The potential of the antiplatelet agent ticagrelor as a new antibacterial agent

The number of deaths caused by drug-resistant bacteria is expected to increase in the future, and there is a need to develop new antimicrobial agents. Recently, the antiplatelet drug ticagrelor has been reported to have promising antibacterial properties. The purpose of this review is to analyze articles and case reports that describe the antimicrobial action of ticagrelor. Ticagrelor was found to have antibacterial reactions against Gram-positive bacteria, including drug-resistant and spore-forming bacteria, while no effect was observed against Gram-negative bacteria. In this paper we discuss a new potential antimicrobial agent, ticagrelor.

Prevalencia y perfil de susceptibilidad antimicrobiana en bacterias aisladas de úlceras crónicas infectadas en adultos / Prevalence and susceptibility pattern of bacteria isolated from infected chronic wounds in adult patients

Resumen Introducción: Las úlceras crónicas son un problema de salud pública, agravándose por infecciones bacterianas causadas principalmente por agentes resistentes. Objetivo: Estudiar prevalencia y perfil de susceptibilidad en bacterias aisladas de úlceras crónicas en pacientes adultos. Pacientes y Métodos: Pacientes atendidos en la Fundación Instituto Nacional de Heridas entre mayo y julio de 2014, con úlceras crónicas en extremidades inferiores con signos inflamatorios clínicos. Las muestras fueron cultivadas en aerobiosis y anaerobiosis y para la identificación bacteriana se empleó el sistema de galerías API (Biomerieux). La susceptibilidad in vitro se evaluó según el método de Kirby Bauer. Resultados: Se reclutaron 73 pacientes, entre quienes 46 presentaron úlceras infectadas, diagnosticándose 33 úlceras venosas con predominio de infección polimicrobiana y 10 úlceras de pie diabético con predominio de infección monomicrobiana (p ≤ 0,05). Se aislaron 68 cepas de los 46 pacientes con úlcera infectada. Las enterobacterias predominaron en infección monomicrobiana (p ≤ 0,05) y los demás grupos bacterianos fueron levemente más frecuentes en infección polimicrobiana. La especie prevalente fue Staphylococcus aureus (24%) seguida de Pseudomonas aeruginosa (18%). Cincuenta cepas (77%) presentaron resistencia a uno o más antibacterianos. Destacamos resistencia de S. aureus a ciprofloxacina (50%) y cefoxitina (37,5%) identificándose así resistencia a meticilina en la comunidad (SARM-AC), siendo todas sensibles a cotrimoxazol. Las enterobacterias presentaron resistencia a sensibilidad a amikacina (95,5%), P. aeruginosa evidenció resistencia a ciprofloxacina (33,3%) con alta sensibilidad a gentamicina (91,7%) y amikacina (83,3%), mientras Acinetobacter spp presentó resistencia a ciprofloxacina y ceftazidima en 60%, con 100% de sensibilidad a imipenem. Streptococcus β hemolítico presentó 50% de resistencia a clindamicina y penicilina. Conclusión: Estos datos entregan información epidemiológica de infecciones de úlceras crónicas, representando un apoyo al diagnóstico, tratamiento y manejo de esta patología.

Background: Chronic wounds are considered a public health problem that may be complicated by bacterial infections, mainly caused by resistant strains. Aim: To study the bacteria prevalence and antimicrobial susceptibility in samples from adult patients with chronic wounds. Methods: Patients treated at National Institute of Wounds Foundation between May and July 2014, with chronic ulcers in lower extremities with clinical inflammatory signs were recluted. Samples were cultured in aerobic and anaerobic atmosphere and species identification was performed by API (Biomerieux) galleries. The in vitro susceptibility was evaluated according to the Kirby Bauer method. Results: From 73 patients, 46 had infected wounds most of them were venous ulcers (33) with prevalence in polymicrobial infections and 10 with foot-diabetes ulcers with prevalence in monomicrobial infections (p ≤ 0.05). Sixty-eight strains were isolated and Enterobacteriaceae were predominant in monomicrobial infection (p ≤ 0.05) and the other groups were slightly higher in polymicrobial infection. The main species were Staphylococcus aureus (24%) followed by P. aeruginosa (18%). Fifty strains (77%) were resistant or multi-resistance. We emphasize resistance of S. aureus to ciprofloxacin (50%) and cefoxitin (37.5%), thus identifying resistance to methicillin in the community (CA-SAMR), all of which are sensitive to cotrimoxazole. Enterobacteria showed sensitivity to amikacin (95.5%), P. aeruginosa showed resistance to ciprofloxacin (33.3%) with high sensitivity to gentamicin (91.7%) and amikacin (83.3%), while Acinetobacter spp showed resistance to ciprofloxacin and ceftazidime in 60%, with 100% sensitivity to imipenem. 50% Streptococcus β hemolytic showed resistance to clindamycin and penicillin. Conclusion: These data provide epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology.

