This study characterized Salmonella enterica serovar Heidelberg from human, abattoir poultry and retail poultry isolates to examine the molecular relationships of cefoxitin resistance between these groups. A total of 147 S. Heidelberg (70 cefoxitin-resistant and 77 cefoxitin-susceptible) isolates were studied. All cefoxitin-resistant isolates were also resistant to amoxicillin-clavulanic acid, ampicillin, ceftiofur and ceftriaxone, and all contained the CMY-2 gene. Pulsed-field gel electrophoresis typing illustrated that 93.9% isolates clustered together with ≥ 90% similarity. Core genome analysis using whole genome sequencing identified 12 clusters of isolates with zero to four single nucleotide variations. These clusters consisted of cefoxitin-resistant and susceptible human, abattoir poultry and retail poultry isolates. Analysis of CMY-2 plasmids from cefoxitin-resistant isolates revealed all belonged to incompatibility group I1. Analysis of plasmid sequences using WGS revealed high identity (95-99%) to a previously described plasmid (pCVM29188_101) found in Salmonella Kentucky. When compared to pCVM29188_101, all sequenced cefoxitin-resistant isolates were found to carry one of ten possible variant plasmids. The discovery of several clusters of isolates from different sources with zero to four SNVs suggests that transmission between human, abattoir poultry and retail poultry sources may be occurring. The classification of newly sequenced plasmids into one of ten sequence variant types suggests transmission of a common CMY-2 plasmid amongst S. Heidelberg with variable genetic backgrounds. / October 2016

Desde a primeira enzima ?-lactamase de espectro estendido (ESBL) detectada, na década de 1980, o número de diferentes enzimas ESBL têm aumentado exponencialmente. Houve também aumento no número de relatos de isolamento de bactérias resistentes presentes em alimentos de origem animal. O objetivo deste estudo foi avaliar enterobactérias de microbiota de frangos comerciais saudáveis, de granjas localizadas no interior do Estado de São Paulo (Brasil), quanto à resistência a antimicrobianos e ao potencial de virulência. Foram avaliadas todas as enterobactérias que apresentaram resistência à cefotaxima e/ou ceftazidima de 200 frangos comerciais para consumo humano. O teste de sensibilidade aos antimicrobianos foi realizado por disco de difusão para diferentes classes de antimicrobianos incluindo ?- lactâmicos e não ?-lactâmicos. Reação em cadeia da polimerase e sequenciamento foram utilizados para a pesquisa de genes codificadores de ESBL, ?-lactamases AmpC e determinantes de resistência às quinolonas mediada por plasmídeos (PMQR). A similaridade genética dos isolados foi caracterizada por eletroforese em campo pulsado (PFGE) e a localização cromossômica ou plasmideal de genes de resistência foi avaliada por I-Ceu IPFGE ou S1-PFGE. Além disso, experimentos de conjugação, tipagem de plasmídeos, investigação de filogenia e de virulência foram realizados. Em todas as amostras de cloaca coletadas foram identificados Enterobacteriaceae, incluindo Escherichia coli, Escherichia fergusonii, Klebsiella oxytoca e Klebsiella pneumoniae resistentes à cefotaxima e/ou ceftazidima. Salmonella sp não foi detectada. Foi encontrada ampla diversidade genômica entre todos os isolados classificados entre diferentes tipos de PFGE. Foram detectados diferentes genes codificadores de ?-lactamases, a maioria em diferentes plasmídeos, de diversos tamanhos, sendo alguns conjugativos, presentes em diferentes populações bacterianas. Foram identificados isolados de E. coli produtores de CTX-M-2, com inserção do gene blaCTX-M-2 no cromossomo bacteriano. Plasmídeo IncI (ST113/ST114) foi identificado carreando o gene blaCTX-M-8. Foram também encontrados os genes codificadores de ?