Academic literature on the topic 'Antibiotic synergy'

ABSTRACT Multiresistant Pseudomonas aeruginosa isolates can chronically infect patients with cystic fibrosis. Acute infective exacerbations are treated with combinations of two antipseudomonal antibiotics. Patients may respond clinically even if the bacteria are resistant, possibly due to antimicrobial synergy. The challenge for testing for synergy in vitro is that there is no standardized method, and the antibiotic susceptibility in a population of P. aeruginosa isolates in a single sputum sample can vary. We therefore compared (i) antibiotic combinations with different examples of resistant bacteria from the same sputum sample and (ii) the results of synergy testing by different methods. Antibiotic synergy was tested by using resistant P. aeruginosa isolates recovered from sputum samples taken just before the start of treatment for an acute infective exacerbation. Several examples of each morphotype of P. aeruginosa were tested by cidal checkerboard, time-kill curve, and multiple-combination bactericidal testing. The isolates were typed by pulsed-field gel electrophoresis (PFGE). The results were compared with the clinical and microbiological responses to 14 days of antibiotic treatment. Forty-four resistant isolates from nine patients were tested. Some P. aeruginosa isolates with the same morphotype and PFGE pulsotype had different results by synergy testing. There was a poor correlation between the results of the different methods of synergy testing, and no one method would have predicted the response to treatment in all patients. The in vitro effects of antibiotic combinations against different isolates from the same sputum sample can vary, and the results depend on the methodology used. The role of combination testing for the treatment of antibiotic-resistant P. aeruginosa in acute exacerbations of chronic infection in patients with cystic fibrosis needs to be reviewed.

We used classical mutagens in Gram-negativeEscherichia colito study synergies with different classes of antibiotics, test models of antibiotic mechanisms of action, and examine the basis of synergy. We used 4-nitroquinoline 1-oxide (4NQO), zebularine (ZEB), 5-azacytidine (5AZ), 2-aminopurine (2AP), and 5-bromodeoxyuridine (5BrdU) as mutagens (with bactericidal potency of 4NQO > ZEB > 5AZ > 2AP > 5BrdU) and vancomycin (VAN), ciprofloxacin (CPR), trimethoprim (TMP), gentamicin (GEN), tetracycline (TET), erythromycin (ERY), and chloramphenicol (CHL) as antibiotics. We detected the strongest synergies with 4NQO, an agent that oxidizes guanines and ultimately results in double-strand breaks when paired with the bactericidal antibiotics VAN, TMP, CPR, and GEN, but no synergies with the bacteriostatic antibiotics TET, ERY, and CHL. Each of the other mutagens displays synergies with the bactericidal antibiotics to various degrees that reflect their potencies, as well as with some of the other mutagens. The results support recent models showing that bactericidal antibiotics kill bacteria principally by ultimately generating more double-strand breaks than can be repaired. We discuss the synergies seen here and elsewhere as representing dose effects of not the proximal target damage but rather the ultimate resulting double-strand breaks. We also used the results of pairwise tests to place the classic mutagens into functional antibacterial categories within a previously defined drug interaction network.

With the increase in bacterial resistance to antibiotics, more and more therapeutic failures are being reported worldwide. The market for antibiotics is now broken due to the high cost of developing new molecules. A promising solution to bacterial resistance is combined phage–antibiotic therapy, a century-old method that can potentiate existing antibiotics by prolonging or even restoring their activity against specific bacteria. The aim of this literature review was to provide an overview of different phage–antibiotic combinations and to describe the possible mechanisms of phage–antibiotic synergy.

Methicillin-resistant Staphylococcus aureus (MRSA) infection is challenging to eradicate because of antibiotic resistance and biofilm formation. Novel antimicrobial agents and alternative therapies are urgently needed. This study aimed to evaluate the synergy of sanguisorbigenin (SGB) isolated from Sanguisorba officinalis L. with six conventional antibiotics to achieve broad-spectrum antibacterial action and prevent the development of resistance. A checkerboard dilution test and time-to-kill curve assay were used to determine the synergistic effect of SGB combined with antibiotics against MRSA. SGB showed significant synergy with antibiotics and reduced the minimum inhibitory concentration of antibiotics by 2–16-fold. Biofilm inhibition assay, quantitative RT-PCR, crystal violet absorption, and transmission electron microscopy were performed to evaluate the synergy mechanism. The results indicated that SGB could inhibit biofilm formation and alter cell membrane permeability in MRSA. In addition, SGB was found to exhibit quite low cytotoxicity and hemolysis. The discovery of the superiority of SGB suggests that SGB may be an antibiotic adjuvant for use in combination therapy and as a plant-derived antibacterial agent targeting biofilms.

Aim: This study investigated the susceptibility of Enterotoxigenic Escherichia coli to curcumin, as well as its synergistic effect with 12 antimicrobial drugs. Methods and Results: Our study shows that curcumin did not affect bacterial growth. The antimicrobial susceptibility of curcumin and antibiotic synergy were identified using disc diffusion on Mueller-Hinton agar. The strain of Enterotoxigenic Escherichia coli used was resistant to Ampicillin, Amoxicillin/Clavulanic acid, Ampicillin/Sulbactam, Ciprofloxacin, and Cefazolin. There was synergy between curcumin and the majority of antibiotics tested. Maximum synergy was observed with combinations of 330 µg/mL curcumin and Ceftazidime, followed by Cefotaxime, Amoxicillin/Clavulanic acid, Ampicillin, Aztreonam, Trimethoprim, Ciprofloxacin, Ceftriaxone, Cefazolin, Tetracycline, and Imipenem. Conclusion: Our findings indicated that curcumin might be useful as a combinatorial strategy to combat the antibiotic resistance of Enterotoxigenic Escherichia coli.

