ar Treating the Sickness at the Heart of Africa By feedproxy.google.com Published On :: Wed, 29 Jun 2005 22:00:00 GMT Full Article
ar Chad: Back towards War? By feedproxy.google.com Published On :: Wed, 31 May 2006 22:00:00 GMT Full Article
ar North Kivu: How to End a War By feedproxy.google.com Published On :: Sun, 02 Dec 2007 23:00:00 GMT Full Article
ar Burundi: Restarting Political Dialogue By feedproxy.google.com Published On :: Mon, 18 Aug 2008 22:00:00 GMT Full Article
ar Burundi: Arusha Spirit Must Prevail By feedproxy.google.com Published On :: Sat, 30 Aug 2008 22:00:00 GMT Full Article
ar A Clear Vision for US and Africa By feedproxy.google.com Published On :: Thu, 11 Dec 2008 23:00:00 GMT Full Article
ar Rape as a Weapon of War in Congo By feedproxy.google.com Published On :: Wed, 10 Jun 2009 22:00:00 GMT Full Article
ar Congo: A Comprehensive Strategy to Disarm the FDLR By feedproxy.google.com Published On :: Wed, 08 Jul 2009 22:00:00 GMT Full Article
ar Time for a New Approach to Disarm the FDLR By feedproxy.google.com Published On :: Thu, 06 Aug 2009 22:00:00 GMT Full Article
ar Les FDLR doivent desarmer By feedproxy.google.com Published On :: Thu, 17 Sep 2009 22:00:00 GMT Full Article
ar UN Must Stop Backing Congo's Disastrous Operation Against Marauding Rebel Militias By feedproxy.google.com Published On :: Sun, 29 Nov 2009 23:00:00 GMT Full Article
ar After MONUC, Should MONUSCO Continue to Support Congolese Military Campaigns? By feedproxy.google.com Published On :: Sun, 18 Jul 2010 22:00:00 GMT For more than a year and a half, UN peacekeepers have continuously supported military operations conducted by the Congolese armed forces (FARDC) against the Rwandan rebels of the Democratic Forces for the Liberation of Rwanda (FDLR) in North and South Kivu. Full Article
ar Kongo muss jetzt Verbrechen aufarbeiten By feedproxy.google.com Published On :: Thu, 28 Oct 2010 22:00:00 GMT Es ist eine einmalige Chance, die sich dieser Tage bietet: Die Veröffentlichung eines lang erwarteten Berichts der Vereinten Nationen über Verbrechen in der Demokratischen Republik Kongo (DRK) ist die Gelegenheit für eine Wiederaufarbeitung der Geschichte der massiven Gewalt im Kongo zwischen 1993 und 2003. Full Article
ar Chad’s North West: <br> The Next High-risk Area? By feedproxy.google.com Published On :: Wed, 16 Feb 2011 23:00:00 GMT Chad’s North West may become the next stage for insurgency, drug-running and religious extremism in the Sahel if the government continues to actively neglect the poorest of the violence-plagued country’s poor regions. Full Article
ar Central African Republic: The Dark Side of Diamonds By feedproxy.google.com Published On :: Sun, 20 Feb 2011 23:00:00 GMT The international watchdog which seeks to prevent diamonds from fuelling conflict, the Kimberley Process, should take a very close look at the situation in the Central African Republic Full Article
ar Implementing Peace and Security Architecture (I): Central Africa By feedproxy.google.com Published On :: Mon, 07 Nov 2011 12:14:00 GMT More than a decade after the Economic Community of Central African States (ECCAS) was requested by the African Union (AU) to give life to a new peace and security architecture, political and security cooperation on the continent is still in need of reinforcement. Full Article
ar The Lord’s Resistance Army: End Game? By feedproxy.google.com Published On :: Wed, 16 Nov 2011 23:00:00 GMT Insufficient political will has thwarted regional efforts to stop the murderous Lord’s Resistance Army (LRA) but vigorous diplomacy led by the African Union (AU), an immediate military push and complementary civilian initiatives could end the misery of thousands. Full Article
ar Préparer le Cameroun à l'après-Biya pour une stabilité durable By feedproxy.google.com Published On :: Sat, 19 Nov 2011 23:00:00 GMT Le président sortant vient d'entamer un sixième mandat au Cameroun. Aujourd'hui, le pays est résolument tourné vers l'avenir et pense à l'après-Biya. Full Article
ar Burundi: Bye-bye Arusha? By feedproxy.google.com Published On :: Wed, 24 Oct 2012 22:00:00 GMT Since the 2010 boycotted elections, Burundi is steadily drifting away from what was initially regarded as a peacemaking model, and violence from both the ruling party and the opposition is threatening stability. Full Article