- ii lactamase, blaCTX-M-2 e blaCTX-M-15, sendo carreados por plasmídeos. Foi identificado gene blaCMY-2 disseminado por plasmídeos de diferentes grupos de incompatibilidade, na população comensal de E. coli. Nos isolados que abrigavam gene PMQR, além das resistências às quinolonas, foi observado também resistência a outras importantes classes de antimicrobianos. Genes determinantes de PMQR abrigados em plasmídeos tipo ColE foram encontrados em E. coli, E. fergusonii, K. oxytoca e K. pneumoniae. Todas as aves comerciais de granjas localizadas no interior do Estado de São Paulo, incluídas nesse estudo, apresentaram isolados considerados multirresistentes a antimicrobianos e o trato intestinal destes frangos é reservatório dos genes de resistência em enterobactérias da microbiota normal. Além disso, alguns isolados demonstraram alto potencial de virulência, incluindo a capacidade de adesão e invasão em células epiteliais in vitro. / of commercial poultry in farms located at the countryside of São Paulo State (Brazil). All enterobacteria presenting cefotaxime and/or ceftazidime resistance from 200 commercial broiler chickens for human consumption were evaluated. Antimicrobial susceptibility testing was performed by disc diffusion for different classes of antimicrobials, including ?-lactams and non-?-lactams. The genes encoding ESBL, ampC ?-lactamases and determinants of plasmid mediated quinolone resistance (PMQR) were screened by polymerase chain reaction and sequencing. Genetic similarity of bacterial isolates was characterized by pulsed field gel electrophoresis (PFGE) and the location of the resistance genes in the chromosome or plasmids was evaluated by I-CeuI-PFGE or S1-PFGE. Additionally, experiments of conjugation, plasmid typing, phylogeny and virulence characterization were performed. Enterobacteriaceae were identified in all cloacal swab samples, including Escherichia coli, Escherichia fergusonii, Klebsiella oxytoca and Klebsiella pneumoniae resistant to cefotaxime and/or ceftazidime. Salmonella sp. was not detected. High genetic diversity was detected among all isolates, classified into diferent types of PFGE. Different genes coding for ?-lactamases were detected, harbored in diverse plasmids, of different sizes, some were conjugative and were present in different bacterial populations. E. coli isolates producing CTX-M-2 were identified, harbouring the blaCTX-M-2 gene inserted into the chromosome. IncI (ST113/ST114) plasmid was identified carrying the blaCTX-M-8 gene. The ?-lactamase coding genes, blaCTX-M-2 and blaCTX-M-15 were also found in plamids. The gene blaCMY-2 was found disseminated in different types of plasmid replicons in the commensal E. coli population. In isolates harbouring PMQR genes, in addition to the quinolones resistance, was observed resistance to other important antimicrobials classes was observed. PMQR determinant genes harbored in ColE-like plasmids were found in E. coli, E. fergusonii, K. oxytoca and K. pneumoniae. All commercial poultry from farms located at São Paulo State, evaluated in this study, carried isolates considered multidrug resistant and the intestinal tract of these chickens is reservoir of resistant genes blaCTX-M-2, blaCTX-M-8 and blaCTX-M-15 in enterobacteria from the normal microbiota. Moreover, some have demonstrated a high virulence potential, with adhesion and invasion capacity in epithelial cells cultured in vitro.