The problem of antibiotic resistance has garnered too much attention over the last few decades for posing a global hazard to the clinical handling and the inhibition of several deadly infections caused by bacteria. It burdens the world not only clinically but also economically... Antibiotic agents known as carbapenems are a very effective and typically designated for the treatment of multidrug-resistant (MDR) bacterial infections. To identify a suitable antibiotic combination to be used in vivo, one must be able to determine the synergism between the antibiotics in vitro. Several methods, such as the checkerboard method, multiple-combination bactericidal test, time-kill and E-test, have been used for this purpose. However, the lack of proper standardization procedures, types of bacterial agents, bacterial load, stage of infection and other factors make it very difficult to reproduce or correlate the results with other methods.Carbapenem-destroying lactases, which have recently emerged as mechanisms of resistance, are increasing in number and decreasing the treatment alternatives available. These infections are treated with colistin and tigecycline, but monotherapy may result in clinical breakdown because of a variety of factors. To control these infections, clinicians often choose combinations of drugs over monotherapy. There is an extreme lack of information on synergistic antibiotic combinations accounting for the diverse mechanisms of GNB resistance commonly encountered. The incidence of carbapenem-resistant GNB in Indian articles is also unknown. Therefore, we anticipate that this study may provide methodology for the selection of an appropriate antibiotic combination.

ABSTRACTGlycerol monolaurate (GML) is a natural surfactant with antimicrobial properties. At ∼0.3 mM, both GML and its component lauric acid were bactericidal for antibiotic-resistantStaphylococcus aureusbiofilms. With the use of MICs of antibiotics obtained from planktonic cells, GML and lauric acid acted synergistically with gentamicin and streptomycin, but not ampicillin or vancomycin, to eliminate detectable viable biofilm bacteria. Images of GML-treated biofilms suggested that GML may facilitate antibiotic interaction with matrix-embedded bacteria.

ABSTRACTTheBurkholderia cepaciacomplex (Bcc) is a group of at least 18 species of Gram-negative opportunistic pathogens that can cause chronic lung infection in cystic fibrosis (CF) patients. Bcc organisms possess high levels of innate antimicrobial resistance, and alternative therapeutic strategies are urgently needed. One proposed alternative treatment is phage therapy, the therapeutic application of bacterial viruses (or bacteriophages). Recently, some phages have been observed to form larger plaques in the presence of sublethal concentrations of certain antibiotics; this effect has been termed phage-antibiotic synergy (PAS). Those reports suggest that some antibiotics stimulate increased production of phages under certain conditions. The aim of this study is to examine PAS in phages that infectBurkholderia cenocepaciastrains C6433 and K56-2. Bcc phages KS12 and KS14 were tested for PAS, using 6 antibiotics representing 4 different drug classes. Of the antibiotics tested, the most pronounced effects were observed for meropenem, ciprofloxacin, and tetracycline. When grown with subinhibitory concentrations of these three antibiotics, cells developed a chain-like arrangement, an elongated morphology, and a clustered arrangement, respectively. When treated with progressively higher antibiotic concentrations, both the sizes of plaques and phage titers increased, up to a maximum.B. cenocepaciaK56-2-infectedGalleria mellonellalarvae treated with phage KS12 and low-dose meropenem demonstrated increased survival over controls treated with KS12 or antibiotic alone. These results suggest that antibiotics can be combined with phages to stimulate increased phage production and/or activity and thus improve the efficacy of bacterial killing.

Antibiotic resistance is an important public health problem. One potential solution is the development of synergistic antibiotic combinations, in which the combination is more effective than the component drugs. However, experimental progress in this direction is severely limited by the number of samples required to exhaustively test for synergy, which grows exponentially with the number of drugs combined. We introduce a new metric for antibiotic synergy, motivated by the popular Fractional Inhibitory Concentration Index and the Highest Single Agent model. We also propose a new experimental design that samples along all appropriately normalized diagonals in concentration space, and prove that this design identifies all synergies among a set of drugs while only sampling a small fraction of the possible combinations. We applied our method to screen two- through eight-way combinations of eight antibiotics at 10 concentrations each, which requires sampling only 2,560 unique combinations of antibiotic concentrations.

