Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : DC26 - DC29 Full Version

Levonadifloxacin: A Novel Approved Drug Exhibiting Potent In vitro Activity against Gram Positive Bacterial Isolates from Patients Admitted in Intensive Care Units


Published: July 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49986.15132
Tasneem Siddiqui, Rafat Shamim, Sangram Singh Patel, Chinmoy Sahu

1. Senior Resident, Department of Microbiology, SGPGI, Lucknow, Uttar Pradesh, India. 2. Assistant Professor, Department of Anaesthesiology, SGPGI, Lucknow, Uttar Pradesh, India. 3. Assistant Professor, Department of Microbiology, SGPGI, Lucknow, Uttar Pradesh, India. 4. Associate Professor, Department of Microbiology, SGPGI, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Dr. Chinmoy Sahu,
Associate Professor, Department of Microbiology, SGPGI,
Lucknow, Uttar Pradesh, India.
E-mail: sahu.chinmoy@gmail.com

Abstract

Introduction: Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolone with potent activity against Methicillin Resistant Staphylococcus aureus (MRSA) and Quinolone Resistant Staphylococcus aureus (QRSA). Both intravenous levonadifloxacin and its oral formulation have recently been approved in India for the treatment of acute bacterial skin related infections.

Aim: To assess the activity of levonadifloxacin against gram positive clinical isolates collected from Intensive Care Units (ICUs) using the disk-diffusion method.

Materials and Methods: The present descriptive study where non duplicate isolates of Staphylococcus aureus (S. aureus) and other gram positive isolates from various clinical samples from all Intensive Care Units (ICUs) were collected from June to December 2020 and subjected to levonadifloxacin susceptibility testing (disk diffusion method) as per the Clinical and Laboratory Standards Institute (CLSI) guidelines, 2020. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 25.0.

Results: A total of 142 gram positive clinical isolates collected from all ICUs of the hospital were analysed. These isolates included coagulase negative S. aureus 109 (76.8%), S. aureus 21 (14.8%) and Enterococcus faecalis 12 (8.4%). All the gram positive isolates of the study were susceptible to levonadifloxacin as per the prespecified interpretive criteria identified based on population pharmacokinetic model and Monte Carlo simulation enabled probability of pharmacodynamic target attainment analysis.

Conclusion: Results of this in vitro study shows good activity of levonadifloxacin against gram positive isolates including difficult to-treat methicillin resistant staphylococcal isolates collected from ICU patients.

Keywords

Antibiotic sensitivity, Drug, Fluoroquinolones, Methicillin resistant Staphylococcus aureus

Methicillin resistant Staphylococcus are a major cause of healthcare-associated infections (1). The World Health Organisation (WHO) has estimated a higher likelihood of mortality due to MRSA compared to infections with non resistant Staphylococcal isolates (2).

Recently, changes in the patient population, including increasing number of elderly, chronically ill and immunocompromised patients has led to the recognition of a large variety of infections caused by Coagulase Negative Staphylococci (CoNS) (3),(4). Moreover, the widespread use of Matrix-Assisted Laser Desorption Ionisation-Time-Of-Flight Mass Spectrometry (MALDI-TOF-MS) has allowed a better understanding of the clinical importance of different CoNS species (3),(4). CoNS represent the most common cause of bacteremia associated with indwelling devices, and most of these infections are hospital acquired (1). Apart from this both CoNS and S. aureus cause Skin and Soft tissue Infections (SSSIs) (1),(4),(5).

Resistant staphylococcal isolates are difficult to treat particularly in ICUs. The two most deployed antibiotics to treat methicillin resistant staphylococcal infections at present are vancomycin and linezolid (teicoplanin and daptomycin to some extent); but both drugs have their limitations like vancomycin is considered as a suboptimal option in critically ill patients due to its weak bactericidal activity, poor penetration into tissues (such as lung), renal toxicity and risk of clinical failure due to Minimum Inhibitory Concentration (MIC) creep (6),(7),(8). Linezolid is a bacteriostatic agent and therefore, not recommended to be used in Blood Stream Infections (BSI). Adverse side effects of linezolid like bone marrow suppression leading to thrombocytopenia requires its usage in shorter duration along with monitoring of safety parameters (9). Thus, for treatment of methicillin resistant staphylococcal infections, clinicians require improved antibiotics that are bactericidal, having good tissue penetration and are safe especially for the longer duration use.

Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolone with potent activity against MRSA and QRSA. Both intravenous levonadifloxacin and its oral formulation, alalevonadifloxacin, have recently been approved in India to treat acute bacterial infections in skin (10). Its approval is based on a successfully conducted Phase three clinical study comparing levonadifloxacin with linezolid (Clinical Trial Registry India, CTRI/2017/06/008843) (11). Good potency of levonadifloxacin against MRSA, QRSA and hetero-vancomycin-intermediate S. aureus is attributed to well differentiated mechanism of action involving preferential targeting to DNA gyrase while retaining high affinity toward topoisomerase IV as well (12). Recently, the potent in vitro activity (MIC) of levonadifloxacin against contemporary Indian MRSA isolates, including the Bengal Bay clones, has been reported (13). In another report, good in vitro activity of levonadifloxacin against gram positive isolates of BSIs have been reported (14).

Since, 10 μg levonadifloxacin disk has been approved by the CLSI in 2016 (15). Thus, in this study Kirby-Bauer disk diffusion assay was used to assess the in vitro activity of levonadifloxacin against the bacterial isolates collected from the hospital.

Material and Methods

The present descriptive study which was conducted in Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, between June to December 2020. The study was conducted after obtaining Ethical Committee approval with Letter number- PGI/BE/1561/2021. A total of 142 gram positive clinical isolates collected from all ICUs of the hospital were analysed.

Inclusion criteria: All consecutive, non duplicate isolates of all Staphylococci and Enterococci from BSI, tissue fluids, indwelling catheter tips, skin and soft tissue and pus samples collected from ICUs considered clinically significant were included in the study.

Exclusion criteria: Duplicate isolates were excluded from study.

Study Procedure

Demographic information and clinical details of the patient included in the study were recorded. Culture of clinical specimens and species identification were performed according to laboratory guidelines. Species identifications of all isolates were confirmed by MALDI-TOF-MS using the Biotyper system according to manufacturer recommendations (VITEK MS, bioMérieux, USA). The zone diameter obtained with a 30 μg cefoxitin disk was used to determine methicillin resistance in Staphylococci.

Antimicrobial Susceptibility Testing (AST): Antibiotic sensitivity was done by Kirby-Bauer disk diffusion method as per CLSI, 2020 (16). MICs were determined using Epsilometer test (E-test) method. It was performed as per manufacturer’s instructions.

A 10 μg disk of Levonadifloxacin (Himedia, Mumbai, India) was used; however rest of the comparator antibiotic disks and E-strips were procured from Oxoid India Ltd., and bioMérieux, France respectively. Confirmation of MIC values was done by concurrent testing of CLSI-recommended quality control strains: S. aureus American Type Culture Collection (ATCC) 29213 and Enterococcus faecalis (E. faecalis) ATCC 29212 (16).

Sensitivity pattern of Staphylococcus and E. faecalis to the tested antibiotics were determined using breakpoints set by the CLSI, 2020 (16). Interpretation of zone diameters of levonadifloxacin for S. aureus and E. faecalis and were done as per zone size ranges (Table/Fig 1) based on population pharmacokinetic model and Monte Carlo simulation enabled probability of pharmacodynamic target attainment analysis (17),(18). As there are no breakpoints for interpretation of levonadifloxacin in case of CoNS so breakpoints of S. aureus was used for its interpretation.

Statistical Analysis

Data analysis was performed using SPSS software, version 25.0 for descriptive statistics. Categorical data were described using numbers and percentages.

Results

Total 142 gram positive clinical isolates were analysed in the study. The age of the patient population ranged from one month to 81 years with a median age of 36.5 years. The number of males and females enrolled in the study were 92 and 50, respectively with a M:F ratio of 1.8:1. Detailed clinical profile of the patients is illustrated in (Table/Fig 2). Distribution of clinical sample is shown in (Table/Fig 3).

The most common clinical isolate was CoNS 109 (76.8%) followed by S. aureus 21 (14.8%) and E. faecalis 12 (8.4%) (Table/Fig 4), (Table/Fig 5).

Of the 109 CoNS isolated most common were Staphylococcus haemolyticus 46 (42.2%), Staphylococcus epidermidis 44 (40.4%), and Staphylococcus hominis 16 (14.7%) and there were two isolates of Staphylococcus lugdunensis and one isolate of Staphylococcus capitis, respectively.

