infections.     

国产甲磺酸左氧氟沙星体外抗菌活性研究

测定国产甲磺酸左氧氟沙星体外抗菌活性,并与进口左氧氟沙星作比较,以临床常用的氧氟沙星和环丙沙星为对照。结果表明,国产甲磺酸左氧氟沙星与进口左氧氟沙星体外抗菌活性无差异。甲磺酸左氧氟沙星抗菌谱广抗菌活性强,对革兰氏阴性肠道杆菌、肺炎克雷伯氏菌、肠杆菌属细菌、变形杆菌及嗜血杆菌和不动杆菌ＭＩＣ５０值是氧氟沙星的１／２,与环丙沙星一致,分别为＜０．０３、＜０．０３、＜０．０３、０．１２５和０．０３ｍｇ／Ｌ;它对大肠埃希氏菌、金葡球菌、肺炎链球菌、肠球菌、厌氧菌的ＭＩＣ５０值是氧氟沙星和环丙沙星的１／２～１／４;对铜绿假单胞菌ＭＩＣ５０为１ｍｇ／Ｌ,是氧氟沙星的１／２,但稍高于环丙沙星。该产品体外抗菌活性受细菌接种量、血清含量和ｐＨ值影响不明显。研究还表明该产品为一杀菌剂,对临床常见致病菌如大肠埃希氏菌、肺炎克雷伯氏菌、变形杆菌、铜绿假单胞菌、不动杆菌、葡萄球菌、肠球菌、肺炎链球菌、厌氧菌均有良好的杀菌作用。     

Antibiotic susceptibility of staphylococcal isolates from patients with vascular catheter-related bacteremia: potential role of the combination of minocycline and rifampin

The antimicrobial susceptibility to ten antibiotics of 197 staphylococcal isolates recovered over a 10-year period from patients with vascular catheter-related bacteremia was examined. Isolated organisms induced methicillin-sensitive Staphylococcus aureus (95 isolates), methicillin-resistant S. aureus (42 isolates) and methicillin-resistant S. epidermidis (60 isolates). A microtiter assay was used to determine the MIC and MBC of individual antibiotics and to conduct time-kill studies of certain drug combinations. The activity of clidamycin, cefamandole and oxacillin was generally restricted to methicillin-sensitive organisms, whereas daptomycin, novobiocin, teicoplanin and vancomycin exhibited bactericidal activity against all tested staphylococcal species. Bacterial resistance to ciprofloxacin was detected among the more recent isolates of methicillin-resistant staphylococci. Minocycline and rifampin demonstrated bacteriostatic and bactericidal activity, respectively, against all groups of organisms. The interaction of rifampin with minocycline, vancomycin, or novobiocin was generally indifferent. The results of this study support the ongoing efforts for evaluation of the antimicrobial efficacy of vascular catheters coated with the combination of minocycline and rifampin.     

Synthesis and in vitro antibacterial activity of 7-(4-alkoxyimino-3-methyl-3-methylaminopiperidin-1-yl)quinolones

To explore new agents of quinolone derivatives with high antibacterial activity, 7-(4-alkoxyimino-3-methyl-3-methylaminopiperidin-1-yl)quinolones were designed and synthesized, and their activity against gram-positive and gram-negative strains was tested in vitro. Sixteen target compounds were obtained. Their structures were established by 1H NMR, HRMS and X-ray crystallographic analysis. Compounds 14k and 14m-14o show good antibacterial activity against the tested five gram-positive strains and five gram-negative strains (MIC: 0.25-16 micromg x mL(-1)), of which the most active compound 14o is 8-fold more potent than levofloxacin against S. pneumoniae (MIC: 4 microg x mL(-1)), and comparable to levofloxacin against S. aureus, S. epidermidis, E. faecalis and E. coli (MIC: 0.25-1 microg x mL(-1)), but generally less potent than gemifloxacin.     

The fluoroquinolones exert a reduced rate of kill against Enterococcus faecalis.

The bactericidal activities of ciprofloxacin, ofloxacin and DR-3355 have been investigated against Enterococcus faecalis, Staphylococcus aureus and Staphylococcus epidermidis over 24 h. The three fluoroquinolones were found to be rapidly bactericidal against the staphylococci, killing over 99% of the bacteria during the first 3 h of exposure with a further reduction in viability of approximately one logarithm occurring over the next 21 h. In contrast, the fluoroquinolones displayed a much slower rate of kill against E. faecalis, as little or no bactericidal activity was detected over the first 3 h for both E. faecalis ATCC19433 and a clinical isolate. At 6 h all three of the drugs were bactericidal against the enterococci although the amount of kill was not as great as against the staphylococci. However, at 24 h the amount of kill obtained with all three drugs was similar to that obtained for staphylococci exposed to these drugs. Ciprofloxacin, ofloxacin and DR-3355 were not active against E. faecalis ATCC19433 in phosphate buffered saline and therefore require cell division for their bactericidal activity against this species.     