L’émergence de formes multirésistantes de tuberculose et la résistance intrinsèque de Mycobacterium abscessus à de nombreux anti-infectieux imposent l’identification de nouveaux antibiotiques et de nouvelles stratégies thérapeutiques. Les mycobactéries sont naturellement peu sensibles aux β-lactamines par production d’une β-lactamase et de cibles atypiques de faible affinité, les L,D-transpeptidases, qui sont efficacement inactivées par une seule classe de β-lactamines, les carbapénèmes. L’objectif de la thèse est d’étudier le mode d’action des β-lactamines afin de proposer des stratégies permettant d’optimiser ces antibiotiques. Pour comprendre la spécificité des L,D-transpeptidases vis-à-vis des carbapénèmes, nous avons étudié la cinétique et le mécanisme de la réaction d’inactivation de ces enzymes par différentes méthodes de spectroscopie en flux arrêté. Nos résultats indiquent que l’efficacité des carbapénèmes est due à leur capacité à former rapidement un intermédiaire tétrahédrique et à la stabilité de l’acylenzyme. La spécificité des L,D-transpeptidases pour les carbapénèmes ne dépend pas de leurs chaînes latérales, qui pourraient être modifiées pour améliorer les propriétés pharmacologiques de ces antibiotiques. Chez M. abscessus, nous avons identifié un inhibiteur de la β-lactamase, l’avibactam, qui augmente l’activité de certaines β-lactamines in vitro, en intracellulaire et dans un modèle d’infection du poisson zèbre. Nos résultats montrent que les β-lactamines peuvent être optimisées pour le traitement des infections dues aux mycobactéries multirésistantes par l’amélioration de l’inactivation des cibles ou l’inhibition des β-lactamases. / The emergence of multidrug-resistant tuberculosis and the intrinsic resistance of Mycobacterium abscessus to most antibiotics require the identification of new drugs and new therapeutic strategies. Mycobacteria are naturally poorly susceptible to β-lactam antibiotics due to production of a β-lactamase and of atypical low-affinity targets, the L,D-transpeptidases, which are effectively inactivated by a single class of β-lactams, the carbapenems. The aim of the thesis is to study the mode of action of β-lactams to propose strategies for the optimization of these antibiotics. To understand the specificity of L,D-transpeptidase for carbapenems, we have studied the kinetics and mechanism of inactivation of these enzymes using various stopped-flow spectroscopic methods. Our results indicate that the efficacy of carbapenems is due to their ability to rapidly form a tetrahedral intermediate and to the stability of the acylenzyme. The specificity of the L,D-transpeptidases for carbapenems does not depend upon the side chains of the drugs, which may be modified to improve their pharmacological properties. In M. abscessus, we have shown that the β-lactamase inhibitor avibactam increases the activity of various β-lactams in vitro, intracellularly, and in zebrafish model. Our results show that β-lactams can be optimized for the treatment of infections due to multidrug-resistant mycobacteria by improving inactivation of the targets and by inhibiting the β-lactamases.

Entre as ß-lactamases, as enzimas CTX-M têm despertado atenção especial pela alta incidência e grande capacidade de propagação. Eventos como recombinação gênica, transferência plasmideal e multirresistência podem ser a razão da manutenção e da ampla disseminação dos genes blaCTX-M. Este é um trabalho retrospectivo que teve como objetivo caracterizar genes blaCTX-M presentes em Klebsiella spp. Foram estudadas 27 linhagens de Klebsiella pneumoniae e 8 linhagens de Klebsiella oxytoca, produtoras de ?