Bibliography
Thesis (MMed (Pathology. Medical Microbiology))--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Acinetobacter baumannii has emerged as one of the most troublesome nosocomial pathogens globally. This organism causes infections that are often extremely difficult to treat because of the widespread resistance to the major antibiotic groups. Colonization or infection with multidrugresistant A. baumannii is associated with the following risk factors: prolonged hospital stay, admission to an intensive care unit (ICU), mechanical ventilation, and exposure to broad spectrum antibiotics, recent surgery, invasive procedures, and severe underlying disease. A. baumannii has been isolated as part of the skin flora, mostly in moist regions such as axillae, groin and toe webs. It has also been isolated from the oral cavity and respiratory tract of healthy adults. Debilitated hospitalized patients have a high rate of colonization, especially during nosocomial Acinetobacter outbreaks. This organism is an opportunistic pathogen as it contains few virulence factors. Clinical manifestations of A. baumannii include nosocomial pneumonia, nosocomial bloodstream infections, traumatic battlefield and other wound infections, urinary tract infections, and post-neurological surgery meningitis. Fulminant community-acquired pneumonia has recently been reported, indicating that this organism can be highly pathogenic. The number of multidrug-resistant A. baumannii strains has been increasing worldwide in the past few years. Therefore the selection of empirical antibiotic treatment is very challenging. Antibiotic combinations are used mostly as empirical therapy in critically ill patients. One rationale for the use of combination therapy is to achieve synergy between agents. The checkerboard and time-kill methods are two traditional methods that have been used for synergy testing. These methods are labor intensive, cumbersome, costly, and time consuming. The E-test overlay method is a modification of the E-test method to determine synergy between the different antibiotics. This method is easy to perform, flexible and time efficient. The aim of this study was to assess the in vitro activity of different combinations of colistin, rifampicin, imipenem, and tobramycin against selected clinical strains of A. baumannii using the checkerboard and the E-test synergy methods. The MICs obtained with the E-test and broth microdilution method were compared. The results of the disk diffusion for imipenem and tobramycin as tested in the routine microbiology laboratory were presented for comparison. Overall good reproducibility was obtained with all three methods of sensitivity testing. The agreement of MICs between the broth dilution and E-test methods was good with not more than two dilution differences in MIC values for all isolates, except one in which the rifampicin E-test MIC differed with three dilutions from the MIC obtained with the microdilution method. However, the categorical agreement between the methods for rifampicin was poor. Although MICs did not differ with more than two dilutions in most cases, many major errors occurred because the MICs clustered around the breakpoints. The combinations of colistin + rifampicin, colistin + imipenem, colistin + tobramycin, rifampicin + tobramycin, and imipenem + tobramycin all showed indifferent or additive results by the E-test method. No results indicating synergy were obtained for all the above-mentioned combinations. There was one result indicating antagonistic effect for the combination of colistin + tobramycin. The results of the checkerboard method showed results indicating synergy in four of the six isolates for which the combination of colistin and rifampicin was tested. The other two isolates showed indifferent/additive results. All the other combinations showed indifferent/additive results for all isolates except isolate 30 (col + tob) and isolate 25 (rif + tob) which showed synergism. No antagonistic results were observed by the checkerboard method. When the results obtained with the E-test and checkerboard methods were compared, it was noted that for most antibiotic combinations an indifferent/additive result was obtained. However, for the colistin + rifampicin combination, the checkerboard method showed synergism for 4 of 6 isolates, whereas the E-test method showed indifference and an additive result in one. For the rifampicin + tobramycin, and colistin + tobramycin combinations, synergism was also shown with the checkerboard method in one isolate for each combination. The E-test method however showed an indifferent and additive result respectively. . The E-test method was found to be a rapid, reproducible, easy-to-perform, and flexible method to determine synergistic antibiotic activity. This study was however limited by low numbers of isolates. This might explain why no synergistic results were obtained with the E-test method and few synergistic results with the checkerboard method. Genotypic analysis using pulse-field gel electrophoresis (PFGE) may be considered in future studies to determine relatedness of the isolates which will facilitate the selection of different strains for synergy testing. Furthermore, clinical studies are needed to establish whether in vitro synergy testing is useful in the clinical setting and whether the results of synergy testing will have any bearing on the clinical outcome of patients infected with multidrug resistant A. baumannii.
AFRIKAANSE OPSOMMING: Acinetobacter baumannii het wêreldwyd as een van die mees problematiese nosokomiale patogene verskyn. Hierdie organisme veroorsaak infeksies wat dikwels baie moeilik is om te behandel weens wydverspreide weerstandigheid teen major antibiotikagroepe. Kolonisasie of infeksie met multi-weerstandige A. baumannii word geassosieer met die volgende riskofaktore: verlengde hospitaalverblyf, toelating tot ‘n intensiewe sorgeenheid (ICU), meganiese ventilasie, blootstelling aan breëspektrum antibiotika, onlangse chirurgie, indringende prosedures en ernstige onderliggende siekte. A. baumannii kan deel vorm van die normale velflora, veral in die axillae, inguinale area en tussen die tone. Dit is ook al vanuit die mondholte en die respiratoriese traktus van gesonde volwassenes geïsoleer. Verswakte gehospitaliseerde pasiënte word veral gekoloniseer gedurende nosokomiale Acinetobacter uitbrake. Hierdie organisme is ‘n opportunistiese patogeen en bevat min virulensie faktore. Kliniese manifestasies van A. baumannii sluit nosokomiale pneumonie, nosokomiale bloedstroom infeksies, troumatiese slagveld- en ander wondinfeksies, urienweginfeksies en meningitis wat volg op neurologiese chirurgie in. Fulminerende gemeenskapsverworwe pneumonie is onlangs beskryf en dui aan dat hierdie organisme hoogs patogenies kan wees. Die aantal multi-weerstandige A. baumannii stamme het wêreldwyd toegeneem oor die laaste paar jare. Daarom is die seleksie van empiriese antibiotiese behandeling ‘n uitdaging. Antibiotika kombinasies word meestal as empiriese behandeling in ernstige siek pasiënte gebruik. Die beginsel hiervan is om sinergistiese werking tussen agente te verkry. Die “checkerboard” en “time-kill” metodes is twee tradisionele metodes van sinergisme toetsing. Hierdie metodes is werksintensief, duur en tydrowend. Die E-toets sinergisme metode is gebaseer op die E-toets metode. Hierdie metode is maklik, buigbaar en tydseffektief. Die doel van hierdie studie was om die in vitro aktiwiteit tussen verskillende antibiotika kombinasies van colistin, rifampisien, imipenem, en tobramisien teen geselekteerde kliniese A. baumannii isolate te toets met die “checkerboard” en E-toets sinergisme toetsing metodes. Die minimum inhibitoriese konsentrasies (MIKs) verkry met die E-toets en “broth microdilution” metode is ook vergelyk. Die resultate van die skyfie diffusie metode (die metode wat in die roetiene mikrobiologie laboratorium gebruik word) vir imipenem en tobramisien word ook verskaf vir vergelyking van die resultate van verskillende sensitiwiteitsmetodes. In oorsig is goeie herhaalbaarheid van resultate verkry met al drie metodes van sensitiwiteitstoetsing. Die ooreenstemming van MIKs tussen die “broth dilution” en E-toets metodes was goed en resultate het met nie meer as twee verdunnings in MIK waardes verskil nie. Daar is een uitsondering waar die rifampisien E-toets MIK waarde met drie verdunnings van die MIK waarde verkry met die “microdilution” metode verskil. Die ooreenstemming tussen die sensitiwiteitskategorie resultate tussen die twee metodes was egter swak vir rifampisien. Alhoewel die MIKs in die meeste gevalle met nie meer as twee verdunnings in waarde verskil het nie, was daar baie major foute aangetoon omdat die MIKs rondom die breekpunte geval het. Die kombinasies van colistin + rifampisien, colistin + imipenem, colistin + tobramisien, rifampisien + tobramisien, en imipenem + tobramisien het oorwegend slegs matige interaksie met die E-toets metode getoon. Geen sinergisme is verkry met enige van die antibiotika kombinasies met hierdie metode nie. Daar was egter een resultaat wat antagonisme getoon het vir die kombinasie van colistin + tobramycin. Die resultate van die “checkerboard” metode het sinergisme getoon in vier van die ses isolate wat vir die kombinasie van colistin en rifampisien getoets was. Die ander twee isolate het slegs matige interaksie getoon. Al die ander kombinasies het ook slegs matige interaksie getoon, behalwe in isolaat 30 (col + tob) en isolaat 25 (rif + tob) waar die spesifieke kombinasies sinergisme getoon het. Geen antagonisme is waargeneem met die “checkerboard” metode nie. Met vergelyking van die E-toets en “checkerboard” metodes, is dit opmerklik dat vir die meeste van die antibiotika kombinasies slegs matige interaksie verkry is. Vir die colistin + rifampisien kombinasie toon die “checkerboard” metode egter sinergisme vir 4 uit 6 isolate, terwyl die E-toets metode slegs matige interaksie toon. Vir rifampisien + tobramisien, en colistin + tobramisien kombinasies is sinergisme getoon met die “checkerboard” metode in een isolaat vir elke kombinasie. Die E-toets metode het slegs matige interaksie getoon. Die E-toets sinergisme metode was vinnig, herhaalbaar en maklik om uit te voer. Hierdie studie word egter beperk deur lae getalle van isolate. Dit mag verklaar waarom geen sinergistiese resultate met die E-toets metode verkry is nie en die min sinergistiese resultate met die “checkerboard” metode. Genotipiese analiese met “pulse-field gel electrophoresis” mag in aanmerking geneem word in toekomstige studies om die verwantskap tussen isolate te bepaal wat die seleksie van verskillende stamme vir sinergisme toetsing sal vergemaklik. Verder, kliniese studies is nodig om te bepaal of in vitro sinergisme toetsing van waarde is en of die resultate van sinergisme toetsing ‘n rol speel in die kliniese uitkoms van pasënte geïnfekteer met multiweerstandige A. baumannii.
The National Health Laboratory Serivice

