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  1. Article ; Online: Waning Interest in Infectious Disease Among Trainees: Is Medicine Pulling the Goalie?

    Sakoulas, George

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2024  

    Abstract: Relatively low salaries in ID compared to other medical specialties in a world where cost of living is skyrocketing are an easy explanation for unmet needs of ID training programs to fill their positions. However, the interest in ID falling short of ... ...

    Abstract Relatively low salaries in ID compared to other medical specialties in a world where cost of living is skyrocketing are an easy explanation for unmet needs of ID training programs to fill their positions. However, the interest in ID falling short of expectations may reflect that some features of the ID specialty are counter to select pervasive tendencies of modern culture, including i) slow uptake of innovation into daily routines of ID practioners, ii) the emphasis of clinical mastery of ID practioners in an environment of medical corporatization and increased focus on revenue generation, and iii) the fact that ID practice takes societal interests into consideration (eg. prevention of antibiotic resistance) in a world dominated by rights of individuals frequently at the expense of the common good. This article reflects on these possibilities in order to determine what steps can be taken to resurrect interest in our specialty.
    Language English
    Publishing date 2024-04-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciae204
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  2. Article ; Online: Expert Update on Acute Bacterial Skin and Skin Structure Infection Treatment Options in the Community Setting.

    Sakoulas, George

    The Journal of family practice

    2022  Volume 71, Issue Suppl 1 Bacterial, Page(s) S2–S8

    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Cellulitis/drug therapy ; Humans ; Skin
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-04-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 197883-4
    ISSN 1533-7294 ; 0094-3509
    ISSN (online) 1533-7294
    ISSN 0094-3509
    DOI 10.12788/jfp.0344
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    Zs.MO 444: Show issues

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  3. Article ; Online: Linezolid versus omadacycline in diabetic soft tissue infections: a signal of different adjunctive immunological properties?

    Sakoulas, George

    The Journal of antimicrobial chemotherapy

    2022  Volume 77, Issue 6, Page(s) 1503–1505

    Abstract: Recent understanding of antimicrobial chemotherapy has expanded to appreciate significant impacts on the host-pathogen relationship by antibiotics. Omadacycline statistically outperformed linezolid in treating acute bacterial skin and skin structure ... ...

    Abstract Recent understanding of antimicrobial chemotherapy has expanded to appreciate significant impacts on the host-pathogen relationship by antibiotics. Omadacycline statistically outperformed linezolid in treating acute bacterial skin and skin structure infections in patients with diabetes mellitus in a recent post-hoc analysis of the OASIS-1 and OASIS-2 clinical trials. This difference may speak directly or indirectly to neutrophil dysfunction in diabetes. Neutrophil dysfunction increases the likelihood of Gram-negative bacterial infection, whereby diabetics may benefit from the broader spectrum of omadacycline compared with linezolid. Indirectly, oxazolidinones like linezolid have been shown to be dependent on neutrophil function, potentially compromising the potency of this drug class in diabetics. Finally, tetracyclines like omadacycline have collateral anti-inflammatory properties that have not been seen in other antibiotic drug classes. These differences may impact clinical outcomes in the treatment of infections that are not predicted by their antimicrobial activities alone, as measured in standard susceptibility testing assays.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Diabetes Mellitus ; Humans ; Linezolid/therapeutic use ; Skin Diseases, Bacterial/drug therapy ; Skin Diseases, Bacterial/microbiology ; Soft Tissue Infections/drug therapy ; Tetracyclines/therapeutic use
    Chemical Substances Anti-Bacterial Agents ; Tetracyclines ; omadacycline (090IP5RV8F) ; Linezolid (ISQ9I6J12J)
    Language English
    Publishing date 2022-02-09
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 191709-2
    ISSN 1460-2091 ; 0305-7453
    ISSN (online) 1460-2091
    ISSN 0305-7453
    DOI 10.1093/jac/dkac030
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.MO 124: Show issues

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  4. Article ; Online: Case Commentary: Imipenem/Cilastatin and Fosfomycin for Refractory Methicillin-Resistant

    Sakoulas, George

    Antimicrobial agents and chemotherapy

    2020  Volume 65, Issue 1

    Abstract: Given that it is unlikely that randomized clinical trials will yield answers for treating the most challenging bacteremic infections caused by methicillin- ... ...

