Strategies for optimization of β-lactams in the treatment of infections due to multidrug resistant mycobacteria

L’émergence de formes multirésistantes de tuberculose et la résistance intrinsèque de Mycobacterium abscessus à de nombreux anti-infectieux imposent l’identification de nouveaux antibiotiques et de nouvelles stratégies thérapeutiques. Les mycobactéries sont naturellement peu sensibles aux β-lactamines par production d’une β-lactamase et de cibles atypiques de faible affinité, les L,D-transpeptidases, qui sont efficacement inactivées par une seule classe de β-lactamines, les carbapénèmes. L’objectif de la thèse est d’étudier le mode d’action des β-lactamines afin de proposer des stratégies permettant d’optimiser ces antibiotiques. Pour comprendre la spécificité des L,D-transpeptidases vis-à-vis des carbapénèmes, nous avons étudié la cinétique et le mécanisme de la réaction d’inactivation de ces enzymes par différentes méthodes de spectroscopie en flux arrêté. Nos résultats indiquent que l’efficacité des carbapénèmes est due à leur capacité à former rapidement un intermédiaire tétrahédrique et à la stabilité de l’acylenzyme. La spécificité des L,D-transpeptidases pour les carbapénèmes ne dépend pas de leurs chaînes latérales, qui pourraient être modifiées pour améliorer les propriétés pharmacologiques de ces antibiotiques. Chez M. abscessus, nous avons identifié un inhibiteur de la β-lactamase, l’avibactam, qui augmente l’activité de certaines β-lactamines in vitro, en intracellulaire et dans un modèle d’infection du poisson zèbre. Nos résultats montrent que les β-lactamines peuvent être optimisées pour le traitement des infections dues aux mycobactéries multirésistantes par l’amélioration de l’inactivation des cibles ou l’inhibition des β-lactamases.The emergence of multidrug-resistant tuberculosis and the intrinsic resistance of Mycobacterium abscessus to most antibiotics require the identification of new drugs and new therapeutic strategies. Mycobacteria are naturally poorly susceptible to β-lactam antibiotics due to production of a β-lactamase and of atypical low-affinity targets, the L,D-transpeptidases, which are effectively inactivated by a single class of β-lactams, the carbapenems. The aim of the thesis is to study the mode of action of β-lactams to propose strategies for the optimization of these antibiotics. To understand the specificity of L,D-transpeptidase for carbapenems, we have studied the kinetics and mechanism of inactivation of these enzymes using various stopped-flow spectroscopic methods. Our results indicate that the efficacy of carbapenems is due to their ability to rapidly form a tetrahedral intermediate and to the stability of the acylenzyme. The specificity of the L,D-transpeptidases for carbapenems does not depend upon the side chains of the drugs, which may be modified to improve their pharmacological properties. In M. abscessus, we have shown that the β-lactamase inhibitor avibactam increases the activity of various β-lactams in vitro, intracellularly, and in zebrafish model. Our results show that β-lactams can be optimized for the treatment of infections due to multidrug-resistant mycobacteria by improving inactivation of the targets and by inhibiting the β-lactamases

COVID-19 and Fungal Infections: A Double Debacle

International audienceFungal infections remain hardly treatable because of unstandardized diagnostic tests, limited antifungal armamentarium, and more specifically, potential toxic interactions between antifungals and immunosuppressants used during anti-inflammatory therapies, such as those set up in critically ill COVID-19 patients. Taking into account pre-existing difficulties in treating vulnerable COVID-19 patients, any co-occurrence of infectious diseases like fungal infections constitutes a double debacle for patients, healthcare experts, and the public economy. Since the first appearance of SARS-CoV-2, a significant rise in threatening fungal co-infections in COVID-19 patients has been testified in the scientific literature. Better management of fungal infections in COVID-19 patients is, therefore, a priority and requires highlighting common risk factors, relationships with immunosuppression, as well as challenges in fungal diagnosis and treatment. The present minireview attempts to highlight these aspects in the three most identified causative agents of fungal co-infections in COVID-19 patients: Aspergillus, Candida, and Mucorales species

Impact of ceftriaxone and temocillin on fecal abundance of extended-spectrum β-lactamase producing Escherichia coli in a mouse model

