Comparison of teicoplanin and vancomycin in vitro activity on clinical isolates of Staphylococcus aureus

Abstract

Ninety-one clinical isolates of Staphylococcus aureus have been tested with the Kirby Bauer and the Etest® method to determine the susceptibility to glycopeptides in the 2007–2010 period. Five strains (5·5%) were resistant to vancomycin and nine (9·9%) to teicoplanin. Teicoplanin showed a median minimal inhibitory concentration (MIC) of 1 mg/l (range 0·125–24 mg/l), an MIC50 of 1 mg/l, and an MIC90 of 2 mg/l; vancomycin had a median MIC of 1·5 mg/l (range 0·38–4 mg/l), an MIC50 of 1·5 mg/l, and an MIC90 of 2 mg/l. More isolates were distributed on higher values of MIC for vancomycin. Inhibition halos induced by vancomycin-impregnated paper diskettes were slightly larger than those by teicoplanin. Glycopeptide resistance among methicillin-resistant Staphylococcus aureus in Italy is an underestimated phenomenon, possibly due to the described underestimation of glycopeptides MICs by the automatic broth microdilution method, when compared to agar MIC assays. A teicoplanin MIC creep, as reported for vancomycin, cannot be assumed.     

The current role of glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in not neutropenic adults: the viewpoint of a group of Italian experts

Staphylococcus aureus is still an important problem in clinical and therapeutic area, worldwide. In Italy, in recent years, methicillin resistance remained stable, yet considerably high, the percentage of strains of MRSA being around 40%. It was deemed interesting and timely to carry out a consensus conference using the RAND/UCLA method to collect the opinion of a group of experts in infectious diseases on the role of glycopeptides in the management of MRSA infections within several clinical scenarios and namely in pneumonia, bacteremia and endocarditis, joint replacement infections, skin and soft tissue infections, diabetic foot, abdominal infections and central nervous system infections. The scenarios proposed by the Scientific Committee have been validated by a group of experts in infectious diseases and then voted in three meetings of infectious disease specialists. The results obtained on each individual condition were analyzed and therapeutic recommendations on each of these were released.     

Determining the prevalence of SCCmec polymorphism,virulence and antibiotic resistance genes among methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from selected hospitals in west of Iran

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important pathogens worldwide and compared to other staphylococcal species that are associated with higher mortality rate. A total of 500 Staphylococcus spp. was collected from selected hospitals in Ilam, Kermanshah, Khorram Abad and Hamadan cities and, via phenotypic and genotypic methods, was assessed to find MRSA. The presence or absence of prevalent antibiotic resistance genes and virulence genes was evaluated among MRSA isolates, using polymerase chain reaction (PCR) method, and then the SCCmec typing of these isolates was assayed by multiplex PCR. A total of 372 (74.4%) Stapylococcus spp. isolates were identified as S. aureus, among which 200 (53.8%) possessed the mecA gene and were distinguished as MRSA. All of MRSA isolates contained blaZ gene. The frequency of ermA and ermC genes among erythromycin-resistant MRSA isolates was 21.6% and 66.7%, respectively. The frequency of the virulence genes eta, hla and sea among MRSA isolates was 10%, 80.5% and 100%, respectively. SCCmec type IV accounted for 30.6% of the MRSA isolates and SCCmec type III, SCCmec type II and SCCmec type I accounted for 30%, 22% and 17.5% of the isolates, respectively. The antibiotic resistance genes and the virulence genes of blaZ, hla, sea, eta and ermC had high frequencies among the MRSA isolates. This study showed that the antibiotic resistance genes had higher frequencies among SCCmec types I and IV, which confirms the previous reports in this field.     

DVD方案与VAD方案治疗伴肾功能不全的初治多发性骨髓瘤疗效比较

 目的　探讨DVD方案与VAD方案治疗初治伴肾功能不全的多发性骨髓瘤（MM）的疗效和不良反应。方法　15例初治的肾功能不全MM患者采用DVD方案（盐酸多柔比星脂质体40 mg静脉滴注,第1天;长春新碱2.0 mg静脉注射,第1天;地塞米松40 mg／d静脉滴注,第1天至第4天;28 d为1个疗程）;19例初治肾功能不全的MM患者采用VAD方案（多柔比星10 mg／d静脉滴注,第1天至第4天;长春新碱0.5 mg／d静脉滴注,第1天至第4天;地塞米松40 mg／d静脉滴注,第1天至第4天、第9天至第12天、第17天至第20天; 28 d为1个疗程）,通过检测患者肾功能恢复情况及临床随访生存时间,评价两种方案的疗效。结果　患者对DVD方案和VAD方案的总体有效（OR）率相似[分别为80.0 %（12／15）、78.9 %（15／19）,χ2＝0.01,P＞0.05];但是和VAD组比较,DVD组能够迅速降低肌酐水平,且远期疗效DVD组更有优势。结论　DVD方案和传统的VAD方案的对初治伴肾功能不全MM的患者疗效及不良反应类似,但DVD方案能够更迅速的缓解病情。     