-lactamase de espectro estendido, isoladas de pacientes hospitalizados no período de janeiro a junho de 2000. A detecção e identificação dos genes blaCTX-M, assim como dos elementos relacionados com a mobilização destes genes, foi realizada por PCR e seqüenciamento. A localização genética e a mobilidade dos genes blaCTX-M foram pesquisadas por análise plasmideal e hibridação e por conjugação. Os perfis de sensibilidade das linhagens estudadas e das linhagens transconjugantes foram comparados pela determinação da concentração inibitória mínima de antibióticos das classes das cefalosporinas, cefamicinas, aminoglicosídeos e quinolonas. Foram encontrados genes blaCTX-M em plasmídeos conjugativos em 13 (37%) linhagens estudadas: blaCTX-M-9 em 4 K. oxytoca, e blaCTX-M-2 em 9 K. pneumoniae. Os genes blaCTX-M-9 estavam associados ao elemento de inserção ISEcp1, enquanto os genes blaCTX-M-2 estavam associados a integrons de classe I contendo ISCR1. O genes blaCTX-M-2, carreado por plasmídeo, pode estar relacionado com disseminação horizontal entre vários clones de K. pneumoniae, enquanto o gene blaCTX-M-9 foi encontrado sendo carreado por um único clone de K. oxytoca. Este estudo determinou a incidência e a diversidade de enzimas CTX-M no período estudado, além de fornecer dados epidemiológicos que podem explicar a sua prevalência no mundo e contribuir para o entendimento e controle da disseminação deste tipo de resistência. / CTX-M enzymes, the world\'s most prevalent ß-lactamases disseminate very easily. Genetic recombination, plasmid transference and multiresistance could be responsible for the wide spread of blaCTM-X genes. This retrospective study aims to characterize blaCTX-M genes found in Klebsiella spp. The strains were isolated in hospital patients from January to June 2000 and consisted of 27 ESBL-producing Klebsiella pneumoniae and 8 ESBL-producing Klebsiella oxytoca. PCR and sequencing were used in the detection and identification of blaCTX-M genes and genetic elements associated with their mobilization. Determination of genetic localization and mobility of blaCTX-M genes was by plasmid analyses, hybridization and transfer assays. The minimal inhibitory concentrations (MICs) of cephalosporins, cefamicins, aminoglycosides and quinolone antimicrobials evaluated the antibiotic susceptibility profile of transconjugants and strains in the study. The blaCTX-M genes were found in 13 strains (37%): blaCTX-M-9 in 4 K. oxytoca and blaCTX-M-2 in 9 K. pneumoniae. The insertion sequence ISEcp1 was associated with blaCTX-M-9 and blaCTX-M-2 was found in a class I integron bearing ISCR1. Plasmid blaCTX-M-2 genes dissemination was due to horizontal transfer among many K. pneumoniae clones, while blaCTX-M-9 dissemination was associated with a particular clone of K. oxytoca. The study characterized incidence and diversity of CTX-M enzymes during the period studied. Moreover it showed epidemiological data, which may explain CTX-M prevalence worldwide and contribute for the understanding and control of the resistance spread.

Submitted by FERNANDA DA SILVA VON PORSTER (fdsvporster@univates.br) on 2014-09-25T18:14:21Z No. of bitstreams: 3 license_text: 22302 bytes, checksum: 1e0094e9d8adcf16b18effef4ce7ed83 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) 2014JohanPrediger.pdf: 1412383 bytes, checksum: 351464f422d7e0f60807a802dec5db00 (MD5) / Approved for entry into archive by Ana Paula Lisboa Monteiro (monteiro@univates.br) on 2014-10-06T14:14:36Z (GMT) No. of bitstreams: 3 license_text: 22302 bytes, checksum: 1e0094e9d8adcf16b18effef4ce7ed83 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) 2014JohanPrediger.pdf: 1412383 bytes, checksum: 351464f422d7e0f60807a802dec5db00 (MD5) / Made available in DSpace on 2014-10-06T14:14:36Z (GMT). No. of bitstreams: 3 license_text: 22302 bytes, checksum: 1e0094e9d8adcf16b18effef4ce7ed83 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) 2014JohanPrediger.pdf: 1412383 bytes, checksum: 351464f422d7e0f60807a802dec5db00 (MD5) / Doenças infecciosas são uma das principais causas de morbidade no mundo inteiro, sendo que o uso indiscriminado de antibióticos favorece o