ar Neustart By feedproxy.google.com Published On :: Wed, 23 Jan 2013 23:00:00 GMT Die Zentralafrikanische Republik kennzeichnet eine lange Geschichte der Instabilität. Wie die jüngste Krise gehandhabt wurde, deutet indessen auf eine neue sicherheitspolitische Konstellation hin. Full Article
ar Restart By feedproxy.google.com Published On :: Wed, 23 Jan 2013 23:00:00 GMT The Central African Republic has a long history of crises, but the way the most recent one was managed indicates that a new security constellation may be emerging in the region. Full Article
ar Central African Republic: Thinking Out of the Box to Save the CAR By feedproxy.google.com Published On :: Tue, 24 Sep 2013 13:16:00 GMT All this foreign involvement has failed to prevent the recent coup or stabilize its aftermath. BINUCA has not been able to implement a disarmament, demobilisation and reintegration program, and it failed to convince Bozizé’s regime to reform the security sector or consolidate the peace. ECCAS has been unable to restore order in one of the smallest capitals of Africa, and troop-contributing countries have proved unable to deliver the 600 extra soldiers they committed to provide in April. Paradoxically, France, while securing Bangui’s airport, is also hosting ousted president Bozizé, who declared from exile in Paris his wish to retake power by force with the “support” of private actors. Full Article
ar Central African Republic is descending into anarchy By feedproxy.google.com Published On :: Tue, 19 Nov 2013 23:00:00 GMT Since the March 24 coup by the Seleka, a loose coalition of Muslim rebels, the Central African Republic has been in free fall. There are about 400,000 internally displaced people, 64,000 refugees, and burned villages, largely in the western part of the country. Banditry, the rise of self-defense militias and clashes between Christian and Muslim communities are now part of daily life for this mineral-rich country in the heart of Africa. The expanding insecurity makes the delivery of humanitarian assistance difficult, and the United Nations has even warned of the risk of genocide. Full Article
ar Imaginación para salvar República Centroafricana. Cómo actuar con rapidez y eficacia para evitar la somalización del país. By feedproxy.google.com Published On :: Sun, 24 Nov 2013 23:00:00 GMT Los conflictos en los países pequeños suelen agravarse debido a la indiferencia internacional. Sin embargo, en el caso de la República Centroafricana (RCA), el problema es ligeramente distinto. Hay una importante presencia internacional en este Estado, pero los actores principales han decidido mantenerse al margen y esperar en vez de intervenir activamente en la crisis. Full Article
ar The CAR Crisis: Thinking Beyond Traditional Peacekeeping By feedproxy.google.com Published On :: Mon, 16 Jun 2014 22:00:00 GMT The crisis that has been occurring in CAR is certainly the most dramatic in its history: more than 600 000 Central Africans are internally displaced or sought refuge in neighbouring countries; according to the United Nations, 1.7 million live in a constant situation of food insecurity and 878 000 need immediate medical assistance; Muslim communities are fleeing Bangui and the western region, subsistence economy no longer exists and the de facto partition of the country, caused by the sectarian violence, is gradually becoming a reality. Full Article
ar Burundi: Godefroid Niyombaré avait mis en garde Nkurunziza By feedproxy.google.com Published On :: Tue, 12 May 2015 22:00:00 GMT Alors qu’une tentative de coup d’Etat contre Pierre Nkurunziza, émanant de l’ex-chef d’état-major, Godefroid Niyombaré, est en cours au Burundi, Thierry Vircoulon chercheur à l'International Crisis Group, explique qui est le général putschiste et analyse, plus généralement, l'appareil sécuritaire du Burundi. Full Article
ar Cameroun : au-delà de Boko Haram, la menace insidieuse du radicalisme religieux By feedproxy.google.com Published On :: Wed, 16 Sep 2015 22:00:00 GMT L’image de havre de paix dans une région en proie aux conflits dont bénéficiait le Cameroun a volé en éclats depuis l’irruption de Boko Haram en 2013 au nord du pays. Ce mouvement, devenu l’Etat islamique en Afrique de l’Ouest en mars 2015, revendique son affiliation à Daech. Néanmoins, l’apparition brutale et sanglante de ce djihadisme africain est moins liée à l’essor de Daech en Irak et en Syrie qu’aux bouleversements du paysage religieux de l’Afrique en général et du Cameroun en particulier. Full Article