The prevalence of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBLs) and carbapenemases is increasing worldwide. Therapeutic options for infections with these bacteria are limited not only by the production of ESBLs and carbapenemases, which confer resistance to cephalosporins and carbapenems, but also by frequent co-resistance to other antibiotics. The overall aim of this thesis was to obtain a better understanding of multidrug-resistant E. coli and K. pneumoniae in relation to epidemiology, selection and susceptibility to antibiotic therapy. In a prospective study ESBL-producing E. coli was found to spread easily through international travel. Twenty-four of 100 Swedes travelling outside Northern Europe acquired ESBL-producing E. coli in the intestinal flora. The risk was highest for travelers visiting India and those suffering from gastroenteritis during travel. To minimize selection of ESBL-producing K. pneumoniae during a hospital outbreak with these bacteria, an educational antibiotic intervention was performed at Uppsala University Hospital in 2006. The primary aim of the intervention was to reduce the consumption of parenteral cephalosporins. An immediate and radical reduction of cephalosporins was demonstrated with interrupted time series analysis. The outbreak declined during 2007 and no increased resistance to replacement antibiotics was detected. The impact of ESBL production on the antibacterial activity of ertapenem was studied in time-kill experiments. It was shown that porin-deficient subpopulations with reduced susceptibility to ertapenem frequently emerged in ESBL-producing E. coli during exposure to ertapenem at concentrations simulating human pharmacokinetics. Further, the antibacterial effects of antibiotic combinations against four strains of K. pneumoniae producing carbapenemases of the metallo-beta-lactamase type were studied in time-kill experiments. Double and triple combinations of aztreonam, fosfomycin, meropenem, rifampin and colistin at clinically relevant static concentrations were effective despite that the bacteria were frequently resistant to the individual drugs. These results indicate that there is a largely unexplored potential of antibiotic combination therapy for multidrug-resistant K. pneumoniae.