In vitro activity of ceftaroline and ceftobiprole against methicillin-resistant Staphylococcus aureus with decreased susceptibility to vancomycin isolated in paediatric patients

Minimal inhibitory concentrations (MIC, mg/l) of ceftaroline and ceftobiprole were evaluated over 70 methicillin-resistant Staphylococcus aureus (MRSA) strains with vancomycin MIC ≥1 isolated in a paediatric hospital. The proportion of non-wild-type strains (MIC?>?epidemiological cut off) was 18% for ceftobiprole and 64% for ceftaroline. Only 1.4% of strains was resistant to ceftobiprole, and none to ceftaroline. These results are worrisome, since show the presence of non-negligible proportions of MRSA strains with high MIC values for ceftaroline and ceftobiprole in a setting where both drugs were never used.     

Carboxypeptidase G2 rescue in patients with methotrexate intoxication and renal failure

The methotrexate (MTX) rescue agent carboxypeptidase G2 (CPDG2) rapidly hydrolyses MTX to the inactive metabolite DAMPA (4-[[2,4-diamino-6-(pteridinyl)methyl]-methylamino]-benzoic acid) and glutamate in patients with MTX-induced renal failure and delayed MTX excretion. DAMPA is thought to be an inactive metabolite of MTX because it is not an effective inhibitor of the MTX target enzyme dihydrofolate reductase. DAMPA is eliminated more rapidly than MTX in these patients, which suggests a nonrenal route of elimination. In a phase II study (May 1997-March 2002), CPDG2 was administered intravenously to 82 patients at a median dose of 50 U kg(-1) (range 33-60 U kg(-1)). Eligible patients for this study had serum MTX concentrations of >10 microM at 36 h or >5 microM at 42 h after start of MTX infusion and documented renal failure (serum creatinine > or =1.5 times the upper limit of normal). Immediately before CPDG2 administration, a median MTX serum level of 11.93 microM (range 0.52-901 microM) was documented. Carboxypeptidase G2 was given at a median of 52 h (range 25-178 h) following the start of an MTX infusion of 1-12 g m(-2) 4-36 h(-1) and resulted in a rapid 97% (range 73-99%) reduction of the MTX serum level. Toxicity related to CPDG2 was not observed. Toxicity related to MTX was documented in about half the patients; four patients died despite CPDG2 administration due to severe myelosuppression and septic complications. In conclusion, administration of CPDG2 is a well-tolerated, safe and a very effective way of MTX elimination in delayed excretion due to renal failure.     

Postoperative acute renal failure in patients with gynecologic malignancies: analysis of 10 cases and review of the literature

Objective

Postoperative acute renal failure (PO-ARF) is an important cause of mortality among surgical patients. Although there have been many reports on PO-ARF after cardiac surgery and liver transplantation, less is known about the risk of PO-ARF after gynecologic operations. We aimed to investigate the risk of PO-ARF on gynecologic malignancy operations.

Methods

1,155 patients'' medical charts were reviewed who underwent therapeutic surgery for gynecologic malignancies from January 1, 2005 to December 31, 2007, at the Asan Medical Center, Seoul, Korea.

Results

Of these, 10 patients, comprising 0.89% of those who underwent radical hysterectomies and 0.86% of those who underwent debulking operations, were diagnosed with PO-ARF. Their mean age was 61.9±10.1 years. Five patients had preoperative risk factors. Mean operating time was 360.8±96.2 minutes. Five patients experienced intra-operative hypotension and all patients were given blood transfusions during surgery. Eight patients underwent hemodialysis, with two continuing on dialysis to date. Only two patients fully recovered.

Conclusion

Patients undergoing surgery for gynecologic malignancies may be at high risk for PO-ARF, because of old age, long operation times, and profuse bleeding. It is necessary to monitor these patients for postoperative renal function and urine output. If a postoperative oliguric state is detected, aggressive volume expansion should be started immediately, followed by hemodialysis.     