ar U.S. Department of Education OKs Modified Texas Assessment By feedproxy.google.com Published On :: Tue, 14 Jul 2009 00:00:00 +0000 Texas has become the first state to have its "alternate assessment aligned to modified academic-achievement standards" pass the U.S. Department of Education's peer-review process. Full Article Assessment+Accountability+Achievement
ar Why Are We Using Standardized Tests? By feedproxy.google.com Published On :: Thu, 02 Oct 2014 00:00:00 +0000 What should be included in a measure of school quality? If not by standardized test scores, how should we measure student achievement? Julian Vasquez Heilig and I each have some thoughts. Full Article Assessment+Accountability+Achievement
ar California Moves Toward New Test-Score Reporting By feedproxy.google.com Published On :: Fri, 05 Dec 2014 00:00:00 +0000 Federal law requires states to report student test scores in achievement levels, but leaders in the Golden State want to take a different approach. Full Article Assessment+Accountability+Achievement
ar Panel Finds Few Learning Gains From Testing Movement By feedproxy.google.com Published On :: Thu, 26 May 2011 00:00:00 +0000 A 10-year study by a blue-ribbon panel of scientists concludes that high-stakes testing and other accountability measures have largely failed to translate to real improvements in student achievement. Full Article Assessment+Accountability+Achievement
ar Panel Finds Few Learning Benefits in High-Stakes Exams By feedproxy.google.com Published On :: Tue, 07 Jun 2011 00:00:00 +0000 A 10-year study by a blue-ribbon panel of scientists concludes that high-stakes testing and other accountability measures have largely failed to translate to real improvements in student achievement. Full Article Assessment+Accountability+Achievement
ar In Some States, ESSA Goals for English-Learners Are 'Purely Symbolic,' Report Finds By feedproxy.google.com Published On :: Fri, 14 Feb 2020 00:00:00 +0000 More than four years after the passage of ESSA, English-language-learner education policies across the country remain "disjointed and inaccessible," a new report concludes. Full Article Assessment+Accountability+Achievement
ar WITHDRAWN: Very strong synergy between modified RANTES and gp41 binding peptides leads to potent anti-HIV-1 activity [Article] By aac.asm.org Published On :: 2009-08-31T14:31:00-07:00 This article, published ahead of print on 28 July 2008, has been withdrawn by the authors. Although moderate synergy between P2-RANTES and C peptides can be observed with high statistical significance in cell fusion assays, this synergy was not able to be verified in HIV viral assays. The authors regret the overstatement of synergy and will revise the paper for publication at a later date. Full Article
ar Efficacy of early oral switch with beta-lactams for low-risk Staphylococcus aureus bacteremia. [Clinical Therapeutics] By aac.asm.org Published On :: 2020-02-03T08:23:03-08:00 Objectives. The aim of this study was to assess the safety of early oral switch (EOS) prior to 14 days for low-risk Staphylococcus aureus bacteremia (LR-SAB), which is the primary treatment strategy employed at our institution. Usually recommended therapy is 14 days of intravenous (IV) antibiotics.Methods. All patients with SAB at our hospital were identified between 1 January 2014 and 31 December 2018. Those meeting low-risk criteria (healthcare-associated, no evidence of deep infection or demonstrated involvement of prosthetic material, and no further positive blood cultures after 72-hours) were included in the study. The primary outcome was occurrence of a SAB-related complication within 90 days.Results. There were 469 SAB episodes during the study period, 100 (21%) of whom met inclusion criteria. EOS was performed in 84 patients. In this group, line infection was the source in 79%, methicillin-susceptible S. aureus caused 95% of SABs and 74% of patients received IV flucloxacillin. The median duration of IV and oral antibiotics in the EOS group was 5 (IQR 4-6) and 10 days (IQR 9-14), respectively. Seventy-one percent of patients received flucloxacillin as their EOS agent. Overall, 86% of oral step-down therapy was with beta-lactams. One patient (1%) undergoing EOS had SAB relapse within 90 days. No deaths attributable to SAB occurred within 90 days.Conclusions. In this low MRSA prevalence LR-SAB cohort, EOS was associated with a low incidence of SAB-related complications. This was achieved with oral beta-lactam therapy in most patients. Larger prospective studies are needed to confirm these findings. Full Article