desenvolvimento de mecanismos de resistência bacteriana, dificultando o combate às infecções. O número de pacientes infectados por microrganismos resistentes vem aumentando consideravelmente e por isso tem chamado atenção dos serviços de saúde. A presente pesquisa teve como objetivo de verificar a infecção bacteriana e sua resistência aos antibióticos, além da presença de genes produtores de beta-lactamases em um hospital do interior do Rio Grande do Sul. Realizou-se a análise retrospectiva das infecções por bactérias multirresistentes durante o período de janeiro de 2011 a junho de 2012. O isolamento e a identificação das bactérias foram realizados por laboratório terceirizado, e para a avaliação de suscetibilidade aos antimicrobianos foi utilizado o método de difusão de disco, padronizado pelo Clinical and Laboratory Standards Institute (CLSI). A análise retrospectiva de 374 amostras mostrou que diferentes bactérias apresentaram resistência a um grande número de antibióticos. Dentre as mais prevalentes no estudo e que também apresentaram maior percentual de resistência estavam: Klebsiella spp., Enterobacter spp., Escherichia coli e Pseudomonas spp. Foram coletadas 62 amostras para análise pelo método de triagem para detecção de beta-lactamases de espectro estendido (ESBL), por aproximação de discos, onde 45% foram classificadas com produtoras de ESBL. A caracterização molecular feita nestes mesmos isolados, realizada pela técnica de Reação em cadeia da polimerase (PCR) identificou o gene TEM em 70,96% dos isolados, o gene SHV em 56,45% e, o gene CTX-M em 91,93%, dos quais 24,19% confirmaram a presença de gene pertencente ao grupo CTX-M1, 14,51% ao grupo CTX-M2 e 22,58% ao grupo CTX-M9. Com o presente estudo conclui-se que os genes CTX-M e TEM foram os mais prevalentes entre os genes dos isolados avaliados. Além disso, também se observa a presença de outros genes produtores de ESBL nas amostras analisadas fato que pode estar relacionado ao alto nível de resistência a antimicrobianos das bactérias estudadas.

Wong Yin Wai. / Thesis submitted in: June 2002. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 82-93). / Abstracts in English and Chinese. / Acknowledgement --- p.ii / Abstract --- p.iii / 摘要 --- p.v / Table of Content --- p.vi / List of Tables --- p.ix / List of Figures --- p.x / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Taxonomy of salmonellae --- p.1 / Chapter 1.2 --- Clinical significance --- p.2 / Chapter 1.3 --- Treatment of Salmonella infections --- p.4 / Chapter 1.4 --- Global and local prevalence of Salmonella --- p.5 / Chapter 1.5 --- Antimicrobial Susceptibilities --- p.8 / Chapter 1.5.1 --- Salmonella Typhimurium --- p.8 / Chapter 1.5.2 --- Other salmonellae --- p.9 / Chapter 1.5.3 --- Emergence of quinolone-resistant salmonellae --- p.9 / Chapter 1.6 --- Mechanisms of β-lactam resistance --- p.10 / Chapter 1.6.1 --- Enzymatic deactivation of β-lactam antibiotics --- p.10 / Chapter 1.6.2 --- Modifications of normal PBPs --- p.11 / Chapter 1.6.3 --- Alternative routes of peptidoglycan synthesis --- p.12 / Chapter 1.6.4 --- Impermeability and active efflux system --- p.12 / Chapter 1.7 --- Classification and nomenclature of β-lactamases --- p.13 / Chapter 1.7.1 --- Functional classification --- p.13 / Chapter 1.7.2 --- Molecular classification --- p.15 / Chapter 1.7.3 --- Nomenclature of β-lactamases --- p.16 / Chapter 1.8 --- β-Lactamases in salmonellae --- p.17 / Chapter 1.8.1 --- Salmonella Typhimurium --- p.17 / Chapter 1.8.2 --- Other salmonellae --- p.18 / Chapter 1.9 --- Methods for the characterization of β-lactamases --- p.18 / Chapter 1.9.1 --- Isoelectric focusing (IEF) --- p.19 / Chapter 1.9.2 --- β-Lactamase activity assays --- p.20 / Chapter 1.9.3 --- Hybridization with DNA probes --- p.20 / Chapter 1.9.4 --- Amplification of β-lactamase genes by polymerase chain reaction (PCR) --- p.21 / Chapter 1.9.5 --- Polymerase chain reaction - Single strand conformational polymorphism (PCR-SSCP) analysis --- p.23 / Chapter 1.9.6 --- Gene sequencing --- p.23 / Chapter 1.10 --- Objectives --- p.25 / Chapter 2 --- Materials and Methods --- p.26 / Chapter 2.1 --- Bacterial Strains --- p.26 / Chapter 2.1.1 --- Identification of salmonellae --- p.26 / Chapter 2.1.2 --- Antibiotics and chemicals used --- p.26 / Chapter 2.1.3 --- Antimicrobial susceptibility testing --- p.28 / Chapter 2.2 --- Localization of β-lactamase genes --- p.30 / Chapter 2.2.1 --- Transferability study --- p.30 / Chapter 2.3 --- Characterization of β-lactamases --- p.31 / Chapter 2.3.1 --- Extraction of crude β-lactamases --- p.31 / Chapter 2.3.2 --- Isoelectric focusing (IEF) --- p.31 / Chapter 2.4 --- Molecular characterization of β-lactamase genes --- p.33 / Chapter 2.4.1 --- Detection of TEM-type β-lactamase genes using polymerase chain reaction (PCR) --- p.33 / Chapter 2.4.2 --- Detection of OXA-type β-lactamase gene using PCR --- p.36 / Chapter 2.4.3 --- Detection of TEM mutations by polymerase chain reaction 一 single strand conformational polymorphism (PCR-SSCP) analysis --- p.37 / Chapter 2.4.4 --- Detection of OXA mutations by PCR-SSCP analysis --- p.38 / Chapter 2.4.5 --- Sequencing of β-lactamase genes --- p.39 / Chapter 2.4.5.1 --- Preparation of sequencing template --- p.39 / Chapter 2.4.5.2 --- Sequencing reaction --- p.39 / Chapter 2.4.5.3 --- Preparation of sequencing gel --- p.40 / Chapter 2.4.5.4 --- Silver staining of the sequencing gel --- p.41 / Chapter 2.5 --- Relatedness of ampicillin-resistant S. Typhimurium --- p.42 / Chapter 2.5.1 --- Pulsed field gel electrophoresis (PFGE) --- p.42 / Chapter 2.5.2 --- Cluster analysis --- p.44 / Chapter 3 --- Results --- p.46 / Chapter 3.1 --- Bacterial Strains --- p.46 / Chapter 3.1.1 --- Antimicrobial susceptibilities --- p.46 / Chapter 3.2 --- Characterization of β-lactamases by isoelectric focusing --- p.52 / Chapter 3.3 --- Characterization of β-lactamase genes --- p.53 / Chapter 3.3.1 --- Transferability of β-lactamase genes --- p.53 / Chapter 3.3.2 --- Detection of OXA-type β-lactamase gene by polymerase chain reaction (PCR) --- p.53 / Chapter 3.3.3 --- Detection of OXA-type mutations by polymerase chain reaction- single strand conformational polymorphism (PCR-SSCP) analysis --- p.56 / Chapter 3.3.4 --- Detection of TEM-type β-lactamase gene by PCR --- p.56 / Chapter 3.3.5 --- Detection of TEM-type mutations by PCR-SSCP analysis --- p.56 / Chapter 3.3.6 --- Sequencing of β-lactamase genes --- p.61 / Chapter 3.3.7 --- Pulsed-field gel electrophoresis --- p.64 / Chapter 4 --- Discussion --- p.67 / Chapter 4.1 --- Antimicrobial susceptibilities of S. Typhimurium in Hong Kong --- p.67 / Chapter 4.2 --- Transferability of resistance --- p.69 / Chapter 4.3 --- β-Lactamases of S. Typhimurium --- p.70 / Chapter 4.4 --- DNA sequence of β-lactamase genes --- p.72 / Chapter 4.5 --- Relatedness of ampicillin-resistant S. Typhimurium --- p.73 / Chapter 4.6 --- Methods for the characterization of β-lactamases --- p.75 / Chapter 4.7 --- Significance of this study --- p.78 / Chapter 4.8 --- Conclusions --- p.79 / Chapter 4.9 --- Further studies --- p.80 / References --- p.83

Objetivos: Avaliar o perfil de suscetibilidade, a prevalência da produção de AmpC, β-lactamase de espectro estendido (ESBL) e Metalo-β-lactamase (M-βla) em Pseudomonas aeruginosa obtidas de dois hospitais universitários distintos (ISCMPA e HCPA) em Porto Alegre. Em adição, tipagem molecular por PFGE foi realizada entre os isolados produtores de M-βla para avaliar a relação clonal. Métodos: Foi determinada a suscetibilidade de 238 isolados de P. aeruginosa para 8 agentes antimicrobianos, através do teste de disco-difusão, usando agar Müller-Hinton (MH) de acordo com “National Committee for Clinical Laboratory Standards” (NCCLS) . Todos isolados foram avaliados para