Activity of gatifloxacin against strains resistant to ofloxacin and ciprofloxacin and its ability to select for less susceptible bacterial variants.

Gatifloxacin is an 8-methoxy fluoroquinolone. On quinolones, this side chain imparts increased activity against Gram-positive bacteria and enhanced killing. Gatifloxacin was tested against ofloxacin non-susceptible (ofloxacin MIC>2 mg/l) strains of Streptococcus pneumoniae (gatifloxacin MIC(90), 1 mg/l) and methicillin-resistant Staphylococcus aureus (MRSA, gatifloxacin MIC(90), 4 mg/l), and to ciprofloxacin non-susceptible (ciprofloxacin MIC>1 mg/l) strains of Escherichia coli (gatifloxacin MIC(90),>16 mg/l) and ciprofloxacin non-susceptible (ciprofloxacin MIC>0.06 mg/l) Neisseria gonorrhoeae (gatifloxacin MIC(50), 0.12 mg/l and MIC(90), 0.5 mg/l). Though gatifloxacin showed some reduced susceptibility to these populations, the MIC(50) and MIC(90) values suggest that gatifloxacin may be useful against pneumococci and some gonococcal strains not susceptible to other fluoroquinolones. Gatifloxacin did not select for less susceptible variants of MRSA and pneumococci, in contrast to the 10- to 100-fold higher selection frequencies with ciprofloxacin and ofloxacin. The single-step E. coli mutants selected by gatifloxacin and the comparator quinolones had quinolone MICs within the susceptible range. These data suggest that gatifloxacin use may hinder the development of quinolone-resistance, particularly in Gram-positive bacteria.     

Synthesis and in-vitro antibacterial activity of 7-(3-aminopyrrolo[3,4-c]pyrazol-5(2H,4H,6H)-yl)-6-fluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid derivatives

A series of novel 7-(3-aminopyrrolo[3,4-c]pyrazol-5(2H,4H,6H)-yl)-6-fluoro-4-oxo-1,4-dihydroquinoline-3-carboxylic acid derivatives was designed, synthesized and characterized by (1)H-NMR, MS and HRMS. These fluoroquinolones were evaluated for their in-vitro antibacterial activity against representative Gram-positive and Gram-negative strains. Generally, all of the target compounds display rather weak potency against the tested Gram-negative strains, but most of them exhibit good potency in inhibiting the growth of S. aureus including methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis including methicillin-resistant S. epidermidis (MRSE) (MIC: 0.125-8 μg/mL). In particular, the compound 9g is 2 to 32 fold more potent than gemifloxacin (GM), moxifloxacin (MX), gatifloxacin (GT), and levofloxacin (LV) against S. pneumoniae 08-3, K. pneumoniae 09-23, and P. aeruginosa ATCC27853, 4 to 32 fold more potent than MX, GM, and LV against K. pneumoniae 09-21, and more active than or comparable to the four reference drugs against P. aeruginosa 09-32.     

Multicentre study of the in vitro evaluation of moxifloxacin and other quinolones against community acquired respiratory pathogens.

The in vitro activity of moxifloxacin was compared with that of ciprofloxacin, levofloxacin, ofloxacin and trovafloxacin against 710 strains (180 Streptococcus pneumoniae, 180 Haemophilus influenzae, 160 Moraxella catarrhalis and 190 Streptococcus pyogenes) isolated from patients with community-acquired respiratory tract infections. MIC values for moxifloxacin, trovafloxacin were 0.25/0.25, 0.03/0.03, 0.06/0.03 and 0.125/0.0125 mg/l for S. pneumoniae, H. influenzae, M. catharralis and S. pyogenes. Based upon the MIC(90) values and the MIC distributions, moxifloxacin and trovafloxacin were the most active of the quinolones tested. They showed enhanced activity against Gram-positive organisms including penicillin non susceptible S. pneumoniae strains. Moxifloxacin was also highly active against ciprofloxacin-resistant S. pneumoniae strains.     