    Abstract Given that it is unlikely that randomized clinical trials will yield answers for treating the most challenging bacteremic infections caused by methicillin-resistant
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Drug Therapy, Combination ; Fosfomycin/therapeutic use ; Humans ; Imipenem/therapeutic use ; Methicillin-Resistant Staphylococcus aureus ; Osteomyelitis ; Salvage Therapy ; Staphylococcal Infections/drug therapy ; Staphylococcus aureus
    Chemical Substances Anti-Bacterial Agents ; Fosfomycin (2N81MY12TE) ; Imipenem (71OTZ9ZE0A)
    Language English
    Publishing date 2020-12-16
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 217602-6
    ISSN 1098-6596 ; 0066-4804
    ISSN (online) 1098-6596
    ISSN 0066-4804
    DOI 10.1128/AAC.02039-20
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Einzelsignatur: Show issues

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  5. Article ; Online: Measuring beta-lactam minimum inhibitory concentrations in

    Sakoulas, George / Nizet, Victor

    Journal of clinical microbiology

    2023  Volume 62, Issue 1, Page(s) e0036623

    Abstract: Significant shortcomings have been identified in standard methods of susceptibility testing in bacteriological media, not only because the media fails to recapitulate ... ...

    Abstract Significant shortcomings have been identified in standard methods of susceptibility testing in bacteriological media, not only because the media fails to recapitulate the
    MeSH term(s) Animals ; Staphylococcus aureus ; beta-Lactams/pharmacology ; Equidae ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/veterinary ; Staphylococcal Infections/drug therapy ; Microbial Sensitivity Tests ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Methicillin-Resistant Staphylococcus aureus
    Chemical Substances beta-Lactams ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-11-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 390499-4
    ISSN 1098-660X ; 0095-1137
    ISSN (online) 1098-660X
    ISSN 0095-1137
    DOI 10.1128/jcm.00366-23
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  6. Article ; Online: Adjunctive Intravenous Immunoglobulin and Glucocorticoid Therapy in Severe Herpes Simplex Encephalitis with Excellent Outcome Begs for Larger Trials Evaluating Immunomodulatory Therapy.

    Sakoulas, George / Roth, Jon / Van der Kuy, Hugo

    The American journal of case reports

    2024  Volume 25, Page(s) e941864

    Abstract: BACKGROUND Despite the preponderance of evidence of immune-driven pathophysiology of disease in herpes simplex virus-1 (HSV-1) encephalitis, current treatment paradigms do not officially recommend adjunctive immunomodulatory therapy in addition to ... ...

    Abstract BACKGROUND Despite the preponderance of evidence of immune-driven pathophysiology of disease in herpes simplex virus-1 (HSV-1) encephalitis, current treatment paradigms do not officially recommend adjunctive immunomodulatory therapy in addition to acyclovir. This may in part explain the poor long-term outcomes in patients with severe HSV encephalitis. This report is of a 21-year-old man presenting with a 4-day history of nausea, headache, and fever and a diagnosis of HSV-1 encephalitis. CASE REPORT We describe the case of a young male with clinically and radiographically severe HSV-1 encephalitis diagnosed by PCR of cerebrospinal fluid (CSF), who demonstrated immediate improvement upon treatment with intravenous immunoglobulin (IVIG, 0.5 g/kg daily ×3 days) in addition to acyclovir and dexamethasone therapy. Acyclovir therapy was extended beyond 21 days due to persistently positive HSV-1 CSF PCR. He developed N-methyl-D-aspartate (NMDA) receptor antibodies at 6 weeks, but his long-term outcome far exceeded expectations. While some of his neurological deficits appear to be permanent, he is living a normal life. CONCLUSIONS Overwhelming evidence demonstrates that brain injury due to HSV encephalitis is driven by immune reactions stimulated by HSV rather than HSV itself. Nevertheless, use of immunomodulatory therapy such as glucocorticoids and IVIG are left to the discretion of individual clinicians rather than being recommended in treatment guidelines, which instead recommend acyclovir therapy. The present case highlights the potential role of immunomodulatory therapy with IVIG in HSV encephalitis and the importance of early diagnosis and treatment.
    MeSH term(s) Humans ; Male ; Young Adult ; Adult ; Encephalitis, Herpes Simplex/diagnosis ; Encephalitis, Herpes Simplex/drug therapy ; Immunoglobulins, Intravenous/therapeutic use ; Antiviral Agents/therapeutic use ; Glucocorticoids/therapeutic use ; Acyclovir/therapeutic use
    Chemical Substances Immunoglobulins, Intravenous ; Antiviral Agents ; Glucocorticoids ; Acyclovir (X4HES1O11F)
    Language English
    Publishing date 2024-01-14
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2517183-5
    ISSN 1941-5923 ; 1941-5923
    ISSN (online) 1941-5923
    ISSN 1941-5923
    DOI 10.12659/AJCR.941864
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  7. Article ; Online: Contemporary Management of Staphylococcus aureus Bacteremia: Some Additional Considerations for Clinicians.