ar Biochemical Characterization of QPX7728, a New Ultra-Broad-Spectrum Beta-lactamase Inhibitor of Serine and Metallo-Beta-Lactamases [Mechanisms of Resistance] By aac.asm.org Published On :: 2020-03-09T08:34:13-07:00 QPX7728 is a new ultra-broad-spectrum inhibitor of serine and metallo beta-lactamases from a class of cyclic boronates that gave rise to vaborbactam. The spectrum and mechanism of beta-lactamase inhibition by QPX7728 were assessed using purified enzymes from all molecular classes. QPX7728 inhibits class A ESBLs (IC50 range 1-3 nM) and carbapenemases such as KPC (IC50 2.9±0.4 nM) as well as class C P99 (IC50 of 22±8 nM) with a potency that is comparable or higher than recently FDA approved BLIs avibactam, relebactam and vaborbactam. Unlike those other BLIs, QPX7728 is also a potent inhibitor of class D carbapenemases such as OXA-48 from Enterobacteriaceae and OXA enzymes from A. baumannii (OXA-23/24/58, IC50 range 1-2 nM) as well as MBLs such as NDM-1 (IC50 55±25 nM), VIM-1 (IC50 14±4 nM) and IMP-1 (IC50 610±70 nM). Inhibition of serine enzymes by QPX7728 is associated with progressive inactivation with a high efficiency k2/K ranging from of 6.3 x 104 (for P99) to 9.9 x 105 M-1 s-1 (for OXA-23). This inhibition is reversible with variable stability of the QPX7728-beta-lactamase complexes with target residence time ranging from minutes to several hours: 5-20 minutes for OXA carbapenemases from A. baumanii, ~50 minutes for OXA-48 and 2-3 hours for KPC and CTX-M-15. QPX7728 inhibited all tested serine enzymes at 1:1 molar ratio. Metallo-beta-lactamases NDM, VIM, and IMP were inhibited by a competitive mechanism with fast-on-fast-off kinetics, with Kis of 7.5±2.1 nM, 32±14 nM and 240±30 nM for VIM-1, NDM-1 and IMP-1, respectively. QPX7728 ultra-broad-spectrum of BLI inhibition combined with its high potency enables combinations with multiple different beta-lactam antibiotics. Full Article
ar In Vitro and In Vivo Characterization of Potent Antileishmanial Methionine Aminopeptidase-1 Inhibitors [Experimental Therapeutics] By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Leishmania major is the causative agent of cutaneous leishmaniasis (CL). No human vaccine is available for CL and current drug regimens present several drawbacks such as emerging resistance, severe toxicity, medium effectiveness, and/or high cost. Thus, the need for better treatment options against CL is a priority. In the present study, we validate the enzyme methionine aminopeptidase-1 (MetAP1), a metalloprotease that catalyzes the removal of N-terminal methionine from peptides and proteins, as a chemotherapeutic target against CL infection. The in vitro antileishmanial activity of eight novel MetAP1 inhibitors (OJT001-OJT008) were investigated. Three compounds OJT006, OJT007, and OJT008 demonstrated potent anti-proliferative effect in macrophages infected with L. major amastigotes and promastigotes at submicromolar concentrations, with no cytotoxicity against host cells. Importantly, the leishmanicidal effect was diminished by almost 10-fold in transgenic L. major promastigotes overexpressing MetAP1LM in comparison to wild-type promastigotes. Furthermore, the in vivo activity of OJT006, OJT007, and OJT008 were investigated in L. major-infected BALB/c mice. In comparison to the control group, OJT008 significantly decreased footpad parasite load by 86%, and exhibited no toxicity against in treated mice. We propose MetAP1 inhibitor OJT008 as a potential chemotherapeutic candidate against CL infection caused by L. major infection. Full Article
ar A histone methyltransferase inhibitor can reverse epigenetically acquired drug resistance in the malaria parasite Plasmodium falciparum [Mechanisms of Resistance] By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Malaria parasites invade and replicate within red blood cells (RBCs), extensively modifying their structure and gaining access to the extracellular environment by placing the plasmodial surface anion channel (PSAC) into the RBC membrane. Expression of members of the cytoadherence linked antigen gene 3 (clag3) family is required for PSAC activity, a process that is regulated epigenetically. PSAC is a well-established route of uptake for large, hydrophilic antimalarial compounds and parasites can acquire resistance by silencing clag3 gene