produção de AmpC com o disco de imipenem (indutor) próximo ao disco de cefepima/ceftazdima (substrato). Um achatamento no halo de cefepime/ceftazidima pela indução da enzima pelo imipenem, indicava resultado positivo para AmpC. Todos isolados forma avaliados para a presença de ESBL através do teste de aproximação de disco com ceftazidima, cefepima, cefotaxima, ceftriaxona e ticarcilina-clavulanato como inibidor de β-lactamase. A produção de M-βla foi determinada através do teste de aproximação de discos de CAZ a discos impregnados com ácido2-mercatopropiônico (2-MPA). As taxas de resistência foram comparadas através do Teste Exato de Fisher. Valor de P<0,05 foi considerado estatisticamente significativo. Análise de macrorestrição com a enzima speI foi realizada em isolados produtores de M-βla. Resultados: As taxas de resistência para todos os agentes foram superiores entre os isolados obtidos na ISCMPA em relação aos do HCPA. A ceftazidima mostrou ser o antibiótico mais efetivo contra os isolados de ambos Hospitais (ISCMPA e HCPA) com taxa de resistência de 25,7% (ISCMPA) e 6,1% (HCPA). A expressão de AmpC foi observada em 190 isolados (83,7% HCPA e 77,1% ISCMPA). Não foi possível detectar a presença de ESBL entre todos as P. aeruginosa avaliadas em ambos hospitais. Foi observada a presença de M-βla em 28 isolados (20,0%) da ISCMPA. Mas não foi detectada M-βla em nenhuma P. aeruginosa do HCPA. A análise de macrorestrição mostrou que 14 de 16 P. aeruginosa Mβla positivas pertenciam a um clone (denominado clone A), e seus subclones. Apenas dois outros clones (B e C) foram identificados em um isolado cada. / Objectives: To evaluate susceptibility profile, the prevalence of extendedspectrum β-lactamases (ESBL) production, AmpC and Metallo-β-lactamases (M-βla) in Pseudomonas aeruginosa obtained from two distinct hospitals (ISCMPA and HCPA) in Porto Alegre, Brazil. In addiction, molecular typing by PFGE was perfomed among isolates producing M-βla in order to evaluate probably clonal relatedness. Methods: The susceptibility of 238 P. aeruginosa to 8 antimicrobial agents was determined by the disk diffusion method, using Müller-Hinton agar (MH) in accordance with “National Committee for Clinical Laboratory Standards” guidelines. All isolates were evaluated for AmpC production with the imipenem disk (strong inducer) near of the cefepime/ceftazidime disk (substrate). A blunting of the cefepime/ceftazidime zone by imipenem-induced enzyme, indicated positive result for AmpC. All isolates were evaluated for ESBL production by disk approximation test with ceftazdime, cefepime, cefotaxime, ceftriaxone plus ticarcillin-clavulanate as inhibitor. M-βla production was determined by disk approximation test with disks containing CAZ and 2-mercatopropionic acid (2-MPA). The results were compared by the Fisher’s Exact Test. Macrorestriction analysis by SpeI, followed by PFGE, was perfomed in isolates M-βla positive. The resistance rates were compared by The Fisher’s Exact Test. P values < 0.05 were considered to be statistically significant. Results: The resistance rates to all antimicrobial agents were higher among isolates obtained from ISCMPA than those obtained from HCPA. The ceftazidime was the more active antibiotic against the isolates in both hospitals with resistance rates of 25,7% (ISCMPA) and 6,1% (HCPA). The derepression of AmpC was observed in 190 isolates (83,7% HCPA and 77,1% ISCMPA). It was not possible to detect the presence of ESBL among all P. aeruginosa evaluated in both hospitals. Positive results for M-βla production were observed in 28 isolates (20,0%) from ISCMPA. But none M-βla production was identified in P. aeruginosa from HCPA. The macrorestriction analysis by PFGE, showed that 14 of 16 M-βla positive P. aeruginosa beloneed to one clone (named clone A) and its subclones.Only two others clones (B and C) were identified in one isolate each.

