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1.
Am J Emerg Med ; 53: 284.e1-284.e3, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1682857

ABSTRACT

Valproic acid (VPA) and derivatives are effective anticonvulsants that are also used for numerous mood disorders. VPA toxicity can cause central nervous system (CNS) depression, dose related hyperammonemia, and eventually hepatotoxicity. While traditional treatment of VPA toxicity often includes l-carnitine, activated charcoal, and hemodialysis; an interaction with carbapenem class antibiotics has been well established in literature and may offer a different avenue of treatment. This case describes a 38 year-old female with a past medical history of epilepsy effectively treated with meropenem to rapidly and safely lower toxic VPA levels after an acute ingestion. A review of four VPA poisoning case reports and the interaction with carbapenem class antibiotics is also included.


Subject(s)
Drug Overdose , Epilepsy , Adult , Anti-Bacterial Agents/therapeutic use , Anticonvulsants , Carbapenems/therapeutic use , Drug Overdose/drug therapy , Drug Overdose/therapy , Epilepsy/drug therapy , Female , Humans , Meropenem/therapeutic use , Valproic Acid
2.
Eur J Clin Microbiol Infect Dis ; 41(3): 495-500, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1603573

ABSTRACT

The objective was to study ceftazidime-avibactam resistant and susceptible Klebsiella pneumoniae isolated from a patient admitted to the Policlinico Umberto I of Rome for SARS-CoV2. Data on the evolution of patient's conditions, antimicrobial therapies, and microbiological data were collected. Whole-genome sequencing performed by Illumina and Nanopore sequencing methods were used to type the strains. During the hospitalization, a SARS-CoV2-infected patient was colonized by a KPC-producing K. pneumoniae strain and empirically treated with ceftazidime-avibactam (CZA) when presenting spiking fever symptoms. Successively, ST2502 CZA-resistant strain producing the KPC-31 variant gave a pulmonary infection to the patient. The infection was treated with high doses of meropenem. The KPC-31-producing strain disappeared but the patient remained colonized by a KPC-3-producing K. pneumoniae strain. An interplay between highly conserved KPC-31- and KPC-3-producing ST2502 strains occurred in the SARS-CoV2 patient during the hospitalization, selected by CZA and carbapenem treatments, respectively.


Subject(s)
Anti-Bacterial Agents , COVID-19 , Klebsiella Infections , Meropenem , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , COVID-19/complications , Ceftazidime/therapeutic use , Drug Combinations , Humans , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/genetics , Meropenem/therapeutic use , Microbial Sensitivity Tests , beta-Lactamases/genetics
5.
Elife ; 92020 12 17.
Article in English | MEDLINE | ID: covidwho-1011747

ABSTRACT

Here, we describe the case of a COVID-19 patient who developed recurring ventilator-associated pneumonia caused by Pseudomonas aeruginosa that acquired increasing levels of antimicrobial resistance (AMR) in response to treatment. Metagenomic analysis revealed the AMR genotype, while immunological analysis revealed massive and escalating levels of T-cell activation. These were both SARS-CoV-2 and P. aeruginosa specific, and bystander activated, which may have contributed to this patient's persistent symptoms and radiological changes.


Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Lymphocyte Activation , Pneumonia, Ventilator-Associated/drug therapy , Pseudomonas Infections/drug therapy , SARS-CoV-2 , T-Lymphocytes/immunology , Anti-Bacterial Agents/pharmacology , COVID-19/immunology , COVID-19/therapy , Drug Resistance, Multiple, Bacterial , Humans , Lung/microbiology , Male , Meropenem/pharmacology , Meropenem/therapeutic use , Metagenomics , Middle Aged , Piperacillin, Tazobactam Drug Combination/pharmacology , Piperacillin, Tazobactam Drug Combination/therapeutic use , Pneumonia, Ventilator-Associated/diagnostic imaging , Pneumonia, Ventilator-Associated/etiology , Pseudomonas Infections/diagnostic imaging , Pseudomonas Infections/etiology , Pseudomonas aeruginosa/isolation & purification , Recurrence , Respiration, Artificial
6.
Eur J Clin Microbiol Infect Dis ; 40(4): 859-869, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-898040

