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Vaneomycin-Resistant Enteroeocci (VRE) Treatment Options (Vaneomycin-Resistant Enteroeocci (VRE) 약물치료방법)

  • Kim, Myo Kyoung
    • Korean Journal of Clinical Pharmacy
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    • v.9 no.1
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    • pp.1-14
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    • 1999
  • Vancomycin-resistant Enterococci (VRE) have recently emerged in Korean hospitals, as well as in those of other countries. VRE have been partially attributed to the overuse and misuse of vancomycin. The mecbanisms of VRE resistance are related to VanA, VanB, and VanC. Both VanA and VanB produce abnormal ligase enzymes to form D-ala-D-lactate termini in E. faecium and E. faecalis, instead of D-ala-D-ala termini. Meanwhile, Van C produces D-ser-D-ala termini in E. gallinarum and E. casseliflavus. These abnormal termini have a low affinity to vancomycin. As a result, VRE avoid the activity of vancomycin by these mechanisms. Unfortunately, there is no approved therapy for the treatment of VRE. Thus, available but uncommonly prescribed antibiotics (due to their toxicity or unproven efficacy) may become possible options. They include chloramphenicol, novobiocin, fosfomycin, and bacitracin. The combination therapy of available agents may also be the other options. They include high doses of a penicillin- or ampicillin-aminoglycoside combination, high doses of an ampicillin/sulbactam and aminoglyoosidcs combination, an ampicillin and vancomycin combination, and a ciprofloxacin, aminoglycosides, and rifampin combination. With respect to the near future, many types of investigational agents will most likely expand their treatment options for VRE. Teicoplanin, a glycopeptide, can be used for VanB- and VanC-related VRE. LY333328, a new generation of glycopeptide, is effective in treating VanA as well as VanB and VanC. RP59500 (quinupristin/dalfopristin), a streptogramin, is effective in treating vancomycin-resistant E. faecium. New generation quinolones (especially clinatloxacin) are potential options for the treatment of VRE, even though they cannot work as effectively against VRE as they can against Staphylococci. Both glycylcyclines (a new generation of tetracyclines) and ketolides (a new generation of macrolides) show good activity against Enterococci, regardless of vancomycin susceptibility. Oxazolidinones (i. e. eperezolid and 1inezolid) and everninomicins (i. e. SCH27899) are new groups of antibiotics, which also demonstrate good activity against VRE. It is imperative that clinical pharmacists take the responsibility of investigating new treatment options for VRE in order to combat this growing problem throughout the world.

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Effect of Bojungikki-tang-gami (Bu Zhong Yi Qi Tang) on the Clearance of Vancomycin-resistant Enterococci Colonization in Patients with Cerebral Nerve Disease: A Case Series (뇌신경질환 환자의 반코마이신 내성 장구균 집락 해제에 보중익기탕가미가 미치는 영향 : 증례 보고)

  • Suh, Won-joo;Kim, Gyeong-muk;Seo, Yu-na;Cho, Ki-ho;Moon, Sang-kwan;Jung, Woo-sang;Kwon, Seung-won;Jin, Chul
    • The Journal of Internal Korean Medicine
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    • v.40 no.5
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    • pp.974-982
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    • 2019
  • Objective: Modern medicine offers no efficient way to clear colonization by vancomycin-resistant enterococci (VRE). However, VRE decolonization needs to be cleared as soon as possible to prevent VRE transmission. This study reports six cases in which the duration of vancomycin resistant enterococcus (VRE) colonization was reduced by Bojungikki-tang-gami. Methods: Six inpatients with VRE colonization were administered Bojungikki-tang-gami and continuously followed up with cultures. After three negative stool cultures, the patients were declared cleared of VRE colonization. We recorded the duration of VRE colonization. Results: The duration of VRE colonization in the six patients was a mean of 58 days and a median of 45 days. This was shorter than the duration reported in most previous studies. No side effects were noted. Conclusions: The findings of this study suggest that Bojungikki-tang-gami might be effective in shortening the duration of VRE colonization.

