Quinolone antimicrobials are synthetic and widely used in clinical medicine. Resistance emerged with clinical use and became common in some bacterial pathogens. Mechanisms of resistance include two ...categories of mutation and acquisition of resistance‐conferring genes. Resistance mutations in one or both of the two drug target enzymes, DNA gyrase and DNA topoisomerase IV, are commonly in a localized domain of the GyrA and ParE subunits of the respective enzymes and reduce drug binding to the enzyme–DNA complex. Other resistance mutations occur in regulatory genes that control the expression of native efflux pumps localized in the bacterial membrane(s). These pumps have broad substrate profiles that include quinolones as well as other antimicrobials, disinfectants, and dyes. Mutations of both types can accumulate with selection pressure and produce highly resistant strains. Resistance genes acquired on plasmids can confer low‐level resistance that promotes the selection of mutational high‐level resistance. Plasmid‐encoded resistance is due to Qnr proteins that protect the target enzymes from quinolone action, one mutant aminoglycoside‐modifying enzyme that also modifies certain quinolones, and mobile efflux pumps. Plasmids with these mechanisms often encode additional antimicrobial resistances and can transfer multidrug resistance that includes quinolones. Thus, the bacterial quinolone resistance armamentarium is large.
Quinolone antimicrobials are widely used in clinical medicine and are the only current class of agents that directly inhibit bacterial DNA synthesis. Quinolones dually target DNA gyrase and ...topoisomerase IV binding to specific domains and conformations so as to block DNA strand passage catalysis and stabilize DNA-enzyme complexes that block the DNA replication apparatus and generate double breaks in DNA that underlie their bactericidal activity. Resistance has emerged with clinical use of these agents and is common in some bacterial pathogens. Mechanisms of resistance include mutational alterations in drug target affinity and efflux pump expression and acquisition of resistance-conferring genes. Resistance mutations in one or both of the two drug target enzymes are commonly in a localized domain of the GyrA and ParC subunits of gyrase and topoisomerase IV, respectively, and reduce drug binding to the enzyme-DNA complex. Other resistance mutations occur in regulatory genes that control the expression of native efflux pumps localized in the bacterial membrane(s). These pumps have broad substrate profiles that include other antimicrobials as well as quinolones. Mutations of both types can accumulate with selection pressure and produce highly resistant strains. Resistance genes acquired on plasmids confer low-level resistance that promotes the selection of mutational high-level resistance. Plasmid-encoded resistance is because of Qnr proteins that protect the target enzymes from quinolone action, a mutant aminoglycoside-modifying enzyme that also modifies certain quinolones, and mobile efflux pumps. Plasmids with these mechanisms often encode additional antimicrobial resistances and can transfer multidrug resistance that includes quinolones.
Driven by applications in chemical sensing, biological imaging and material characterisation, Raman spectroscopies are attracting growing interest from a variety of scientific disciplines. The Raman ...effect originates from the inelastic scattering of light, and it can directly probe vibration/rotational-vibration states in molecules and materials. Despite numerous advantages over infrared spectroscopy, spontaneous Raman scattering is very weak, and consequently, a variety of enhanced Raman spectroscopic techniques have emerged. These techniques include stimulated Raman scattering and coherent anti-Stokes Raman scattering, as well as surface- and tip-enhanced Raman scattering spectroscopies. The present review provides the reader with an understanding of the fundamental physics that govern the Raman effect and its advantages, limitations and applications. The review also highlights the key experimental considerations for implementing the main experimental Raman spectroscopic techniques. The relevant data analysis methods and some of the most recent advances related to the Raman effect are finally presented. This review constitutes a practical introduction to the science of Raman spectroscopy; it also highlights recent and promising directions of future research developments.
Modern medicine is threatened by the global rise of antibiotic resistance, especially among Gram-negative bacteria. Metallo-β-lactamase (MBL) enzymes are a particular concern and are increasingly ...disseminated worldwide, though particularly in Asia. Many MBL producers have multiple further drug resistances, leaving few obvious treatment options. Nonetheless, and more encouragingly, MBLs may be less effective agents of carbapenem resistance
, under zinc limitation, than
Owing to their unique structure and function and their diversity, MBLs pose a particular challenge for drug development. They evade all recently licensed β-lactam-β-lactamase inhibitor combinations, although several stable agents and inhibitor combinations are at various stages in the development pipeline. These potential therapies, along with the epidemiology of producers and current treatment options, are the focus of this review.