Comparative activities of six different fluoroquinolones against 9,682 clinical bacterial isolates from 20 European university hospitals participating in the European SENTRY surveillance programme

The in-vitro activities of gatifloxacin, trovafloxacin, levofloxacin, sparfloxacin, ofloxacin, and ciprofloxacin were tested against 9,682 clinical bacterial isolates from 20 European university hospitals participating in the European SENTRY surveillance programme. Gatifloxacin and trovafloxacin exhibited the highest activities against Gram-positive cocci, while levofloxacin, ofloxacin, ciprofloxacin, and gatifloxacin were the most active against Enterobacteriaceae. Ciprofloxacin and levofloxacin showed the highest antimicrobial activities against Pseudomonas spp., while gatifloxacin and trovafloxacin were the most active against Acinetobacter spp. and Stenotrophomonas maltophilia. All Haemophilus spp. and Moraxella catarrhalis isolates were fully susceptible to all quinolones tested. Overall, the new quinolones, showed improved activity against Gram-positive cocci and Gram-negative non-fermenters while retaining their broad-spectrum activity against Gram-negative bacilli.     

7-[3-氨甲基-4-(脲亚氨基)吡咯烷-1-基]喹诺酮衍生物的合成与抗菌作用研究

目的 寻找新的喹诺酮类抗菌药.方法 设计合成7-位具有较强亲水性取代基的7个氟喹诺酮衍生物,测定其体外抗菌活性.结果 化合物10对金葡菌(包括MRSA)和表葡菌(包括MRSE)的活性(MIC:0.06～4μg/mL)与左氧氟沙星和吉米沙星基本相当.化合物11对肺炎链球菌08-2的活性(MIC:0.25μg/mL)分别是左氧氟沙星和吉米沙星的128倍和32倍,化合物12对肺炎克雷伯菌09-22和09-23的活性(MIC:1μg/mL)分别是左氧氟沙星和吉米沙星的16倍和4倍,但目标物对革兰阴性菌的活性普遍弱于对照药.结论 7-位取代基的水溶性并非决定喹诺酮抗菌活性的主要因素.     

The bactericidal activity of levofloxacin against ampicillin-resistant and ampicillin-susceptible Haemophilus influenzae in comparison with ofloxacin, ciprofloxacin and sparfloxacin

The bactericidal activity of levofloxacin against four Haemophilus influenzae clinical isolates (two ampicillin-resistant and two susceptible) was compared with that of ofloxacin, ciprofloxacin and sparfloxacin at concentrations simulating the peak serum concentrations obtained with the recommended oral doses. Bactericidal activity was assessed using time-kill curves and minimum kill-time values. Both concentrations of levofloxacin rapidly killed all the study strains, with mean kill times of 4 h and no viable bacteria remaining after 18-h exposure. The bactericidal activities of levofloxacin, ofloxacin and sparfloxacin were similar. The minimum kill-times for both concentrations of ciprofloxacin were 28-35% longer than those of levofloxacin. These results support the use of levofloxacin for H. influenzae infections, including ampicillin-resistant strains.     

In vitro short-term bactericidal activity and accumulation of NM394, the active metabolite of prulifloxacin,for Staphylococcus aureus,Escherichia coli and Pseudomonas aeruginosa: comparison with ciprofloxacin,levofloxacin, and gatifloxacin

The in vitro short-term bactericidal activity and accumulation of NM394, the active metabolite of prulifloxacin, was compared with those of ciprofloxacin (CPFX), levofloxacin (LVFX) and gatifloxacin (GFLX), using Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Of the 4 fluoroquinolones examined, NM394 accumulated to the highest concentration in all three strains. The order of concentration of the fluoroquinolones accumurated in S. aureus 209P JC-1, E. coli NIHJ JC-2 and P. aeruginosa PAO1 were NM394 > CPFX > GFLX > or = LVFX. The accumulation of fluoroquinolones into bacterial cells correlated with their MICs of the drugs for E. coli and P. aeruginosa, whereas there was no correlation between the accumulation and MICs of the drugs for S. aureus. We also studied the reduction of viable cells after addition of each fluoroquinolones to clarify relationship between the short-term bactericidal activity and the accumulation of the quinolones. The short-term bactericidal activity of NM394 against S. aureus 209P JC-1, E. coli NIHJ JC-2 and P. aeruginosa PAO1 were stronger than those of CPFX, LVFX and GFLX when compared at the same concentration. In conclusion, the strong short-term bactericidal activity of NM394 may be attributed to its high accumulation in bacterial cells.     