C-reactive protein (CRP) is a part of the innate immune system, is synthesized in the liver, its blood level increases in inflammatory states, and it binds to Streptococcus pneumoniae. The conformation of CRP is altered under conditions mimicking an inflammatory milieu and this non-native CRP also binds to immobilized/aggregated/pathogenic proteins. Experiments in mice have revealed that one of the functions of CRP is to protect against pneumococcal infection. For protection, CRP must be injected into mice within two hours of administering pneumococci, thus, CRP is protective against early-stage infection but not against late-stage infection. It is unknown how CRP protects or why CRP does not protect against late-stage infection. The hypotheses are that the protection requires complement activation by CRP-pneumococci complexes and that CRP cannot protect if pneumococci have time to recruit complement inhibitor factor H on their surface to become complement attack-resistant. To test these hypotheses, we generated CRP mutants by site-directed mutagenesis: a mutant that binds to pneumococci but does not activate complement and a mutant that binds to immobilized factor H. We found that mutant CRP incapable of activating complement was not protective against infection and that mutant CRP capable of binding to factor H was protective against both early and late stage infections. Additional experiments showed that CRP enhances the effects of the antibiotic clarithromycin in reducing bacteremia in infected mice. Moreover, we observed that mutant CRP capable of binding to factor H bound to several proteins immobilized on plastic, suggesting that CRP recognizes a pattern, probably an amyloid-like structure, on immobilized proteins. Indeed, mutant CRP, after binding to amyloid b peptides, prevented the formation of pathogenic amyloid fibrils. Lastly, employing a hepatic cell line, we investigated the mechanism of CRP expression in response to pro-inflammatory cytokines. We found that the transcription factor C/EBPb and two C/EBP-binding sites on the CRP promoter were critical for inducing CRP expression. We conclude that complement activation is necessary for CRP-mediated protection against infection, that CRP functions in two structural conformations, that CRP and clarithromycin act synergistically, that CRP has anti-amyloidogenic properties, and the increased CRP expression requires C/EBPb.