expression, thereby reducing drug uptake. We found that exposure to sub-IC50 concentrations of the histone methyltransferase inhibitor chaetocin caused substantial changes in both clag3 gene expression and RBC permeability, reversing acquired resistance to the antimalarial compound blasticidin S that is transported through PSAC. Chaetocin treatment also altered progression of parasites through their replicative cycle, presumably by changing their ability to modify chromatin appropriately to enable DNA replication. These results indicate that targeting histone modifiers could represent a novel tool for reversing epigenetically acquired drug resistance in P. falciparum. Full Article
ar Effect of drug pressure on promoting the emergence of antimalarial resistant parasites among pregnant women in Ghana [Mechanisms of Resistance] By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Continuous spread of antimalarial drug resistance is a threat to current chemotherapy efficacy. Therefore, characterizing the genetic diversity of drug resistance markers is needed to follow treatment effectiveness and further update control strategies. Here, we genotyped Plasmodium falciparum resistance gene markers associated with sulfadoxine-pyrimethamine (SP) and artemisinin-based combination therapy (ACT) in isolates from pregnant women in Ghana. The prevalence of the septuple IRNI-A/FGKGS/T pfdhfr/pfdhps haplotypes including the pfdhps A581G and A613S/T mutations was high at delivery among post-SP treatment isolates (18.2%) compared to those of first-antenatal care (before initiation of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP); 6.1%; p = 0.03). Regarding the pfk13 marker gene, two non-synonymous mutations (N458D and A481C) were detected at positions previously related to artemisinin resistance in isolates from Southeast-Asia. These mutations were predicted in silico to alter the stability of the pfk13 propeller-encoding domain. Overall, these findings highlight the need for intensified monitoring and surveillance on additional mutations associated with increased SP resistance as well as emergence of resistance against artemesinin derivatives. Full Article
ar Significant efficacy of single low dose primaquine compared to stand alone artemisinin combination therapy in reducing gametocyte carriage in Cambodian patients with uncomplicated multidrug resistant Plasmodium falciparum malaria [Epidemiology and Surveil By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Since 2012, single low dose of primaquine (SLDPQ, 0.25mg/kg) has been recommended with artemisinin-based combination therapies, as first-line treatment of acute uncomplicated Plasmodium falciparum malaria, to interrupt its transmission, especially in low transmission settings of multidrug, including artemisinin, resistance. Policy makers in Cambodia have been reluctant to implement this recommendation due to primaquine safety concerns and lack of data on its efficacy.In this randomized controlled trial, 109 Cambodians with acute uncomplicated P. falciparum malaria received dihydroartemisinin-piperaquine (DP) alone or combined with SLDPQ on the first treatment day. Transmission-blocking efficacy of SLDPQ was evaluated on Days 0, 1, 2, 3, 7, 14, 21, 28 and recrudescence by reverse transcriptase polymerase chain reaction (RT-PCR) (gametocyte prevalence) and membrane-feeding assays with Anopheles minimus mosquitoes (gametocyte infectivity). Without the influence of recrudescent infections, DP+SLDPQ reduced gametocyte carriage 3 fold compared to DP. Of 48 patients tested on Day 0, only three patients were infectious to mosquitoes (~6%). Post-treatment, three patients were infectious: on D14 (3.5%, 1/29), and on the first and seventh day of recrudescence (8.3%, 1/12 for each); this overall low infectivity precluded our ability to assess its transmission blocking efficacy.Our study confirms effective gametocyte clearance of SLDPQ when combined with DP in multidrug resistant P. falciparum and the negative impact of recrudescent infections due to poor DP efficacy. Artesunate-mefloquine (ASMQ) has replaced DP and ASMQ-SLDPQ has been deployed to treat all P. falciparum symptomatic patients to further support the elimination of multidrug resistant P. falciparum in Cambodia. Full Article