3,4,5,3',5'-Pentabromo-2-(2'-hydroxybenzoyl)pyrrole: a potential lead compound as anti-Gram-positive and anti-biofilm agent

The activity against Gram-positive bacteria of 3,4,5,3',5'-pentabromo-2-(2'-hydroxybenzoyl)pyrrole I, a synthetic anti-bacterial compound related to pyrrolomycins, was tested in vitro using seven reference bacterial strains and Staphylococcus epidermidis and Staphylococcus aureus preformed biofilms. Compound I was active against all strains tested, with minimum inhibitory concentration (MIC) values ranging from 0.002 to 0.097 mg/l and minimum bactericidal concentrations (MBCs) from 0.37 to 12.5 mg/l. Compound I was also active at low concentrations against preformed S. epidermidis and S. aureus biofilms.     

Section Review Anti-infectives: The future role of quinolones

Quinolones, such as ciprofloxacin and ofloxacin, have gained wide acceptance for the treatment of bacterial infections of the respiratory tract, urinary tract, skin and soft tissues, as well as sexually transmitted diseases. Good pharmacokinetic profiles and potent activities against a wide range of Gram-negative and Gram-positive pathogens result in the use of these antibacterials in both hospital and community settings. Although recently developed clinical quinolones dominate in the chemotherapy of various bacterial infections, their use is restricted by limited activities against a number of clinically-important Gram-positive bacteria such as Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and enterococci. Ciprofloxacin, the market leader, also has low potency against anaerobes. Bacterial resistance (such as in Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus) to ciprofloxacin is increasing rapidly. Many quinolone compounds are being synthesised to address these drawbacks. The new quinolones currently under development are characterised by enhanced activities against streptococci, staphylococci, enterococci and anaerobes. Although the treatment of traditional bacterial infections is at present the focus of quinolone research, the future role of quinolones will extend current applications to include new indications of bacterial infections and other non-bacterial diseases. This review will concentrate on the more recently developed quinolones which possess significantly more therapeutic value than existing quinolones, and will provide information on those compounds under commercial development with major therapeutic potential. Recent developments in research into the identification of quinolones for the treatment of tuberculous, cancer, viral, fungal infections and parasitic diseases will also be discussed.     

Selection of resistant variants of respiratory pathogens by quinolones.

Quinolones are widely used in the treatment of respiratory tract infections. However, some disquiet has been expressed over using quinolones for community-acquired pneumonia since their activity is generally rather poor against Streptococcus pneumoniae. In addition, it is known that resistant variants emerge at a fairly high frequency during exposure of Enterobacteriaceae to quinolones; if this also occurred during quinolone treatment of community-acquired pneumonia it could lead to an increased risk of clinical failure. We therefore determined the selection rate of quinolone-resistant variants for six strains of S. pneumoniae, Haemophilus influenzae and Moraxella catarrhalis with nalidixic acid (except for S. pneumoniae), ciprofloxacin, ofloxacin and levofloxacin. We were only able to select resistant variants at low frequency from two of the six strains of S. pneumoniae with ciprofloxacin: no resistant variants were selected by either ofloxacin or levofloxacin. Variants of H. influenzae and M. catarrhalis with decreased susceptibility to quinolones were produced both with more strains and with a greater frequency; however, these variants still remained susceptible according to the NCCLS guidelines. Our study suggests that resistant variants of S. pneumoniae are relatively unlikely to occur in individuals treated with fluoroquinolones especially if they are given quinolones with enhanced anti-gram-positive activity compared to ciprofloxacin.     

Emergence of phenotypic resistance to ciprofloxacin and levofloxacin in methicillin-resistant and methicillin-sensitive Staphylococcus aureus strains

The emergence of phenotypic resistance to ciprofloxacin and levofloxacin in methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MRSA) strains was studied. Twenty MRSA and 77 methicillin-sensitive S.aureus (MSSA) strains susceptible to both quinolones were investigated for resistance after single step or serial passages. No growth of 20 MRSA strains was observed at 4xMIC of levofloxacin after 48 h incubation, but 4 of 77 (5%) MSSA strains grew at the same concentration. At 4xMIC concentration of ciprofloxacin, 10 MSSA (13%) and five MRSA (25%) strains were grown. In the serial passages of MRSA strains, resistance to ciprofloxacin was 75 and 5% for levofloxacin by the third passage. In the seventh passage this resistance was 100 and 15%, respectively. In MSSA strains, resistance to ciprofloxacin was 75 and 19% to levofloxacin at the third passage and at the seventh passage, 100 and 61%, respectively. Emergence of ciprofloxacin resistance was more common and developed more rapidly than resistance to levofloxacin in both MRSA and MSSA strains.     