Urban emissions of antibiotics into the environment have the potential to adversely affect terrestrial and aquatic organisms. Developed standardized test methods allow the quantification of the resulting ecotoxicological risk, which strongly relies on a comprehensive situation analysis by predicting or measuring a representative antibiotic concentration of interest. Predicting the input loads of antibiotics to wastewater treatment plants using secondary input data (e.g. prescriptions) is a reasonable method if no analytical data is available. The absence of such data poses the question of an aquired reasonable sample quantity to capture local seasonal differences in prescriptions as well as flow conditions within the catchment area. Both, the theoretical and measurement based determination of environmental concentrations have been scarcely verified in practice. Hence, high resolution prescription data in combination with an extensive monitoring campaign at the wastewater treatment plant Dresden-Kaditz (WWTP) were used as a basis to evaluate the reliability of predicting and measuring urban antibiotic emissions. As expected, the recovery of antibiotic input loads strongly varies among substances. The group of macrolides as well as sulfamethoxazole and trimethoprim were almost fully recovered whereas nearly all substances of the beta-lactam family exhibit high elimination rates during the wastewater transport in the sewer system. Yet other antibiotics (e.g. fluoroquinolones) show distinct fluctuations through the year, which was not obvious from relatively constant prescriptions. The latter substances are an example that available data are not per se sufficient to predict the actual release into the environment which, in certain cases, emphasizes the necessity of adequate measuring campaings. The extensive data pool of this study was hence used to calculate the necessary number of samples to determine a representative annual mean load to the WWTP. Based on the applied approach, a minimum number of 20 to 40 samples per year is proposed to reasonably estimate a representative annual input load of antibiotics and other micropollutants. Regarding the WWTP, the mass flow analysis revealed that macrolides, clindamycin/ clindamycin-sulfoxide and trimethoprim were mainly released with the effluent, while penicillins, cephalosporins as well as sulfamethoxazole were partly degraded in the studied WWTP. Levofloxacin and ciprofloxacin are the only antibiotics under investigation with a significant mass fraction bound to primary, excess and digested sludge. In this context, the sludge concentrations are considered to be highly inconsistent which leads to questionable results. It remains unclear whether the inconsistencies are due to insufficiencies in sampling and/or analytical determination or if the fluctuations can be considered reasonable for digesters. Subsequently, verified antibiotic loads were evaluated regarding their ecotoxicological effects in the aquatic environment. Two approaches were applied (1) to address the ecological impact on individual trophic levels algae, daphnia and fish, and (2) to assess the possible synergistic potential of antibiotic combinations. Ciprofloxacin, levofloxacin and the group of cephalosporins showed to significantly affect the aquatic environment. They either have the highest impact on (one of) the lowest trophic level(s) or disproportionately increase the ecotoxicological risk due to their synergistic characteristics. In this regard, the deficiencies regarding the input prediction of these antibiotics is of particular concern. The underestimation of such critical mass flow conditions weakens the approach of assessing environmental risks on the basis of secondary data like prescriptions. Hence, efforts must be made to further develop the projection model by improving the quality of secondary data, identifying additional emitters and understanding possible retention and degradation dynamics of antibiotics within the sewer system
In der Humanmedizin eingesetzte Antibiotika werden im menschlichen Körper nicht vollständig metabolisiert und gelangen über die Ausscheidungen in das kommunale Abwasser. In der Kläranlage erfolgt nur eine unvollständige Elimination dieser Stoffe, so dass der Kläranlagenablauf einen Hot Spot für Antibiotikaemissionen in die Umwelt darstellt. Das induzierte ökotoxikologische Risiko kann anhand standardisierter Testverfahren und allgemein anerkannter Bewertungsansätze für Einzelsubstanzen abgeschätzt werden. Erfolgt jedoch die Betrachtung von Antibiotikagemischen, wie es für den gereinigten Ablauf einer Kläranlage sinnvoll ist, sind aufgrund zumeist unspezifischer Wirkmechanismen und dem Mangel an repräsentativen Daten eine Reihe von Vereinfachungen und Annahmen zu treffen. Es besteht in der Folge die Gefahr einer Unterschätzung des durch Substanzgemische hervorgerufenen ökotoxikologischen Risikos. Eine vielversprechende Möglichkeit den Entscheidungsprozess über mögliche Vermeidungs- und Eliminationsmaßnahmen zu unterstützen besteht in der Priorisierung von Antibiotika entsprechend ihres Effektpotentials. Hierbei sind Substanzen zu identifizieren, die den größten Einfluss auf die Nahrungskette im Gewässer bzw. das höchste (negative) Synergiepotential mit anderen Substanzen aufweisen. Die Verringerung dieser Substanzen führt zu einer hohen ökologischen Effektivität und Effizienz der eingesetzten Mittel. Wie im Fall des klassischen Bewertungsansatzes, ist auch für den Priorisierungsansatz eine umfängliche und zuverlässige Situationsanalyse die Grundvoraussetzung für verwertbare Ergebnisse. Die Situationsanalyse beruht auf der analytischen Bestimmung bzw. der Abschätzung von emittierten Antibiotikafrachten zur Berechnung von repräsentativen Umweltkonzentrationen. Analytisch ermittelte Umweltkonzentrationen vieler Antibiotika weisen aufgrund saisonaler Verschreibungsmuster eine hohe zeitliche und räumliche Variabilität auf. Die für eine adäquate Erfassung der Situation notwendigen Messkampagnen sind kostenintensiv, wobei die tatsächlich notwendige Häufigkeit der Probenahme von zumeist nicht hinreichend bekannten substanzspezifischen Informationen, wie der chemischen Stabilität im Rohabwasser und der saisonal beeinflussten Applikation, abhängt. Alternativ können Antibiotikaeinträge in die Kanalisation anhand von Verschreibungsdaten abgeschätzt und mit Hilfe von Stoffflussanalysen (SFA) zur ökotoxikologischen Bewertung herangezogen werden. Eine vom Umfang befriedigende, direkte Gegenüberstellung von prognostizierten und analytisch ermittelten Frachten ist bisher jedoch nicht erfolgt, so dass die Verifizierung dieses Ansatzes noch aussteht. Für den Fall einer bestehenden Verschreibungspflicht für Antibiotika besitzen Verschreibungsdaten eine vergleichsweise hohe zeitliche und räumliche Informationsgüte. In Verbindung mit einer an diese Datenqualität angepassten Messkampagne, ergibt sich die Möglichkeit einer detaillierten SFA mit substanzspezifischer Bewertung der Eignung des Prognoseansatzes. Die am Beispiel der Stadt Dresden durchgeführte Bewertung des Prognoseansatzes fußt auf einer 15-monatigen Messkampagne und den für das Einzugsgebiet der Zentralkläranlage Dresden-Kaditz verfügbaren Verschreibungsdaten der AOK PLUS. Erwartungsgemäß ergibt der Abgleich von erwarteten und analytisch ermittelten Frachten eine starke Variation der für den Zulauf der Kläranlage ermittelten Wiederfindungsdaten verschiedener Substanzen. Die analytisch ermittelten Frachten von Sulfamethoxazol, Trimethoprim sowie der Gruppe der Makrolid-Antibiotika entsprechen nahezu den prognostizierten Mengen. Die Beta-Laktam-Antibiotika unterliegen bereits während des Abwassertransports einer umfänglichen, zumeist biologisch bedingten, Elimination, was zu hohen Unterbefunden im Zulauf der Kläranlage führt. Andere Substanzen hingegen (z.B. Fluorchinolone) weisen messtechnisch eine signifikante Jahresdynamik auf, die aufgrund der weitgehend konstanten Verschreibung in dieser Ausprägung nicht zu erwarten ist. Die Auswertung zuletzt genannter Substanzen zeigt deutlich, dass die Nutzung von Verschreibungsdaten nicht per se ausreicht, um die Emission von Antibiotika (und anderer Pharmazeutika) sowie die sich daraus ergebenden Umweltkonzentrationen mit ausreichender Sicherheit prognostizieren zu können. Für eine nachgelagerte ökotoxikologische Bewertung ist in diesen Fällen die Durchführung von Messungen unumgänglich. Zur effizienten Planung derartiger Kampagnen wurde der umfassende Datenpool dieser Studie hinsichtlich der erforderlichen Probenanzahl zur Bestimmung einer repräsentativen mittleren Jahresfracht ausgewertet. Es ergibt sich ein Minimum von 20 bis 40 homogen über das Jahr verteilten Proben, um die jährlich in die Kläranlage eingetragene Fracht an Antibiotika bzw. anderer Mikroschadstoffe mit ausreichender Sicherheit abschätzen zu können. Im Rahmen der SFA in der Kläranlage Dresden-Kaditz wird deutlich, dass Makrolide, Clindamycin und dessen Humanmetabolit Clindamycin-Sulfoxid sowie Trimethoprim in der nahezu keiner Elimination unterliegen, wohingegen Penizilline, Cefalosporine und auch Sulfamethoxazol teilweise bis vollständig abgebaut werden. Mit Levofloxacin und Ciprofloxacin handelt es sich um die einzigen untersuchten Antibiotika, welche zu einem signifikanten Massenanteil an Primär-, Überschuss- und Faulschlamm gebunden vorgefunden werden. Aufgrund der hohen Relevanz dieses Eliminationspfades für die zuvor genannten Antibiotika bedarf die Beobachtung von z. T. widersprüchlichen Schwankungen einer kritischen Betrachtung der Ergebnisse. Es ist nicht abschließend geklärt, ob die beobachteten Fluktuationen auf eine unzureichende Qualität der Probenahme und/oder der Analytik zurückzuführen sind oder sich die Schwankungen in einem für Faulbehälter tolerierbaren Bereich befinden. Im Anschluss an die verifizierten Antibiotikaemissionen erfolgte die Priorisierung der betrachteten Antibiotika nach ihrem ökotoxikologischen Effektpotential. Zum einen wurde der ökologische Einfluss auf verschiedene, die Nahrungskette bildende trophische Ebenen (Alge, Daphnie, Fisch) untersucht. In Anlehnung an die humanmedizinische Kombinationstherapie erfolgte im zweiten Ansatz die Beurteilung der Antibiotika hinsichtlich ihres möglichen Potentials zur Verstärkung von negativen Effekten durch das gleichzeitige Auftreten mit anderen Substanzen. Für Ciprofloxacin, Levofloxacin und die Gruppen der Makrolide und Cefalosporine konnten signifikante Beeinträchtigungen der aquatischen Umwelt nachgewiesen werden. Diese Stoffe und Stoffgruppen führten im Rahmen der untersuchten Substanzen entweder zur höchsten Schadwirkung gegenüber der niedrigsten trophischen Ebene oder besitzen das höchste Synergiepotential in Kombination mit anderen Substanzen. Die Auswertung der SFA bestätigt die grundsätzliche Eignung der Verschreibungsdaten sowie des entwickelten Prognosemodells zur Vorhersage von Antibiotikaemissionen im urbanen Raum. Die Stoffflussanalyse stellt somit ein strategisches, im Vergleich zur Messung kostengünstiges Instrument zur Identifikation von Hot Spots der Antibiotikaemission dar und erleichtert die Entscheidungsfindung für monetär aufwendige Reduktionsmaßnahmen am Ort der Entstehung oder in der Kläranlage (z.B. 4. Reinigungsstufe). Die Vorgehensweise zur Priorisierung von Substanzen hinsichtlich ihres ökotoxikologischen Effektpotentials eignet sich sehr gut, Antibiotika mit dem höchsten Schadpotential zu identifizieren. Die Verschneidung der Kenntnis dieser Substanzen mit den Ergebnissen der SFA macht deutlich, dass mit Ausnahme der Makrolide, alle ökotoxikologisch priorisierten Antibiotika eine mangelhafte Prognosefähigkeit aufweisen. Die unvollständige Abbildung kritischer Stoffströme, wie z.B. Frachtspitzen, führt insbesondere im Fall der ökotoxikologisch priorisierten Substanzen zu einer Minderung der Aussagekraft des auf Verschreibungsdaten beruhenden Prognoseansatzes. An diesem Punkt ist in zukünftigen Betrachtungen anzusetzen, um die Qualität von Verschreibungsdaten zu verbessern, potentiell nicht erfasste Emittenten in die Betrachtungen einzubeziehen, sowie die Dynamik der Rückhalte- und Eliminationsprozesse in der Kanalisation adäquat beschreiben zu können. Die ergänzende Betrachtung weiterer Anlagentechnologien (z.B. Festbettreaktoren) kann zur Bestätigung der am Beispiel der Kläranlage Dresden-Kaditz gewonnenen Ergebnisse beitragen bzw. Unterschiede bei der Elimination von Antibiotika das Potential, die Problematik der Antibiotika und anderer Mikroschadstoffe bereits während der Planung von Abwasseranlagen berücksichtigen zu können