ar Comparison of Cefepime/Cefpirome and Carbapenem Therapy for Acinetobacter Bloodstream Infection: A Multicentre Study [Clinical Therapeutics] By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Carbapenems are currently the preferred agents for the treatment of serious Acinetobacter infections. However, whether cefepime/cefpirome can be used to treat Acinetobacter bloodstream infection (BSI) if it is active against the causative pathogens is not clear. This study aimed to compare the efficacy of cefepime/cefpirome and carbapenem monotherapy in patients with Acinetobacter BSI. The population included 360 patients with monomicrobial Acinetobacter BSI receiving appropriate antimicrobial therapy admitted to four medical centres in Taiwan in 2012–2017. The predictors of 30-day mortality were determined by Cox regression analysis. The overall 30-day mortality rate in the appropriate antibiotic treatment group was 25.0% (90/360 patients), respectively. The crude 30-day mortality rates for cefepime/cefpirome and carbapenem therapy were 11.5% (7/61 patients) and 26.3% (21/80 patients), respectively. The patients receiving cefepime/cefpirome/carbapenem therapy were infected by Acinetobacter nosocomialis (51.8%), A. baumannii (18.4%) and A. pittii (12.1%). After adjusting for age, Sequential Organ Failure Assessment (SOFA) score, invasive procedures, and underlying diseases, cefepime/cefpirome therapy was not independently associated with a higher or lower 30-day mortality compared to the carbapenem therapy. SOFA score (hazard ratio [HR], 1.324; 95% confidence interval [CI], 1.137–1.543; P < 0.001) and neutropenia (HR, 7.060; 95% CI, 1.607–31.019; P = 0.010) were independent risk factors for 30-day mortality of patients receiving cefepime/cefpirome or carbapenem monotherapy. The incidence density of 30-day mortality for cefepime/cefpirome versus carbapenem therapy was 0.40% versus 1.04%. The therapeutic response of cefepime/cefpirome therapy was comparable to that of carbapenems among patients with Acinetobacter BSI receiving appropriate antimicrobial therapy. Full Article
ar ZN148 - a modular synthetic metallo-{beta}-lactamase inhibitor reverses carbapenem-resistance in Gram-negative pathogens in vivo [Experimental Therapeutics] By aac.asm.org Published On :: 2020-03-16T08:17:37-07:00 Carbapenem-resistant Gram-negative pathogens are a critical public health threat and there is an urgent need for new treatments. Carbapenemases (β-lactamases able to inactivate carbapenems) have been identified in both serine β-lactamase (SBL) and metallo β-lactamase (MBL) families. The recent introduction of SBL carbapenemase-inhibitors has provided alternative therapeutic options. Unfortunately, there are no approved inhibitors of MBL-mediated carbapenem-resistance and treatment options for infections caused by MBL-producing Gram-negatives are limited. Here, we present ZN148, a zinc-chelating MBL-inhibitor capable of restoring the bactericidal effect of meropenem and in vitro clinical susceptibility to carbapenems in >98% of a large international collection of MBL-producing clinical Enterobacterales strains (n=234). Moreover, ZN148 was able to potentiate the effect of meropenem against NDM-1-producing Klebsiella pneumoniae in a murine neutropenic peritonitis model. ZN148 showed no inhibition of the human zinc-containing enzyme glyoxylase II at 500 μM and no acute toxicity was observed in an in vivo mouse model with cumulative dosages up to 128 mg/kg. Biochemical analysis showed a time-dependent inhibition of MBLs by ZN148 and removal of zinc ions from the active site. Addition of exogenous zinc after ZN148 exposure only restored MBL activity by ~30%, suggesting an irreversible mechanism of inhibition. Mass-spectrometry and molecular modelling indicated potential oxidation of the active site Cys221 residue. Overall, these results demonstrate the therapeutic potential of a ZN148-carbapenem combination against MBL-producing Gram-negative pathogens and that ZN148 is a highly promising MBL inhibitor, capable of operating in a functional space not presently filled by any clinically approved compound. Full Article