Characterization of Vancomycin Resistant Enterococci and Drug Ligand Interaction between vanA of E. faecalis with the Bio-Compounds from Aegles marmelos

  • Jayavarsha V;Smiline Girija A.S;Shoba Gunasekaran;Vijayashree Priyadharsini J
    • Journal of Pharmacopuncture
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    • v.26 no.3
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    • pp.247-256
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    • 2023
  • Objectives: Enterococcus faecalis is a gram positive diplococci, highly versatile and a normal commensal of the gut microbiome. Resistance to vancomycin is a serious issue in various health-care setting exhibited by vancomycin resistant Enterococci (VRE) due to the alteration in the peptidoglycan synthesis pathway. This study is thus aimed to detect the VRE from the patients with root caries from the clinical isolates of E. faecalis and to evaluate the in-silico interactions between vanA and the Aegles marmelos bio-compounds. Methods: E. faecalis was phenotypically characterized from 20 root caries samples and the frequency of vanA and vanB genes was detected by polymerase chain reaction (PCR). Further crude methanolic extracts from the dried leaves of A. marmelos was assessed for its antimicrobial activity. This is followed by the selection of five A. marmelos bio-compounds for the computational approach towards the drug ligand interactions. Results: 12 strains (60%) of E. faecalis was identified from the root caries samples and vanA was detected from two strains (16%). Both the stains showed the presence of vanA and none of the strains possessed vanB. Crude extract of A. marmelos showed promising antibacterial activity against the VRE strains. In-silico analysis of the A. marmelos biocompounds revealed Imperatonin as the best compound with high docking energy (-8.11) and hydrogen bonds with < 140 TPSA (Topological polar surface area) and zero violations. Conclusion: The present study records the VRE strains among the root caries with imperatorin from A. marmelos as a promising drug candidate. However the study requires further experimentation and validation.

Clinical Observations in Vancomycin-Resistant Enterococci Isolated from Pediatric Patients (소아 환아에서 분리된 Vancomycin 내성 장구균에 대한 임상적 고찰)

  • Lee, Dong Woo;Lee, Kyung Jae;Jang, Gwang Choen;Kim, Dong Soo;Lee, Kyung Won;Park, Eun Suk
    • Pediatric Infection and Vaccine
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    • v.8 no.2
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    • pp.199-205
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    • 2001
  • Purpose : Since the first report of vancomycin-resistant enterococci(VRE) in 1986, the resistance to vancomycin in enterococci has been increasingly rapidly. In this study, we investigated the clinical manifestations of pediatric patients with VRE and the pattern of the antibiotic use with increasing the rate of VRE in pediatrics Methods : We studied retrospectively 36 pediatric patients who were isolated VRE from January 1998 to December 2000. We classified patients into ICU and non ICU groups and reviewed species of VRE, specimens in which VRE were first detected and procedures performed before VRE detected. Results : We have found that the number of pediatric patients isolated VRE is increasingly annually in this study. In addition, the number of VRE-isolation in the ICU group and in patients who were operated or who underwent active procedures is much higher than that of in the non ICU group and in patients who were taken medication only. Enterococcus faecium is the main species of VRE. VRE showed high resistance to almost all antibiotics except tetracycline, and resistance was closely related to the duration of hospitalization and history of the antibiotic use. The proportion of the cephalosporin use was higher than any other antibiotic before VRE detection. In contrast, that of teicoplanin was higher than any other antibiotic after VRE detection(P<0.05). The cases of superinfection is higher in the ICU group than in non ICU group. Conclusion : In the hospital level, prevention of nosocomial infection through proper administrative policies, through surveillance of high risk VRE regions and prudent antibiotic use can prevent VRE outbreaks and corresponding side effects.

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Treatment of Meningitis Caused by Vancomycin-Resistant Enterococcus with Synercid

  • Oh, Hyung-Suk;Jeon, Byung-Chan;Kim, Young-Su;Chun, Tae-Sang
    • Journal of Korean Neurosurgical Society
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    • v.39 no.2
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    • pp.141-143
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    • 2006
  • Vancomycin-resistant enterococci[VRE] are rare cause of meningitis, occurring in immunocompromised patients, severely ill, hospitalized patient, and patients who have undergone neurosurgical procedures. Resistance to vancomycin has increased in frequency during the past few years. Limited therapeutic options are available for VRE infectionsandtheoptimumtherapy has not been established. We report a case of VRE meningitis that was successfully treated with administration of quinupristin-dalfopristin [Synercid] by both intravenous and intraventricular routes. A brief review of the literature is provided, which indicates that optimal management with Synercid should include daily intraventricular doses of at least 2mg and intravenous 0.5mg/kg every 8 hours. We also review the previously reported cases of VRE meningitis.