An alpha-amino ester hydrolase (AEH) applicable to synthesis of semi-synthetic antibiotics was cloned from the genomic DNA of Xanthomonas campestris pv. campestris sp. strain ATCC 33913. AEHs catalyze the synthesis and hydrolysis of alpha-amino beta-lactam antibiotics. The enzyme was characterized for thermodynamic and kinetic parameters. The enzyme shows optimal ampicillin hydrolytic activity at 25C and pH 6.8. The AEH enzymes have been shown to have excellent synthetic capability. Additionally, we demonstrated the first fully aqueous enzymatic one-pot synthesis of ampicillin direct from the natural product penicillin G eliminating the isolation of the intermediate 6-APA. Lastly, to improve the thermostability of the AEH a modified structure-guided consensus model of seven homologous enzymes was generated along with analysis of the B-factors from the available crystal structures of the known AEH from Xanthomonas citri. Our best variant, which is a quadruple mutant, E143H/A275P/N186D/V622I, which has a T_50_30, the temperature at which the half-life is 30 minutes, of 34C and 1.3-fold activity compared to wild-type. Overall, we have successfully improved the understanding of the AEH class of enzymes and applied a novel cascade application, demonstrating AEHs unique applicability in the synthesis of beta-lactam antibiotics. The improved thermostability will further improve the industrial relevance of AEHs.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The use of antibiotics and antimicrobial drugs has played a large role in the elimination of many infectious diseases, however the wide spread use of such drugs has given rise to the phenomenon of antimicrobial resistance and has rendered antibiotics ineffective to a broad range of bacteria. The aim of the study was to ascertain the differences if any in the phenotypic and genotypic resistance profiles of K. pneumoniae isolated from a single tertiary hospital in two surveillance studies undertaken at different times, viz., 2001 and 2007 with special emphasis on ESBLs. A correlation with antibiotic use was also undertaken. ESBL positives were identified and phenotypic resistance profiles were generated based on the resistance profiles of individual isolates by means of their MIC data. The molecular detection of ESBLs was carried out using representative isolates and sequencing was based on the phenotypic expression of the most common ESBL genes. The data was summarized using median values and interquartile ranges. Antibiotic use and susceptibility in 2000 was compared to that in 2007 using a Wilcoxon signed rank test for paired data since the same drugs were tested in both years. Of the isolates that were tested, sequencing revealed that TEM – 1 was identified in all isolates and SHV-1 and SHV-2 were identified in 60 % in the isolates collected in 2000 and 77 % and 11 % respectively in the isolates collected in 2007. SHV – 11 was present in 67% of isolates from 2007 and 55% of those were in combination with SHV – 1. Sequencing also revealed CTXM-15 present in one of the isolates collected in 2007. There was 100% susceptibility to cefoxitin and only one isolate in 2007 showing an intermediate result to imipenem. No novel β-lactamases were identified in this study; however the decrease in susceptibility over time is proof of bacterial evolution. The variety of β-lactamases and diversity of plasmid profiles in these two small populations provides proof to the claim that dissemination of resistance in Klebsiella pneumonia is effortless. Statistical analysis showed an increase in resistance from the year 2000 to 2007 however the correlation between overall antibiotic use and the increase in resistance did not reach statistical significance. It was observed that resistance increased despite only a slight increase in the use of a few antibiotics to which we attributed co-carriage of resistance genes. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Westville, 2012.