芬太尼透皮贴剂用于肝肾功能受损伴腹腔积液晚期癌痛患者的临床分析

 目的　观察芬太尼透皮贴剂对肝肾功能受损伴腹腔积液的晚期癌症患者中重度疼痛的镇痛效果、安全性、不良反应及生活质量的改善情况。方法　将晚期癌症伴肝肾功能受损的慢性持续性中重度疼痛患者98例按随机数字表法分为两组,56例使用芬太尼透皮贴剂的患者（简称芬太尼组）为试验组,以42例使用硫酸吗啡控释片（商品名：美施康定）的患者（简称吗啡组）为对照组,记录治疗前后疼痛强度、肝肾功能变化指标、不良反应、生活质量等变化情况。结果　两组患者治疗前后止痛效果满意,差异无统计学意义（χ2值分别为0.01、0.07、0.01、0.04,均P＞0.05）;两组不良反应便秘、排尿困难差异有统计学意义（χ2值分别为7.32、3.96,均P＜0.05）,嗜睡、头晕、恶心、呕吐等差异无统计学意义（χ2值分别为0.12、0.54、0.54、0.02,均P＞0.05）,经对症治疗处理大部分不良反应均可缓解或消失;芬太尼组治疗前后肌酐（Scr）、肌酐清除率（Ccr）、丙氨酸氨基转移酶（ALT）、天冬氨酸转移酶（AST）差异无统计学意义（t值分别为1.43、1.67、0.91、0.11,均P＞0.05）,而吗啡组差异有统计学意义（t值分别为17.59、49.17、42.12、36.23,均P＜0.05）;两组患者食欲、精神、睡眠、疲乏、日常生活、面部表情指标较治疗前有改善（吗啡组t值分别为3.37、4.40、2.07、5.66、4.48,均P＜0.05;芬太尼组t值分别为2.03、2.27、3.59、4.16、2.79,均P＜0.05）,芬太尼组精神状况改善较明显（t＝2.93,P＜0.05）。结论　芬太尼透皮贴剂与硫酸吗啡控释片对肝肾功能受损伴癌性腹腔积液中重度癌痛患者的止痛效果相近,止痛效果较好,芬太尼透皮贴剂不良反应较硫酸吗啡控释片轻;对肝肾功能影响小,能明显改善患者的生活质量。     

Predictors,utilization patterns,and overall survival of patients undergoing metastasectomy for metastatic renal cell carcinoma in the era of targeted therapy

Introduction

Metastasectomy (MSX) is considered a treatment option in patients with metastatic renal cell carcinoma (mRCC) at diagnosis, but its role in the targeted therapy era is unclear. We sought to describe the utilization trends of MSX and survival outcomes in a large US cohort.

Results and patterns of failure in patients treated with adjuvant combined chemoradiation therapy for resected pancreatic adenocarcinoma

BACKGROUND:

Although adjuvant chemoradiation is used commonly in the United States for the treatment of resected pancreatic cancer, there is no consensus on the benefit of this therapy, because the results from randomized trials are conflicting. The authors of this report reviewed their experience in a consecutive, unselected series of patients who received adjuvant 5‐fluorouracil (5‐FU) and radiation therapy (RT) for resected pancreatic adenocarcinoma.

METHODS:

Eighty‐six patients with resected pancreatic adenocarcinoma who received adjuvant therapy from 1998 to 2005 were identified, and their medical records were reviewed. Ninety‐three percent of patients were treated with external beam RT to ≥50.4 grays, and 91% of patients received concurrent 5‐FU by continuous infusion. Forty‐five percent of patients went on to receive adjuvant gemcitabine.

RESULTS:

The median follow‐up was 31 months (range, 21‐62 months) among the 20 patients who remained alive. Less than half of patients had positive (33%) or close (<1 mm; 15%) resection margins, 81% of tumors were classified as T3, and 66% of patients had involved lymph nodes. The median overall survival (OS) for all patients was 22 months. Negative lymph node status (P = .016) was a significant prognostic factor for improved OS, whereas treatment with gemcitabine trended toward improved OS (P = .080). The median disease‐free survival (DFS) for all patients was 10 months: Treatment with gemcitabine (P = .044) and the receipt of any chemotherapy (P = .047) were significant predictors of DFS. Seventy‐five patients (87%) had disease recurrence, and the majority recurred with peritoneal metastases (55%) or liver metastases (53%). Patients who had negative lymph nodes trended toward a lower rate of distant failure (P = .060).

CONCLUSIONS:

The median survival of the current cohort was greater than that of the chemoradiation arms of European Organization for Research and Treatment of Cancer trials and European Study Group for Pancreatic Cancer 1 trials and was comparable to the survival observed on the Gastrointestinal Tumor Study Group chemoradiation arm. Lymph node status and treatment with adjuvant chemotherapy were significant predictors of OS and DFS, respectively. Future survival improvements should be directed at reducing peritoneal and liver metastases. Further randomized trials will be required to define the role of adjuvant therapy for pancreatic adenocarcinoma. Cancer 2009. © 2009 American Cancer Society.     

Oncological outcomes in patients undergoing radical nephrectomy and vena cava thrombectomy for renal cell carcinoma with venous extension: A single-centre experience

Objective

To report on the effectiveness of the surgical management of renal cell carcinoma (RCC) in patients with a neoplastic thrombus of the vena cava.