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CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Neste trabalho investigou-se diferentes sínteses de nanopartículas de prata (AgNPs), misturadas ou não com antibióticos e misturadas ou não com quitosana com o objetivo de verificar as propriedades antibacterianas das misturas, e as interações químicas dos adsorbatos na superfície das AgNPs através da técnica de Espectroscopia por espalhamento Raman Intensificada por Superfície (SERS). A proposta considera uma alternativa para o uso de antibióticos, devido a um número crescente de linhagens bacterianas resistentes. Os testes biológicos contra as bactérias Escherichia coli, Pseudonomas aeruginosa, Klebisiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis e Staphylococcus epidermides foram realizados em colaboração com Laboratório de Fisiologia e Genética Molecular Bacteriana do Instituto de Ciências Biológicas da Universidade Federal de Juiz de Fora (UFJF). Nos testes biológicos verificou-se que algumas associações de AgNPs, quitosana e os antibióticos levofloxacina (LV), tetraciclina (TC), rifampicina (RP), benzilpenicilina (BP), meropenem (MP), ampicilina (AP), amicacina (AC), gentamicina (GT), vancomicina (VC) e oxacilina (OC) promoveram a intensificação do efeito antibacteriano de forma sinérgica. Também foram obtidos os espectros SERS dos antibióticos LV, TC, BP e RP e realizados os cálculos teóricos dos modos normais de vibração dos complexos destas espécies com prata, em colaboração com o Núcleo de Estudos em Química Computacional do departamento de química da UFJF. Com isso, foi possível realizar as atribuições vibracionais dos espectros Raman dos compostos sólidos e SERS das espécies adsorvidas, inferindo-se assim as geometrias de adsorção.
In this work were investigated several synthesis of silver nanoparticles (AgNPs), mixed or not with antibiotics and mixed or not with chitosan, in order to verify the antibacterial properties of the mixtures and the chemical interaction of the adsorbates with silver surface by Surface-Enhanced Raman Scattering (SERS) spectroscopy. The proposal consists in an alternative for antibiotic use, due to a large number of resistant bacteria strains. The biological tests against Escherichia coli, Pseudonomas aeruginosa, Klebisiella pneumoniae, Staphylococcus aureus, Enterococcus faecalis and Staphylococcus epidermides were made in collaboration with the Laboratório de Fisiologia e Genética Bacteriana in the Instituto de Ciências Biológicas of the Universidade Federal de Juiz de Fora (UFJF). In biological tests, some associations of the AgNPs and chitosan and the antibiotics levofloxacin (LV), benzylpenicillin (BP), tetracycline (TC), rifampicina (RP), meropenem (MP), amikacin (AC), gentamicin (GT), ampicillin (AP), oxacillin (OC) promotes the antibacterial effect in a synergic mechanism. Also were obtained the SERS spectra of LV, TC, BP and RP and the vibrational assignment were obtained by density functional theory (DFT) calculations. Such work was made in collaboration with the Núcleo de Estudos em Química Computacional from the Departamento de Química of the UFJF. In this way, it was possible to perform the vibrational assignment of the Raman spectra of the solid compounds and the SERS spectra of the adsorbed species, inferring the adsorption geometries.