    Sakoulas, George / Tsou, Erin E / Geriak, Matthew / Vasina, Logan

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2024  

    Language English
    Publishing date 2024-03-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciae080
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  8. Article: Azithromycin: An Underappreciated Quinolone-Sparing Oral Treatment for

    Ulloa, Erlinda R / Sakoulas, George

    Antibiotics (Basel, Switzerland)

    2022  Volume 11, Issue 4

    Abstract: Outpatient treatment ... ...

    Abstract Outpatient treatment of
    Language English
    Publishing date 2022-04-13
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2681345-2
    ISSN 2079-6382
    ISSN 2079-6382
    DOI 10.3390/antibiotics11040515
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  9. Article ; Online: Omadacycline in treating community-based infections: a review and expert perspective.

    Sakoulas, George / Nowak, Michael / Geriak, Matthew

    Expert review of anti-infective therapy

    2023  Volume 21, Issue 3, Page(s) 255–265

    Abstract: Introduction: Omadacycline is approved for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and soft tissue infection (ABSSSI). The integration of newer agents into clinical use involves understanding the nuances ... ...

    Abstract Introduction: Omadacycline is approved for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and soft tissue infection (ABSSSI). The integration of newer agents into clinical use involves understanding the nuances of clinical decision-making. This review will provide an in-depth focus on omadacycline in clinical practice.
    Areas covered: Literature review of omadacycline utilizing PubMed was performed to provide a comprehensive evaluation of omadacycline pharmacology, microbiology, registrational Phase 3 clinical trials, and post-marketing clinical studies. In addition, the immunomodulatory and other attributes of tetracycline class of antibiotics, of which omadacycline is a member, are reviewed, introducing the concept of antibiotic selection with attention to the bacterial pathogen and human host relationship.
    Expert opinion: Omadacycline builds upon the favorable attributes of tetracycline antibiotics and provides very reliable empiric coverage for both
    MeSH term(s) Humans ; Bacteria ; Skin Diseases, Bacterial/drug therapy ; Tetracyclines/therapeutic use ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/microbiology
    Chemical Substances omadacycline (090IP5RV8F) ; Tetracyclines ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-02-06
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 2181279-2
    ISSN 1744-8336 ; 1478-7210
    ISSN (online) 1744-8336
    ISSN 1478-7210
    DOI 10.1080/14787210.2023.2174100
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  10. Article ; Online: Understanding vancomycin nephrotoxicity augmented by β-lactams: a synthesis of endosymbiosis, proximal renal tubule mitochondrial metabolism, and β-lactam chemistry.

    Alosaimy, Sara / Rybak, Michael J / Sakoulas, George

    The Lancet. Infectious diseases

    2023  Volume 24, Issue 3, Page(s) e179–e188

    Abstract: The recent understanding that hydrophobic β-lactams have greater affinity for organic anion transporter-3 (OAT-3) of the proximal renal tubule could provide valuable insights for anticipating β-lactams that may exacerbate vancomycin-induced ... ...

    Abstract The recent understanding that hydrophobic β-lactams have greater affinity for organic anion transporter-3 (OAT-3) of the proximal renal tubule could provide valuable insights for anticipating β-lactams that may exacerbate vancomycin-induced nephrotoxicity. Vancomycin alone provides oxidative stress on the highly metabolic proximal tubular cells. Hydrophobic β-lactams (eg, piperacillin and anti-staphylococcal β-lactams) could have greater OAT-3 mediated uptake into proximal tubular cells than hydrophilic β-lactams (eg, most cephalosporins and carbapenems), thereby causing greater mitochondrial stress on these susceptible cells. It remains to be seen whether concomitant drugs that inhibit OAT-3 mediated cellular uptake of β-lactams into proximal tubular cells or provide antioxidant effects might mitigate β-lactam augmented vancomycin nephrotoxicity. Furthermore, the serum creatinine rise seen with vancomycin and hydrophobic β-lactams might represent competition for creatinine-secreting transporters (of which OAT-3 is one), thus, indicating creatinine retention rather than renal injury. In the meantime, clinicians are advised to utilise less nephrotoxic combinations in both empirical and directed antibiotic selection settings until further research is conducted.
    MeSH term(s) Humans ; Vancomycin/toxicity ; beta-Lactams ; Kidney Tubules, Proximal ; Symbiosis ; Creatinine ; Anti-Bacterial Agents/toxicity ; Anti-Bacterial Agents/therapeutic use
    Chemical Substances Vancomycin (6Q205EH1VU) ; beta-Lactams ; Creatinine (AYI8EX34EU) ; Anti-Bacterial Agents
    Language English
    Publishing date 2023-10-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2061641-7
    ISSN 1474-4457 ; 1473-3099
    ISSN (online) 1474-4457
    ISSN 1473-3099
    DOI 10.1016/S1473-3099(23)00432-2
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