Impact of exposure of methicillin-resistant Staphylococcus aureus to polyhexanide in vitro and in vivo.

Staphylococcus aureus (MRSA) resistant to decolonization agents such as mupirocin and chlorhexidine increase the need to develop alternative decolonization molecules. The absence of reported adverse reactions and bacterial resistance to polyhexanide makes it an excellent choice as topical antiseptic. In the present study we evaluated the in vitro and in vivo capacity to generate strains with reduced polyhexanide susceptibility and cross-resistance with chlorhexidine and/or antibiotics currently used in clinic. Here we report the in vitro emergence of reduced-susceptibility to polyhexanide by prolonged-stepwise exposure to low concentrations in broth culture. Reduced susceptibility to polyhexanide was associated with genomic changes in the mprF and purR genes, and with concomitant decreased susceptibility to daptomycin and other cell-wall active antibiotics. However, the in vitro emergence of reduced-susceptibility to polyhexanide did not result in cross-resistance to chlorhexidine antiseptic. During in vivo polyhexanide clinical decolonization treatment, neither polyhexanide reduced-susceptibility nor chlorhexidine cross-resistance were observed. Together, these observations suggest that polyhexanide could be used safely for decolonisation of carriers of chlorhexidine-resistant S. aureus strains but highlight the need for careful use of polyhexanide at low antiseptic concentrations

Styrene, an Unpalatable Substrate with Complex Regulatory Networks

Styrene, a volatile organic compound (VOC), is an important industrial material involved in the production of plastic, synthetic rubber and resin, insulation and other industrial materials containing molecules such as polystyrene, butadiene-styrene latex, styrene copolymers and unsaturated polyester resins. Styrene exposure may cause contact-based skin inflammation, irritation of eyes, nose and respiratory tract. Neurological effects such as alterations in vision, hearing loss and longer reaction times, have been associated with styrene exposure in the workplace. In addition, styrene oxide may act as an established mutagen and carcinogen (www.epa.gov/chemfact/styre-sd.pdf). It has been reported that, in 2002, 22,323 tons of styrene were released to the environment (82), in spite of the US Clean Air Act mandate on reduction in the volume of allowable styrene emission (www.epa.gov/chemfact/styre-sd.pdf). Among a variety of emerging air pollution technologies, biofiltration is an attractive option for the treatment of VOCs, because it is cost-effective and does not generate secondary contaminants (45). Moreover, microbial biodegradation is the major route for the removal of non-aqueous compounds from soils. Styrene is also naturally present in non polluted environments, since it derives from fungal decarboxylation of cinnamic acid (90). Therefore it is not surprising that microorganisms of different families have been found to be able to degrade this compound (31). The promising results obtained in the removal of styrene from contaminated waste-gases by biofiltration (5, 39, 103) have led to an increasing attention to the regulatory mechanisms underlying styrene degradation, with the aim to improve bioremediation processes. Despite the diffusion in nature of this degradative capability, only few strains, mainly belonging to the Pseudomonas genus, have been characterized (66). This chapter is focused on the up-to-now discovered regulatory mechanisms underlying the expression of the styrene-catabolism genes. Moreover, open questions on environmental and metabolic constrains that govern styrene degradation are discussed. Biotechnological relevance of styrene-degrading strains in fine chemicals production and bioremediation processes is not examined here. Main topics on these application fields have recently been reviewed by Dobson and co-workers (66)

Edoxaban versus warfarin in patients with atrial fibrillation

Contains fulltext : 125374.pdf (publisher's version ) (Open Access)BACKGROUND: Edoxaban is a direct oral factor Xa inhibitor with proven antithrombotic effects. The long-term efficacy and safety of edoxaban as compared with warfarin in patients with atrial fibrillation is not known. METHODS: We conducted a randomized, double-blind, double-dummy trial comparing two once-daily regimens of edoxaban with warfarin in 21,105 patients with moderate-to-high-risk atrial fibrillation (median follow-up, 2.8 years). The primary efficacy end point was stroke or systemic embolism. Each edoxaban regimen was tested for noninferiority to warfarin during the treatment period. The principal safety end point was major bleeding. RESULTS: The annualized rate of the primary end point during treatment was 1.50% with warfarin (median time in the therapeutic range, 68.4%), as compared with 1.18% with high-dose edoxaban (hazard ratio, 0.79; 97.5% confidence interval [CI], 0.63 to 0.99; P<0.001 for noninferiority) and 1.61% with low-dose edoxaban (hazard ratio, 1.07; 97.5% CI, 0.87 to 1.31; P=0.005 for noninferiority). In the intention-to-treat analysis, there was a trend favoring high-dose edoxaban versus warfarin (hazard ratio, 0.87; 97.5% CI, 0.73 to 1.04; P=0.08) and an unfavorable trend with low-dose edoxaban versus warfarin (hazard ratio, 1.13; 97.5% CI, 0.96 to 1.34; P=0.10). The annualized rate of major bleeding was 3.43% with warfarin versus 2.75% with high-dose edoxaban (hazard ratio, 0.80; 95% CI, 0.71 to 0.91; P<0.001) and 1.61% with low-dose edoxaban (hazard ratio, 0.47; 95% CI, 0.41 to 0.55; P<0.001). The corresponding annualized rates of death from cardiovascular causes were 3.17% versus 2.74% (hazard ratio, 0.86; 95% CI, 0.77 to 0.97; P=0.01), and 2.71% (hazard ratio, 0.85; 95% CI, 0.76 to 0.96; P=0.008), and the corresponding rates of the key secondary end point (a composite of stroke, systemic embolism, or death from cardiovascular causes) were 4.43% versus 3.85% (hazard ratio, 0.87; 95% CI, 0.78 to 0.96; P=0.005), and 4.23% (hazard ratio, 0.95; 95% CI, 0.86 to 1.05; P=0.32). CONCLUSIONS: Both once-daily regimens of edoxaban were noninferior to warfarin with respect to the prevention of stroke or systemic embolism and were associated with significantly lower rates of bleeding and death from cardiovascular causes. (Funded by Daiichi Sankyo Pharma Development; ENGAGE AF-TIMI 48 ClinicalTrials.gov number, NCT00781391.)