Analysis on clinical distribution and antibacterial resistance of Acinetobacter Baumannii from 2010 to 2014 / 国际检验医学杂志

Objective To investigate the clinical distribution characteristics and trend in antibacterial resistance of Acinetobacter baumannii in Pudong Hospital Affiliated to Fudan University,so as to provide the guidance for clinical rational use of antibacterial agents and infection control.Methods SPSS 1 9.0 statistical software was adopted to retrospectively analyze the specimen source, department distribution and antibacterial resistance change of the 1 678 strains of Acinetobacter baumannii in this hospital from Jan-uary 2010 to October 2014.Results Clinical isolates of Acinetobacter baumannii mainly came from respiratory tract specimens(ac-counted for 79.1%).The intensive care unit(21.1%),department of neurosurgery(1 7.7%)and department of cardiology(1 7.6%) were the top three departments from which the strains were isolated.The isolates of Acinetobacter baumannii were highly resistant to the first and second generation of cephalosporins,cephamycin,ampicillin and nitrofurantoin,and the resistance rates reached a-bove 90%.The resistance rates of these isolates against carbapenems,aztreonam,cefperazone-sulbactam and ampicillin-salbactam showed obviously uptrends,but the resistance rates of these isolates against amikacin and cotrimoxazole showed downtrends.And the resistance rates of these isolates against other antibacterial agents stayed between 30% and 50%.During the five years,the de-tection rates of multi-drug resistant strains steadied around 35.0%.Though the detection rates of pan-drug resistant strains de-clined year by year,the strains were isolated each year.Conclusion The antibacterial resistance of Acinetobacter baumannii is seri-ous in this hospital,with multi-drug and pan-drug resistance persisting.It is necessary to enhance monitoring antibacterial resist-ance,ensure rational use of antibacterial agents,and promote implementation of disinfection and isolation,so as to prevent the spread and popularity of Acinetobacter baumannii resistance in hospital.

Analysis of distribution and antibacterial resistance of common pathogenic bacteria of clinical infectious diseases in hospital / 国际检验医学杂志

Objective To analyse distribution and antibacterial resistance of common pathogenic bacteria of clinical infectious diseases and provide scientific basis for the treatment of infectious diseases ,rational use of antibacterial agents and nosocomial infec‐tion control .Methods The distribution and antibacterial resistance of common pathogens clinically isolated from inpatients and out‐patients from August 2012 to July 2013 were analyzed .Bacterial identification and drug susceptibility test were carried out by using MicroScan WorkAway 40 automated bacterial identification and drug‐susceptibility analyzer ,and the results of drug susceptibility test were analysed by using the WHONET5 .5 software .Results A total of 1 434 strains of pathogenic bacteria were isolated ,and gram‐negative bacteria ,gram‐positive bacteria and other pathogenic bacteria accounted for 53 .8% ,28 .1% and 18 .1% respectively . The detection rate of methicillin‐resistant Staphylococcus aureus and methicillin‐resistant coagulase negative Staphylococcus were 31 .6% and 57 .4% respectively .No strains of vancomycin‐resistant Staphylococcus were found ,while strains of vancomycin‐resist‐ant Enterococcus faecium accounted for 8 .8% .The detection rate of extended‐spectrum beta‐lactamases producing Escherichia coli and Klebsiella pneumoniae were 47 .2% and 12 .2% respectively .Isolates of Staphylococcus and Enterococcus faecium were sensi‐tive to vancomycin ,linezolid and moxifloxacin ,and the resistance rates were less than 10 .0% .While isolates of Staphylococcus were resistant to the penicillin ,macrolides ,quinolones ,tetracycline ,cephalosporin ,and the resistance rates were more than 30 .0% .Most isolates of gram‐negative bacteria were sensitive to ertapenem ,imipenem ,amikacin ,meropenem ,piperacillin/tazobactam ,ticarcillin/clavulanic acid and levofloxacin ,and the resistance rates were less than 10 .0% .Conclusion It is necessary to enhance monitoring of distribution and antibacterial resistance of pathogenic bacteria ,so as to provide references for guiding rational use of antibacterial a‐gents in different departments .