ar Combination Therapy with Ibrexafungerp (formerly SCY-078), a First-in-Class Triterpenoid Inhibitor of (1->3)-{beta}-D-Glucan Synthesis, and Isavuconazole for Treatment of Experimental Invasive Pulmonary Aspergillosis [Experimental Therapeutics] By aac.asm.org Published On :: 2020-03-16T08:17:36-07:00 Ibrexafungerp (formerly SCY-078) is a semisynthetic triterpenoid and potent (1->3)-β-D-glucan synthase inhibitor. We investigated the in vitro activity, pharmacokinetics, and in vivo efficacy of ibrexafungerp (SCY) alone and in combination with anti-mould triazole isavuconazole (ISA) against invasive pulmonary aspergillosis (IPA). The combination of ibrexafungerp and isavuconazole in in vitro studies resulted in an additive and synergistic interactions against Aspergillus spp. Plasma concentration-time curves of ibrexafungerp were compatible with linear dose proportional profile. In vivo efficacy was studied in a well established persistently neutropenic NZW rabbit model of experimental IPA. Treatment groups included untreated rabbits (UC) and rabbits receiving ibrexafungerp at 2.5(SCY2.5) and 7.5(SCY7.5) mg/kg/day, isavuconazole at 40(ISA40) mg/kg/day, or combinations of SCY2.5+ISA40 and SCY7.5+ISA40. The combination of SCY+ISA produced in vitro synergistic interaction. There was significant in vivo reduction of residual fungal burden, lung weights, and pulmonary infarct scores in SCY2.5+ISA40, SCY7.5+ISA40, and ISA40-treatment groups vs that of SCY2.5-treated, SCY7.5-treated and UC (p<0.01). Rabbits treated with SCY2.5+ISA40 and SCY7.5+ISA40 had prolonged survival in comparison to that of SCY2.5-, SCY7.5-, ISA40-treated or UC (p<0.05). Serum GMI and (1->3)-β-D-glucan levels significantly declined in animals treated with the combination of SCY7.5+ISA40 in comparison to those treated with SCY7.5 or ISA40 (p<0.05). Ibrexafungerp and isavuconazole combination demonstrated prolonged survival, decreased pulmonary injury, reduced residual fungal burden, lower GMI and (1->3)-β-D-glucan levels in comparison to those of single therapy for treatment of IPA. These findings provide an experimental foundation for clinical evaluation of the combination of ibrexafungerp and an anti-mould triazole for treatment of IPA. Full Article
ar A Comparison of Clinical Outcomes among Intensive Care Unit Patients Receiving Ceftriaxone 1 gram daily or 2 grams daily [Clinical Therapeutics] By aac.asm.org Published On :: 2020-03-23T08:47:35-07:00 Background: Intensive care unit (ICU) patients may experience ceftriaxone underexposure but clinical outcomes data are lacking. The objective of this study was to determine the impact of ceftriaxone dosing on clinical outcomes amongst ICU patients without central nervous system (CNS) infection.Methods: A retrospective study of ICU patients receiving intravenous, empiric ceftriaxone for non-CNS infections was conducted. Patients ≥18 years of age who received ≤2 grams of ceftriaxone daily for ≥72 hours were included and categorized as receiving ceftriaxone 1 gram or 2 grams daily. The primary, composite outcome was treatment failure: inpatient mortality and/or antibiotic escalation due to clinical worsening. Propensity score matching was performed based on the probability of receiving ceftriaxone 2 grams daily. Multivariable logistic regression determined the association between ceftriaxone dose and treatment failure in a propensity-matched cohort.Results: A total of 212 patients were included in the propensity-matched cohort. The most common diagnoses (83.0%) were pneumonia and urinary tract infection. Treatment failure occurred in 17.0% and 5.7% of patients receiving 1 gram and 2 grams daily, respectively (p=0.0156). Overall inpatient mortality was 8.5%. Ceftriaxone 2 gram dosing was associated with a reduced likelihood of treatment failure (adjusted odds ratio=0.190; 95% confidence interval: 0.059 – 0.607). Other independent predictors of treatment failure included sequential organ failure assessment score (aOR 1.440, 95% CI 1.254 – 1.653) and creatinine clearance at 72 hours from ceftriaxone initiation (aOR 0.980, 95% CI (0.971 – 0.999).Conclusions: Ceftriaxone 2 grams daily when used as appropriate antimicrobial coverage may be appropriate for ICU patients with lower mortality risk. Full Article