유산균 투여가 건강한 성인의 분변미생물 및 부패산물 생성에 미치는 영향

  • Shin, Myeong-Su;Kim, Yong-Jae;Bae, Hyoung-Suk;Baek, Young-Jin
    • Microbiology and Biotechnology Letters
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    • v.24 no.2
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    • pp.254-260
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    • 1996
  • To investigate the effects of lactic acid bacteria administration on fecal microflora and putrefactive metabolites in human being, Lactobacillus acidophilus and Bifidobacterium longum powder (1.5 $\times$ 10$^{9}$ cells, respectively) was administrated to six healthy volunteers (average 28 years old) twice a day for 2 weeks. During the administration of lactic acid bacteria, the numbers of bifidobacteria, lactobacilli, and enterococci in feces were increased significantly, whereas those of Staphylococcus and lecithinase-negative Clostridium were decreased considerably. In addition, a number of anaerobic Bacteroides were increased. However, the contents of fecal ammonia and putrefactive metabolites (indole, skatole, p-cresole) were not changed during the administration.

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Synthesis of Oxazolidinone Phosphonate Derivatives, Part II

  • Hwang, Jae-Min;Yeom, Sung-Ho;Jung, Kang-Yeoun
    • Bulletin of the Korean Chemical Society
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    • v.28 no.5
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    • pp.821-826
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    • 2007
  • Several oxazolidinones, a new class of synthetic antibacterial agents, have shown biological activity against multidrug-resistant gram positive organisms such as staphylococci, streptococci, and enterococci. Previous results of our studies with benzoxazolidinone phosphonate derivatives have demonstrated very low antibacterial activity. In the course of our studies directed towards the discovery of noble antibacterial agents, we have synthesized several new derivatives of oxazolidinone phosphonates prepared efficiently from commercially available amino acids. These compounds are tested for in vitro antibacterial activity and one of the compounds showed promising results allowing us to pursue further studies.

Prevalence of Antibiotics in Nectar and Honey in South Tamilnadu, India

  • Solomon, RD. Jebakumar;Santhi, V. Satheeja;Jayaraj, Vimalan
    • Animal cells and systems
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    • v.10 no.3
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    • pp.163-167
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    • 2006
  • Reverse-Phase High-performance Liquid Chromatography (RP-HPLC) based technique is one of the most sensitive techniques to detect the antibiotics present in honey. In the southern part of Tamilnadu, India, majority of the farmlands are occupied by plantations such as coconut, banana and rubber. A variety of antimicrobial compounds and antibiotics, which have been reported in pollen, nectar and other floral parts of the plant, gets accumulated in honey through honeybees (Apis mellifera). We have collected the nectar samples from banana (Musa paridasiaca) and rubber (Ficus elastica) flowers and the honey from honey hives of banana and rubber cultivated areas. The extracted nectar and honey samples are subjected to RP-HPLC analysis with authentic antibiotic standards. Nectar and honey samples showed 4-17, 11-29 ${\mu}g/kg$ of streptomycin, 2-29, 3-44 ${\mu}g/kg$ of ampicillin and 17-34, 26-48 ${\mu}g/kg$ of kanamycin respectively.

Complete Genome Sequence of an optrA-positive Linezolid-resistant Staphylococcus rostri Strain PJFA-333 Isolated from a Pig in Korea

  • Gi Yong Lee;Soo-Jin Yang
    • Microbiology and Biotechnology Letters
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    • v.51 no.3
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    • pp.293-295
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    • 2023
  • Linezolid, the first oxazolidinone introduced into human clinical use, has become a last resort antibiotic in treatment of serious infections caused by Gram-positive pathogens, including methicillin-resistant staphylococci and vancomycin-resistant enterococci. Although oxazolidinones are strictly prohibited for use in food-producing animals, occurrence of linezolid-resistant staphylococci has recently been reported in livestock farms in Korea. Here, we report the complete genome sequence of an optrA-positive linezolid-resistant Staphylococcus rostri strain PJFA-333 isolated from a pig farm in Korea.