Throughout the 19th and 20th century, chirality has mostly been associated with chemistry. However, while chirality can be very useful for understanding molecules, molecules are not well suited for ...understanding chirality. Indeed, the size of atoms, the length of molecular bonds and the orientations of orbitals cannot be varied at will. It is therefore difficult to study the emergence and evolution of chirality in molecules, as a function of geometrical parameters. By contrast, chiral metal nanostructures offer an unprecedented flexibility of design. Modern nanofabrication allows chiral metal nanoparticles to tune the geometric and optical chirality parameters, which are key for properties such as negative refractive index and superchiral light. Chiral meta/nano‐materials are promising for numerous technological applications, such as chiral molecular sensing, separation and synthesis, super‐resolution imaging, nanorobotics, and ultra‐thin broadband optical components for chiral light. This review covers some of the fundamentals and highlights recent trends. We begin by discussing linear chiroptical effects. We then survey the design of modern chiral materials. Next, the emergence and use of chirality parameters are summarized. In the following part, we cover the properties of nonlinear chiroptical materials. Finally, in the conclusion section, we point out current limitations and future directions of development.
Chiral metal nanostructures have allowed unprecedented control over chiroptical effects. The flexibility in design in novel nanofabrication techniques has resulted in a proliferation of new chiral nanomaterials. These nanomaterials are now shaping up numerous emerging research trends that offer promising practical applications and deep insights into fundamental scientific questions.
Self-reported penicillin allergy infrequently reflects an inability to tolerate penicillins. Inpatients reporting penicillin allergy receive alternative antibiotics that might be broader spectrum, ...more toxic, or less effective.
To develop and assess a clinical guideline for the general inpatient provider that directs taking a history and prescribing antibiotics for patients with penicillin or cephalosporin allergy.
A guideline was implemented to assist providers with assessing allergy history and prescribing antibiotics for patients with reported penicillin or cephalosporin allergy. The guideline used a standard 2-step graded challenge or test dose. A quasi-experimental study was performed to assess safety, feasibility, and impact on antibiotic use by comparing treatment 21 months before guideline implementation with 12 months after guideline implementation.
Significantly more test doses to β-lactam antibiotics were performed monthly after vs before guideline implementation (median 14.5, interquartile range 13-16.25, vs 2, interquartile range 1-3.25, P < .001). Seven adverse drug reactions occurred during guideline-driven test doses, with no significant difference in rate (3.9% vs 6.1%, P = .44) or severity (P > .5) between periods. Guideline-driven test doses decreased alternative antimicrobial therapy after the test dose, including vancomycin (68.3% vs 37.2%, P < .001), aztreonam (11.5% vs 0.5%, P < .001), aminoglycosides (6.0% vs 1.1%, P = .004), and fluoro quinolones (15.3% vs 3.3%, P < .001).
The implementation of an inpatient antibiotic prescribing guideline for patients with penicillin or cephalosporin allergy was associated with an almost 7-fold increase in the number of test doses to β-lactams without increased adverse drug reactions. Patients assessed with guideline-driven test doses were observed to have significantly decreased alternative antibiotic exposure.
Because of their large figures of merit, surface lattice resonances (SLRs) in metal nanoparticle arrays are very promising for chemical and biomolecular sensing in both liquid and gas media. SLRs are ...sensitive to refractive index changes both near the surface of the nanoparticles (surface sensitivity) and in the volume between them (bulk sensitivity). Because of its intrinsic surface-sensitivity and a power law dependence on electric fields, second harmonic generation (SHG) spectroscopy can improve upon both the surface and volume sensitivities of SLRs. In this report on SHG spectroscopy of plasmonic nanoparticles, we show that the SHG signal is greatly increased (up to 450 times) by the SLRs. We also demonstrate very narrow resonances in SHG intensity (∼5 nm fwhm). We illustrate how the SHG resonances are highly sensitive to SLRs by varying the fundamental wavelength, angle of incidence, nanoparticle material, and lattice constant of the arrays. Finally, we identify an SHG resonance (10 nm fwhm) that is electric dipole forbidden and can be attributed to higher-order multipoles, enhanced by the strong near-fields of SLRs. Our results open up new and very promising avenues for chemical and biomolecular sensing based on SHG spectroscopy of SLRs.
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