ar Structure and molecular recognition mechanism of IMP-13 metallo-{beta}-lactamase [Mechanisms of Resistance] By aac.asm.org Published On :: 2020-03-23T08:47:35-07:00 Multi-drug resistance among Gram-negative bacteria is a major global public health threat. Metallo-β-lactamases (MBLs) target the most widely-used antibiotic class, the β-lactams, including the most recent-generation carbapenems. Interspecies spread renders these enzymes a serious clinical threat and there are no clinically-available inhibitors. We present crystal structures of IMP-13, a structurally-uncharacterized MBL from Gram-negative Pseudomonas aerugionasa found in clinical outbreaks globally, and characterize the binding using solution NMR-spectroscopy and molecular-dynamics simulations. Crystal structures of apo IMP-13 and bound to four clinically-relevant carbapenem antibiotics (doripenem, ertapenem, imipenem and meropenem) are presented. Active site plasticity and the active-site loop, where a tryptophan residue stabilizes the antibiotic core scaffold, are essential to the substrate-binding mechanism. The conserved carbapenem scaffold plays the most significant role in IMP-13 binding, explaining the broad substrate specificity. The observed plasticity and substrate-locking mechanism provide opportunities for rational drug design of novel metallo-β-lactamase inhibitors, essential in the fight against antibiotic resistance. Full Article
ar Fosmanogepix (APX001) is Effective in the Treatment of Pulmonary Murine Mucormycosis Due to Rhizopus arrhizus [Experimental Therapeutics] By aac.asm.org Published On :: 2020-03-23T08:47:35-07:00 Mucormycosis is a life-threatening infection with high mortality that occurs predominantly in immunocompromised patients. Manogepix (MGX) is a novel antifungal that targets Gwt1, an early step in the conserved glycosylphosphotidyl inositol (GPI) post-translational modification pathway of surface proteins in eukaryotic cells. Inhibition of inositol acylation by MGX results in pleiotropic effects including inhibition of maturation of GPI-anchored proteins necessary for growth and virulence. MGX has been previously shown to have in vitro activity against some strains of Mucorales. Here we assessed the in vivo activity of the prodrug fosmanogepix, currently in clinical development for the treatment of invasive fungal infections, against two Rhizopus arrhizus strains with high (4.0 μg/ml) and low (0.25 μg/ml) minimum effective concentration (MEC) values. In both invasive pulmonary infection models, treatment of mice with 78 mg/kg or 104 mg/kg fosmanogepix, along with 1-aminobenzotriazole to enhance the serum half-live of MGX in mice, significantly increased median survival time and prolonged overall survival by day 21 post infection when compared to placebo. In addition, administration of fosmanogepix resulted in a 1-2 log reduction in both lung and kidney fungal burden. For the 104 mg/kg fosmanogepix dose, tissue clearance and survival were comparable to clinically relevant doses of isavuconazole (ISA), which is FDA approved for the treatment of mucormycosis. These results support continued development of fosmanogepix as a first in class treatment for invasive mucormycosis. Full Article
ar Updated approaches against SARS-CoV-2 [Minireviews] By aac.asm.org Published On :: 2020-03-23T08:47:35-07:00 The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lies behind the ongoing outbreak of coronavirus disease 2019 (COVID-19). There is a growing understanding of SARS-CoV-2 in the virology, epidemiology and clinical management strategies. However, no anti-SARS-CoV-2 drug or vaccine has been officially approved due to the absence of adequate evidence. Scientists are racing towards the development of treatment for COVID-19. Recent studies have revealed many attractive threptic options, even if some of them remain to be further confirmed in rigorous preclinical models and clinical trials. In this minireview, we aim to summarize the updated potential approaches against SARS-CoV-2. We emphasize that further efforts are warranted to develop the safest and most effective approach. Full Article
ar Mutations in ArgS arginine-tRNA synthetase confer additional antibiotic-tolerance protection to ESBL-producing Burkholderia thailandensis [Mechanisms of Resistance] By aac.asm.org Published On :: 2020-03-23T08:47:35-07:00 Highly conserved PenI-type class A β-lactamase in pathogenic members of Burkholderia can evolve to extended-spectrum β-lactamase (ESBL), which exhibits hydrolytic activity towards third-generation cephalosporins, while losing its activity towards the original penicillin substrates. We describe three single-amino-acid-substitution mutations in the ArgS arginine-tRNA synthetase that confer extra antibiotic tolerance protection to ESBL-producing Burkholderia thailandensis. This pathway can be exploited to evade antibiotic tolerance induction in developing therapeutic measures against Burkholderia species, targeting their essential aminoacyl-tRNA synthetases. Full Article