Les bactéries multirésistantes (BMR) représentent un véritable problème de santé publique. Les antibiotiques conventionnels commencent à devenir inefficaces et des bactéries qu’à une époque étaient contrôlées, commencent à devenir de plus en plus pathogènes. L’utilisation des actifs dérivant des plantes comme certains composants issus des huiles essentielles ont déjà démontré une action bactérienne contre plusieurs bactéries dites résistantes. Pour l’administration de ces actifs, à nature lipophile, nous les avons encapsulés à l’intérieur des nanocapsules au cœur lipidique (NCL) grâce à une modification de la méthode d’inversion de phase développé dans le laboratoire Inserm U1066 au début des années 2000. Le but de cette thèse est de trouver une association avec des antibiotiques qui puisse s’avérer synergique contre des BMR. Nous avons obtenu une synergie sur plusieurs souches bactériennes avec un mélange avec trois actifs différents : l’eugénol, le carvacrol et le cinnamaldéhyde et la doxycycline (antibiotique bactériostatique de la famille des tetracyclines). Cette synergie a été également testée in vivo sur un modèle pneumopatique de souris avec des résultats qui semblent en concordance avec les résultats in vitro. Nous nous sommes servis des méthodes physico-chimiques comme l’angle de contact ou la mobilité électrophorétique, dans le but d’étudier les interactions entre les NCL et les bactéries. Les résultats obtenus semblent indiquer que les NCL recouvrent la surface de la bactérie et libèrent leurs actifs, néanmoins nous n’écartons pas l’hypothèse qu’une certaine quantité des NCL puisse aussi pénétrer la bactérie
Multiresistant bacteria (MRB) present today a public health problem. Some antibiotics are ineffective and bacteria formerly controlled, begin to become more and more pathogenic. The use of drugs derived from plants as some components from essential oils have demonstrated a bactericidal effect against resistant bacteria.For the administration of these lipophilic drugs, they have been encapsulated in the core of lipidnanocapsules (LNC), formulated via the phase inversion method. This method was developed in the laboratory Inserm U1066 in the early 2000s.The aim of this thesis is to find a combination with an antibiotic that prove to be synergistic against MRB. We have found a synergistic effect with the combination of doxycycline (bacteriostatic antibiotic of the tetracycline class) and the LNC of a mixture of three aromatic components of essential oils (eugenol,carvacrol and cinnamaldehyde). This synergy was also tested in vivo in a pneumopathicmice model with interesting results which appear consistent with in vitro results.The interactions between LNC and bacteria were studied using physicochemical method as electrophoretic mobility and contact angle measurement. Obtained results suggest that LNC cover the surface of the bacteria and release the aromatic components. These results are also observed by confocal microscopy. Nevertheless, we also accept the hypothesis that, a certain amount of LNC can cross the bacteria