International audienceBackground: Gut colonization by ESBL-producing Enterobacteriaceae (ESBL-PE) is widespread and is promoted by antibiotic exposure. Higher fecal abundance of ESBL-PE promotes the dissemination of the bacteria in the environment and is associated with increased risk of infection. Ceftriaxone and temocillin are commonly used antibiotics with a different activity on gut flora. Their impact on fecal abundance of ESBL-producing Enterobacteriaceae has not been studied. The objective of this study was to compare the propensity of ceftriaxone and temocillin to modify the abundance of ESBL-producing Escherichia coli in feces of colonized mice.Methods: Mice received broad-spectrum antibiotics in order to disrupt their normal gut flora. A CTX-M-type ESBL-producing E. coli clinical isolate was then administered orally, leading to durable colonization. Thirty days later, mice received either temocillin or ceftriaxone with drinking water at a concentration simulating human intestinal exposure. Third-generation-cephalosporin resistant (3GCR) E. coli were enumerated in feces on selective medium before, 2 days and 10 days after the end of antibiotic exposure. The experiment was performed with two E. coli isolates with different temocillin minimum inhibitory concentrations.Results: Exposure to ceftriaxone induced an increase in the fecal abundance of 3GCR E. coli. In contrast, temocillin had no effect or transiently decreased the number of 3GCR E. coli. Results obtained with the two strains were similar.Conclusion: Contrary to ceftriaxone, temocillin does not promote expansion of ESBL-producing E. coli in feces of colonized mice. Thus temocillin may be a therapeutic of choice when a temocillin-susceptible strain infection is suspected or proven to prevent the expansion of ESBL-PE in a previously colonized patient

Colistin–glycopeptide combinations against multidrug-resistant Acinetobacter baumannii in a mouse model of pneumonia

International audienceAim: To assess the effect of colistin-glycopeptide combination against a multidrug-resistant strain of Acinetobacter baumannii. Materials & methods: We used in vitro procedures (Etest method, checkerboard test and kill-time assays) and a mouse model of a carbapenem-resistant A. baumannii pneumonia. Results: The colistin-teicoplanin combination allowed a 74% increase of the survival in the mouse model within the 4 days following bacterial inoculation as compared with saline or colistin alone (p = 0.06). Concurrently, the colistin-vancomycin combination presented a similar efficacy as compared with saline or colistin alone in the mouse model. Conclusion: According to those preliminary results, using the colistin-teicoplanin combination in therapeutic deadlocks encountered in certain multiresistant A. baumannii pneumonia could be envisaged if the results are confirmed

Topical rapamycin (sirolimus) for treatment of cutaneous microcystic lymphatic malformation of the gluteal area

International audienceCutaneous microcystic lymphatic malformations (CMLMs) are rare conditions that result from abnormal embryological development of lymphatic vessels [1]. They present as clusters of vesicles that are full of lymph and blood. CMLMs commonly affect the lower limbs, gluteal areas, or the head and neck. The most frequent complications are oozing, bleeding, aesthetic impairment, pain, or bacterial infections. The management is challenging. Treatment options include surgery, laser therap

Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study

Background. The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. Methods. Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. Results. The three groups (n = 77; mean ± SD, 88 ± 5 years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p = 0.03). Conclusions. Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly

Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study

International audienceBackground. The objective of this quasi-experimental study was to determine whether bolus vitamin D supplementation taken either regularly over the preceding year or after the diagnosis of COVID-19 was effective in improving survival among hospitalized frail elderly COVID-19 patients. Methods. Seventy-seven patients consecutively hospitalized for COVID-19 in a geriatric unit were included. Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group 2). The comparator group involved participants having received no vitamin D supplements (Group 3). Outcomes were 14-day mortality and highest (worst) score on the ordinal scale for clinical improvement (OSCI) measured during COVID-19 acute phase. Potential confounders were age, gender, functional abilities, undernutrition, cancer, hypertension, cardiomyopathy, glycated hemoglobin, number of acute health issues at admission, hospital use of antibiotics, corticosteroids, and pharmacological treatments of respiratory disorders. Results. The three groups (n = 77; mean ± SD, 88 ± 5 years; 49% women) were similar at baseline (except for woman proportion, p = 0.02), as were the treatments used for COVID-19. In Group 1 (n = 29), 93.1% of COVID-19 participants survived at day 14, compared to 81.2% survivors in Group 2 (n = 16) (p = 0.33) and 68.7% survivors in Group 3 (n = 32) (p = 0.02). While considering Group 3 as reference (hazard ratio (HR) = 1), the fully-adjusted HR for 14-day mortality was HR = 0.07 (p = 0.017) for Group 1 and HR = 0.37 (p = 0.28) for Group 2. Group 1 had longer survival time than Group 3 (log-rank p = 0.015), although there was no difference between Groups 2 and 3 (log-rank p = 0.32). Group 1, but not Group 2 (p = 0.40), was associated with lower risk of OSCI score ≥5 compared to Group 3 (odds ratio = 0.08, p = 0.03). Conclusions. Regular bolus vitamin D supplementation was associated with less severe COVID-19 and better survival in frail elderly