Antibiotic susceptibility profile of clinical isolates: Amongst the 142 isolates of the study methicillin resistance in S.aureus and CoNS was seen in 8 (38.1%) out of 21 and 98 (89.9%) out of 109, respectively. Overall levofloxacin resistant was 98 (69%) isolates. The percentages of levofloxacin resistance were 17 (80.9%) out of 21 in S. aureus, 74 (67.9%) out of 109 in CoNS and 7 (58.3%) out of 12 in E. faecalis (Table/Fig 5). All the isolates of S. aureus were 100% sensitive to vancomycin, teicoplanin and daptomycin. Susceptibility of other comparator antibiotics tested is shown in (Table/Fig 4). Based on the diameter of zone of inhibition observed with 10 μg levonadifloxacin disk, by employing the interpretive criteria provided in (Table/Fig 1), all the isolates including MRSA and MR-CoNS and VRE were susceptible to levonadifloxacin. Additionally all the levofloxacin resistant S. aureus, CoNS and E. faecalis isolates were susceptible to levonadifloxacin. The (Table/Fig 5) show the range and mean zone diameter values obtained for each of the gram positive organism groups tested in this study. In general, the zone diameter values were ≥20 mm suggesting the potent activity of levonadifloxacin against gram positive isolates.

Discussion

In the present study most common isolates was CoNS (76.8%) followed by S. aureus and E. faecalis which shows increasing trend of CoNS isolation which was similar to other ICU studies from India (19),(20). Of the 109 CoNS isolated, most common were S. haemolyticus (42.2%) followed by S. epidermidis and S. hominis which was similar to other studies (20),(21). Thirty eight percent methicillin resistance in S. aureus was seen which was consistent with other studies (22),(23). We found 89.9% of methicillin resistance CoNS which is consistent with other studies (24),(25).

Levofloxacin resistance was noted in 67.9% CoNS, 80.9% S. aureus and 58.3% E. faecalis in the study. All the isolates of S. aureus were 100% sensitive to vancomycin, teicoplanin and daptomycin but 50% isolates of E. faecalis were resistant to vancomycin and teicoplanin but these results were in concordance with data from India (26). The activity of levonadifloxacin against gram positive isolates observed in this study was consistent with various previous reports (13),(15),(17),(18),(27),(28),(29). For instance, in a recent report by Appalaraju B et al., levonadifloxacin exhibited potent activity against 390 S. aureus isolates (98.7% susceptibility) collected from 15 tertiary hospitals, located in different parts of India including MRSA as well as quinolone resistant phenotypes (29). In a study, 793 S. aureus isolates collected at a large tertiary care hospital at Vellore, Tamil Nadu and all were found to be susceptible to levonadifloxacin (13).

The Deoxyribonucleic Acid (DNA) gyrase and topoisomerase IV are two bacterial enzymes that are critical for bacterial DNA replication. Most quinolones approved to date for gram positive bacteria, are reported to have primary affinity for topoisomerase IV rather than DNA gyrase. Hence, activity of these agents is significantly impacted against those S. aureus isolates that carry mutations in topoisomerase IV. On the other hand, levonadifloxacin overcomes ciprofloxacin- and levofloxacin-resistance in S. aureus due to its preferential affinity towards DNA gyrase (12).

The 100% susceptibility rate observed for levonadifloxacin in this study supports its use as a therapeutic option for methicillin resistant staphylococcal infections. Additionally, it could also be used as an empirical therapy. In spite of vancomycin and linezolid showing similar high susceptibility rates, vancomycin use is often associated with nephrotoxicity and longer duration use of linezolid leads to myelosuppression. Contrary to vancomycin, levonadifloxacin can be administered to patient with renal or liver impairment without the need for dose adjustments. Moreover, the availability of oral formulation of levonadifloxacin with comparable pharmacokinetics feature allows easy intravenous to oral switch (30). Enterococci are known to display high level of resistance to most of the antibiotic classes, but in this study all the Enterococcus isolates including levofloxacin resistant ones were susceptible to levonadifloxacin.

Limitation(s)

A study recruiting more number of Enterococci isolates is needed to prove activity of levonadifloxacin against Enterococcus spp.

Conclusion

Results of this in vitro study shows good activity of levonadifloxacin against gram positive isolates including difficult-to-treat methicillin resistant staphylococcal isolates. The 100% susceptibility of isolates to levonadifloxacin observed in this study supports its potential clinical use in the treatment of infections particularly caused by methicillin resistant Staphylococcus and other gram positive organisms.

Acknowledgement

Authors like to thank Wockhardt India for providing “levonadifloxacin” disks.

References

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Bocher S, Tonning B, Skov RL, Prag J. Staphylococcus lugdunensis, a common cause of skin and soft tissue infections in the community. J Clin Microbiol. 2009;47(4):946-50. [crossref] [PubMed]
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DOI and Others

10.7860/JCDR/2021/49986.15132

Date of Submission: Apr 19, 2021
Date of Peer Review: May 21, 2021
Date of Acceptance: Jun 09, 2021
Date of Publishing: Jul 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 20, 2021
• Manual Googling: Jun 08, 2021
• iThenticate Software: Jun 30, 2021 (20%)

ETYMOLOGY: Author Origin

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