Patients and methods

We examined pre- and post-operative clinical data for all patients who had received a nephrectomy for the management of RCC with a neoplastic thrombus of the vena cava between spanning 10 years. The procedure depended on the exact location and size of the thrombus according to the Mayo Clinic and the 2009 TNM classifications.

Results

A total of 32 patients underwent surgery. Eight of these patients had stage I, nine had stage II, six had stage III and nine had stage IV thrombi according to the Mayo Clinic staging, and twenty were T3b, eight were T3c and four were T4 according to the 2009 TNM classifications. An open abdominal approach was performed in patients with stage I and II thrombi, whereas five of the stage III patients and all of the stage IV patients required combined sternotomies. Five patients whose thrombi extended to the right atrium were treated with a cardiac bypass. The complication rate was 53% and the peri-operative mortality rate was 12.5%. The median follow-up interval was 64 months. The overall and cancer-specific five-year survival rates for all stages combined were 47% and 52%, respectively.

Conclusion

Surgical resection remains the first-line treatment for patients with RCC infiltrating the vena cava, but surgical morbidity is prevalent and survival is poor.     

Adjuvant 5-flurouracil,alpha-interferon and interleukin-2 versus observation in patients at high risk of recurrence after nephrectomy for renal cell carcinoma: Results of a Phase III randomised European Organisation for Research and Treatment of Cancer (Genito-Urinary Cancers Group)/National Cancer Research Institute trial

BackgroundThe purpose of this trial was to compare adjuvant 5-flurouracil, alpha-interferon and interleukin-2 to observation in patients at high risk of recurrence after nephrectomy for renal cell carcinoma (RCC) in terms of disease free survival, overall survival and quality of life (QoL).Patients and MethodsPatients 8 weeks post nephrectomy for RCC, without macroscopic residual disease, with stage T3b–c,T4 or any pT and pN1 or pN2 or positive microscopic margins or microscopic vascular invasion, and no metastases were randomised to receive adjuvant treatment or observation. QoL was assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-30 (QLQC-30). Treatment delivery and toxicity were monitored. The trial was designed to detect an increase in 3 year disease free survival (DFS) from 50% on observation to 65% on treatment (hazard ratio (HR) = 0.63) with 90% power and two-sided alpha = 0.05.ResultsFrom 1998 to 2007, 309 patients were randomised (155 to observation; 154 to treatment). 35% did not complete the treatment, primarily due to toxicity (92% of patients experienced ⩾grade 2, 41% ⩾grade 3). Statistically significant differences between the arms in QoL parameters at 2 months disappeared by 6 months although there was suggestion of a persistent deficit in fatigue and physical function. Median follow-up was 7 years (maximum 12.1 years). 182 patients relapsed or died. DFS at 3 years was 50% with observation and 61% with treatment (HR 0.84, 95% confidence interval (CI) 0.63–1.12, p = 0.233). 124 patients died. Overall survival (OS) at 5 years was 63% with observation and 70% with treatment (HR 0.87, 95% CI 0.61–1.23, p = 0.428).ConclusionsThe treatment is associated with significant toxicity. There is no statistically significant benefit for the regimen in terms of disease free or overall survival.     

Impact of short warm ischemic time on longitudinal kidney function and survival rate after partial nephrectomy for renal cell carcinoma in patients with pre-existing chronic kidney disease stage III: A multi-institutional propensity score-matched study

PurposeIt remains unclear whether a short warm ischemic time (WIT) improves long-term renal function after partial nephrectomy (PN) for patients with pre-existing chronic kidney disease (CKD). We evaluated renal function after PN according to WIT duration in patients with stage III CKD.Materials and methodsWe identified 277 patients with stage III CKD who underwent PN during 2004–2017. Propensity score matching was used to created two matched groups of patients: Group A (WIT of <25 min) and Group B (WIT of ≥25 min). The outcomes of interest were longitudinal kidney function change, new-onset stage IV CKD (eGFR <30 mL/min/1.73 m²) and overall survival.ResultsThe two matched groups contained 85 patients each. The median follow-up durations were 49 months in Group A and 42 months in Group B. The median pre-treatment eGFRs were 52.4 mL/min/1.73 m² in Group A and 52.6 mL/min/1.73 m² in Group B. There were no differences in kidney function between the two groups throughout the follow-up period (P > 0.05). The 5-year rates of new-onset stage IV CKD were not significantly different between Group A and Group B (8.2% vs. 7.1%), with no significant difference in the risk of developing stage IV CKD in Group A (vs. group B, hazard ratio: 0.527, 95% confidence interval: 0.183–1.521; P = 0.236). The 5-year overall survival rates were 90.3% for Group A and 96.2% for Group B (P = 0.549).ConclusionsA short WIT was not associated with better postoperative kidney function or survival after PN in patients with stage III CKD.