Microbiologic profile of hospitalized healthcare workers / Perfil microbiológico de profissionais de saúde com internação hospitalar

Objective: according to the epidemiologic and antimicrobial resistance profile, infections are usually classified as community-acquired or nosocomial. Reports on patients without the classic criteria for nosocomial infection with multidrug-resistant germs are increasing. There is a particular concern regarding which microbiological profile must be addressed in case of infections in healthcare workers. This study was carried out with the purpose of identifying the prevalence of infection by multidrug-resistant germs in healthcare workers exposed to occupational contact with such germs at work. Methods: observational and retrospective study. In a 7-year period, healthcare worker hospitalizations were identified and the cultures results were assessed in order to identify the prevalence of infection by multidrug-resistant pathogens. Results: 1,487 healthcare workers hospitalizations were identified. In 105 of these hospitalizations, cultures were collected on the first 5 days after admission, and in 22 patients, 24 germs were identified. Multidrug-resistant pathogens were not found. Conclusion: in our sample, composed of workers from a tertiary public hospital who were hospitalized, none of the individuals presented MDR colonization or infection. These results suggest that when healthcare workers present infections, they must receive antibiotic therapy directed to community-acquired pathogens. In light of the limitations of this study, further larger and multicenter studies must be developed to enlighten such issue. .

Objetivo: conforme perfil epidemiológico e resistência antimicrobiana, as infecções costumam ser divididas entre comunitárias e nosocomiais. É crescente o relato de pacientes sem critérios clássicos para infecções nosocomiais com infecções por germes multirresistentes (GMR). Há particular preocupação perante qual perfil microbiológico deve ser coberto na presença de infecções em profissionais de saúde. Realizamos este trabalho com intuito de identificar a prevalência de infecção por GMR em profissionais de saúde expostos a contato laboral com tais germes. Métodos: estudo observacional, retrospectivo. Em um período de 7 anos, foram identificadas internações hospitalares de profissionais de saúde e aferidos resultados de culturas visando a identificar prevalência de infecção por GMR. Resultados: identificamos 1.487 internações de profissionais de saúde. Em 105 internações, foram solicitadas culturas nos primeiros 5 dias de internação. Em 22 internações, foram identificados 24 germes. Não houve isolamento de GMR. Conclusão: na amostra, composta por funcionários de um hospital público de nível terciário que apresentaram internação hospitalar, nenhum funcionário apresentou colonização ou infecção por GMR. O resultado sugere que trabalhadores da área de saúde, ao apresentar infecções, devem receber antibioticoterapia voltada para patógenos comunitários. Tendo em vista as limitações deste estudo, são necessários estudos maiores e multicêntricos para elucidar essa questão. .

An epidemiological survey of nosocomial infections in Chinese patients with active rheumatoid arthritis in Shanghai / 中国感染与化疗杂志

Objective To investigate the incidence,pathogens and clinical features of nosocomial infections in patients with ac-tive rheumatoid arthritis (RA).Methods A total of 2 452 active RA patients were reviewed and analyzed retrospectively in Shanghai hospitals between January 2009 and February 2011.The demographic and clinical characteristics were described.Re-sults A total of 721 episodes of infection were found in 503 patients (20.51%).About 40.97% of the infections were of respir-atory tract,22.35% of urinary tract,and 8.58% of skin and soft tissues.Major pathogens were bacteria (623,86.40%),in-cluding E.coli (226,31.35%),P .aeruginosa (40,5.55%),A.baumannii (48,5.42%),Enterococcus (144,16.25%), methicillin-resistant Staphylococcus aureus (15, 2.08%), methicillin-resistant coagulase-negative Staphylococcus (7, 0.97%).The other pathogens included fungi (74,10.26%),herpes zoster (16,2.21%),and Mycobacterium tuberculosis (8,1.10%).Conclusions Nosocomial infection is mainly seen in respiratory and urinary tracts,usually associated with E.co-li,P .aeruginosa,A.baumanii,methicillin-resistant Staphylococcus and Enterococcus .

Consumo comunitario de antimicrobianos en Chile, 2000-2008 / Community antibiotic consumption in Chile, 2000-2008

Background: The Chilean Ministry of Health has implemented regulatory rules for the consumption of anti-biotics since September 1999, with sales restriction limited only with medical prescription. Aim: To analyze the impact of established regulatory measures from 2000 to 2008. Material and Methods: A retrospective analysis of antibiotics sales in pharmacies from 2000 to 2008 was performed. The information was obtained from the International Marketing System (IMS Health), an auditing system of pharmacy sales. The consumption unit used was the Defined Daily Dose per 1000 inhabitants/day (DDD). Results: From 2000 to 2002 the regulatory rules had a great impact, but since 2002 the antibiotic consumption increased, especially amoxicillin, returning to similar levéis observed in 1998. Conclusions: The regulatory measures had an initial impact, but there was not reinforcement in the time and there was no further control. It is necessary to assume a permanent task and support of the authorities of health to edúcate the population about the implications of the inadequate use of antimicrobials and his effect on the microbial ecology.