In vitro susceptibility of 4903 bacterial isolates to gemifloxacin--an advanced fluoroquinolone

The in vitro activity of gemifloxacin against over 4900 bacterial isolates was determined by microbroth dilution with interpretation in accordance with NCCLS guidelines. Susceptibility results were compared with those for ciprofloxacin, gatifloxacin, levofloxacin and moxifloxacin. Gemifloxacin and the other fluoroquinolones were not affected by either beta-lactamase production or penicillin-resistance in Streptococcus pneumoniae. The MIC90 values for gemifloxacin were: S. pneumoniae 0.063 mg/l; Haemophilus influenzae 0.016 mg/l; Moraxella catarrhalis 0.008 mg/l, methicillin-susceptible Staphylococcus aureus 0.063 mg/l; methicillin-susceptible Streptococcus pyogenes 0.031 mg/l; Enterobacteriaceae 0.031-0.16 mg/l; Pseudomonas aeruginosa 4 mg/l; Neisseria meningitidis 0.008 mg/l. The MIC90 for gemifloxacin was lower than those for the other quinolones tested against S. pneumoniae (ciprofloxacin 2-4 mg/l, gatifloxacin 0.5 mg/l, levofloxacin 1-2 mg/l, moxifloxacin 0.25 mg/l). This study confirms the enhanced potent activity of gemifloxacin against Gram-positive pathogens, its broad-spectrum, Gram-negative activity and indicates that gemifloxacin is likely to have an important role in treating patients with Gram-positive and/or Gram-negative infections.     

Susceptibility in vitro of gram-positive aerobe and anaerobe bacteria to ofloxacin

Ofloxacin is a new fluoroquinolone derivative active against Gram-positive and Gram-negative bacteria including obligate anaerobes. In this study the in vitro activity of ofloxacin was evaluated against 325 Gram-positive organisms freshly isolated from clinical specimens, in comparison with that of ampicillin, erythromycin, clindamycin and ceftazidime. Susceptibility tests indicated that the MIC90 was 2 mg/l (range 0.25-2) against both methicillin-susceptible (MS) and methicillin-resistant (MR) Staphylococcus aureus. A value of 2 mg/l (range 0.5-4) was also found for all other staphylococci. The MIC of ofloxacin was 8 mg/l for 90% of Streptococcus faecalis (range 1-16), Str. faecium (range 2-8) and members of JK group (range 0.5-16). Propionibacterium acnes strains were all inhibited by 2 mg/l and 90% of Clostridia spp. (range 2-16) by 8 mg/l. Ofloxacin activity compared favourably with that of ampicillin, erythromycin, clindamycin and ceftazidime determined on the same isolates. MBC and time-kill studies indicated that this compound is rapidly bactericidal against enterococci. The great intrinsic activity against MS and MR staphylococci, refractory enterococci and JK bacteria may make ofloxacin a useful adjunct to the therapeutic arsenal.     

替考拉宁对葡萄球菌的体外抗菌活性研究

目的 :测定替考拉宁对葡萄球菌的体外抗菌活性。方法 :采用琼脂二倍稀释法测定替考拉宁对 492株葡萄球菌的最低抑菌浓度 (MIC) ,其中金黄色葡萄球菌 3 2 4株 ,表皮葡萄球菌 1 68株。结果 :替考拉宁对葡萄球菌的MIC90 值均为 1mg·L-1,明显低于氧氟沙星、红霉素和苯唑西林 ,与万古霉素相当 ;替考拉宁对甲氧西林耐药金黄色葡萄球菌 (MR SA)和对甲氧西林耐药表皮葡萄球菌 (MRSE)的MIC90 分别为 4mg·L-1和 2mg·L-1,是万古霉素的1 / 2。抗菌活性明显高于氧氟沙星和红霉素。结论 :替考拉宁对葡萄球菌的体外抗菌活性是万古霉素的 2倍 ,明显强于氧氟沙星和红霉素     

In vitro activity of four fluoroquinolones against Mycobacterium tuberculosis

The in vitro activity of ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin against strains of Mycobacterium tuberculosis was studied. Moxifloxacin and levofloxacin showed the greatest activity having an MIC(90) of 1 mg/l. The MIC(90) for ofloxacin was 2 mg/l and for ciprofloxacin 4 mg/l. Further studies should be made to determine the role played by these compounds in the treatment of tuberculosis.