ABSTRACT

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17-99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1-13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , Bacterial Infections/epidemiology , COVID-19/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Ampicillin/therapeutic use , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/epidemiology , Azithromycin/therapeutic use , Bacterial Infections/drug therapy , Cohort Studies , Coinfection/epidemiology , Enterobacteriaceae Infections/drug therapy , Enterobacteriaceae Infections/epidemiology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/epidemiology , Female , Germany/epidemiology , Humans , Klebsiella Infections/drug therapy , Klebsiella Infections/epidemiology , Linezolid/therapeutic use , Male , Meropenem/therapeutic use , Middle Aged , Piperacillin, Tazobactam Drug Combination/therapeutic use , Retrospective Studies , SARS-CoV-2 , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Streptococcal Infections/drug therapy , Streptococcal Infections/epidemiology , Sulbactam/therapeutic use , Vancomycin/therapeutic use , Young Adult
7.
Blood Purif ; 50(1): 132-136, 2021.
Article in English | MEDLINE | ID: covidwho-690598

ABSTRACT

It is of crucial importance to diagnose patients in a timely and clear manner during the outbreak of COVID-19. Different causes of pneumonia makes it difficult to differentiate COVID-19 from others. Hemodialysis patients are a special group of people in this outbreak. We present a successfully treated case of a patient with maintenance hemodialysis from acute eosinophilic pneumonia for using meropenem when treating bacterial pneumonia, avoiding possible panic and waste of quarantine materials in dialysis centers.


Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19/complications , Kidney Diseases/complications , Meropenem/therapeutic use , Pneumonia, Bacterial/etiology , Pulmonary Eosinophilia/etiology , Acute Disease , COVID-19/epidemiology , COVID-19/therapy , Disease Outbreaks , Humans , Kidney Diseases/therapy , Male , Middle Aged , Pneumonia, Bacterial/therapy , Pulmonary Eosinophilia/therapy , Renal Dialysis , SARS-CoV-2/isolation & purification , Treatment Outcome
8.
J Recept Signal Transduct Res ; 40(6): 605-612, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-457256

ABSTRACT

Recently, a pathogen has been identified as a novel coronavirus (SARS-CoV-2) and found to trigger novel pneumonia (COVID-19) in human beings and some other mammals. The uncontrolled release of cytokines is seen from the primary stages of symptoms to last acute respiratory distress syndrome (ARDS). Thus, it is necessary to find out safe and effective drugs against this deadly coronavirus as soon as possible. Here, we downloaded the three-dimensional model of NSP10/NSP16 methyltransferase (PDB-ID: 6w6l) and main protease (PDB-ID: 6lu7) of COVID-19. Using these molecular models, we performed virtual screening with our anti-viral, inti-infectious, and anti-protease compounds, which are attractive therapeutics to prevent infection of the COVID-19. We found that top screened compound binds with protein molecules with good dock score with the help of hydrophobic interactions and hydrogen bonding. We observed that protease complexed with Cyclocytidine hydrochloride (anti-viral and anti-cancer), Trifluridine (anti-viral), Adonitol, and Meropenem (anti-bacterial), and Penciclovir (anti-viral) bound with a good docking score ranging from -6.8 to -5.1 (Kcal/mol). Further, NSP10/NSP16 methyltransferase complexed with Telbivudine, Oxytetracycline dihydrate (anti-viral), Methylgallate (anti-malarial), 2-deoxyglucose and Daphnetin (anti-cancer) from the docking score of -7.0 to -5.7 (Kcal/mol). In conclusion, the selected compounds may be used as a novel therapeutic agent to combat this deadly pandemic disease, SARS-CoV-2 infection, but needs further experimental research.HighlightsNSP10/NSP16 methyltransferase and main protease complex of SARS CoV-2 bind with selected drugs.NSP10/NSP16 methyltransferase and protease interacted with drugs by hydrophobic interactions.Compounds show good DG binging free energy with protein complexes.Ligands were found to follow the Lipinski rule of five.


Subject(s)
Antiviral Agents/chemistry , Coronavirus Infections/drug therapy , Pneumonia, Viral/drug therapy , Viral Nonstructural Proteins/chemistry , Viral Regulatory and Accessory Proteins/chemistry , Acyclovir/analogs & derivatives , Acyclovir/chemistry , Acyclovir/therapeutic use , Ancitabine/chemistry , Ancitabine/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus/drug effects , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/virology , Drug Evaluation, Preclinical , Guanine , Humans , Meropenem/chemistry , Meropenem/therapeutic use , Methyltransferases , Models, Molecular , Molecular Docking Simulation , Pandemics , Pneumonia, Viral/virology , Protein Conformation/drug effects , Ribitol/chemistry , Ribitol/therapeutic use , SARS-CoV-2 , Trifluridine/chemistry , Trifluridine/therapeutic use , User-Computer Interface , Viral Nonstructural Proteins/antagonists & inhibitors , Viral Nonstructural Proteins/ultrastructure , Viral Regulatory and Accessory Proteins/antagonists & inhibitors , Viral Regulatory and Accessory Proteins/ultrastructure
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