Introducción: El Ministerio de Salud de Chile reguló el consumo de antimicrobianos en el mes de septiembre de 1999, mediante restricción de venta limitada sólo a venta con receta médica. El objetivo de este estudio es conocer el impacto de las medidas regulatorias entre los años 2000 y 2008. Metodología: Se realizó un análisis retrospectivo de las ventas en farmacias privadas desde el año 2000 al 2008. La información se obtuvo del International Marketing System Health (IMS Health), una empresa internacional encargada de auditar las ventas de farmacias. La unidad de consumo usada fue la DDD/1.000 habitantes-día. Resultados: A partir del año 2000 al 2002, las medidas regulatorias tuvieron un gran impacto; sin embargo, desde el año 2002 el consumo de antimicrobianos aumentó, especialmente amoxicilina, obteniéndose valores similares a los existentes en 1998. Conclusiones: Las medidas regulatorias tuvieron un impacto inicial; sin embargo, no fueron reforzadas ni controladas en el tiempo. Es necesario que las autoridades de salud del país asuman la tarea pennanente de educar a la comunidad acerca del uso inadecuado de antimicrobianos y su efecto sobre la ecología bacteriana.

Prospective analysis of nosocomial infections in a Burn Care Unit, Turkey.

Background & objectives: Prevention of infection in burned patients poses a great challenge as infection is the most common cause of mortality after burn injury. An analysis of burned patients, admitted and treated between January 2004 and December 2005 in a nine-bed burn unit in Turkey, was performed prospectively to identify the common pathogens and incidence of nosocomial infection in these patients. Methods: Of the 182 burn cases admitted to Burn Care Unit during the study period, 169 met the inclusion criteria. Information related to nosocomial infection (NI) was collected. Samples were collected for culture and microorganisms isolated were tested for antimicrobial sensitivity. Results: Of the 169 burn patients, 127 acquired 166 nosocomial infection (NI) (15.7% pneumonia, 56.0% burn wound infection, 8.4% urinary tract infection and 19.9% blood stream infection) with an overall NI rate of 18.2 per 1000 patient-days. The mean age (38 ± 21 yr), the mean length of hospitalization (45.06 ± 11.67 days) and the total burned surface area (TBSA) (34.58 ± 18.46%) of the patients with NI were higher than those of the patients with non NI (23 ± 17 yr), (16.38 ± 11.14 days) and (12.44± 8.69%) (P=0.03, P=0.001, P=0.01) respectively. By multiple logistic regression analysis, TBSA co-morbidities, broad spectrum antibiotic usage and invasive devices usage were significantly related to acquisition of NI. Pseudomonas aeruginosa (57%), Acinetobacter baumannii (21%) and Staphylococcus aureus (14%) were the most common resistant organisms isolated. Interpretation & conclusion: Our findings emphasize the need for careful disinfection and more strict infection control procedures in areas that serve immunosupressed individuals, such as burn patients.

Rates of antimicrobial resistance in latin america (2004-2007) and in vitro activity of the glycylcycline tigecycline and of other antibiotics

As a part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.), Gram-positive and Gram-negative bacterial isolates were collected from 33 centers in Latin America (centers in Argentina, Brazil, Chile, Colombia, Guatemala, Honduras, Jamaica, Mexico, Panama, Puerto Rico, and Venezuela) from January 2004 to September 2007. Argentina and Mexico were the greatest contributors of isolates to this study. Susceptibilities were determined according to Clinical Laboratory Standards Institute guidelines. Resistance levels were high for most key organisms across Latin America: 48.3 percent of Staphylococcus aureus isolates were methicillin-resistant while 21.4 percent of Acinetobacter spp. isolates were imipenem-resistant. Extended-spectrum β-lactamase were reported in 36.7 percent of Klebsiella pneumoniae and 20.8 percent of E. coli isolates. Tigecycline was the most active agent against Gram-positive isolates. Tigecycline was also highly active against all Gram-negative organisms, with the exception of Pseuodomonas aeruginosa, against which piperacillin-tazobactam was the most active agent tested (79.3 percent of isolates susceptible). The in vitro activity of tigecycline against both Gram-positive and Gram-negative isolates indicates that it may be an useful tool for the treatment of nosocomial infections, even those caused by organisms that are resistant to other antibacterial agents.