joruiz@clinic.ub.es / Objective: To characterize two Achromobacter xylosoxidans recovered from 2 patients diagnosed with pertussis during a Bordetella pertussis surveillance program. Methods: Nasopharyngeal swabs from 2 children under 1 year of age with clinical suspicion of pertussis were analyzed by culture and PCR. Results: Two Achromobacter xylosoxidans A8, closely related to Bordetella spp. were recovered from 2 patients diagnosed of pertussis, both carrying the ptxA gene and IS418 the pertussis toxin encoding gene. Subsequently, antibiotic susceptibility was evaluated by disk-diffusion method and by PCR. Conclusions: Although more detailed studies are needed, the present data highlight the possibility that Achromobacter xylosoxidans, closely related Bordetella pertussis microorganisms and not covered under the vaccine umbrella, might also result in cases of whooping cough. Thereby further surveillance is necessary to determine the extension and relevance of their pathogenic role in order to discriminate their real public health implication.

Achromobacter xylosoxidans (A. xylosoxidans) é um bacilo gram negativo, aeróbio, móvel, não fermentador de glicose e oxidase positivo, que coloniza habitualmente o trato digestivo e auditivo de humanos. Este bacilo tem sido associado a infecções oportunistas graves, especialmente pneumonia, em indivíduos imunossuprimidos, que em geral, são de difícil controle devido principalmente a fatores de virulência, mecanismos de escape e mutirresistência a antibióticoterapia. Dentre as condições que predispõem o desenvolvimento de infecção pulmonar por A. xylosoxidans, o câncer, a fibrose cística (FC) e a doença pulmonar obstrutiva crônica (DPOC) são as mais comuns. Essas doenças apresentam produção aumentada de vários mediadores lipídicos, como LTB4 e PGE2. A PGE2 é um lipídeo imunossupressor atuante no sistema imune inato e adaptativo que regula, por exemplo, a liberação de citocinas e quimiocinas, a ativação de células T, além de inibir as funções efetoras dos macrófagos. O LTB4, por outro lado, está associado ao recrutamento de células para o foco infeccioso, a ativação dos mecanismos efetores dos macrófagos, e aumento de mediadores inflamatórios. Neste trabalho, nosso objetivo foi investigar se, esses mediadores são liberados durante a infecção pulmonar por A. xylosoxidans e o possível papel dos mesmos. Nossos resultados demonstram que os tratamentos com celecoxibe, inibidor da síntese de prostaglandinas (PGs), nas doses de 1mg/kg ou 5mg/kg, não alteram a sobrevida dos animais infectados com inóculo letal ou subletal de A. xylosoxidans. No entanto, o tratamento com MK886, um inibidor da produção de leucotrienos (LTs), resultou em aumento da mortalidade dos animais infectados com inóculos letal ou subletal, redução do recrutamento de neutrófilos no dia 1 após infecção, redução de IL-6 do dia 14 e aumento de TNF-, IL-1 e MIP-1 no dia 7, KC no dia 14 e PGE2, em todos os períodos estudados. Este tratamento também induziu no lavado broncoalveolar, a diminuição não significativa do extravasamento de proteínas no dia 1, mas aumento significativo no dia 3. Com base nesses dados, podemos sugerimos que o tratamento com MK886 aumenta a mortalidade dos animais, devido ao aumento da permeabilidade vascular, com consequente edema, que leva os animais a insuficiência respiratória. Outros experimentos serão realizados para determinar o papel das prostaglandinas (PGs) e/ou metabolitos do ácido araquidônico neste fenômeno. / Achromobacter xylosoxidans (A. xylosoxidans) is a gram negative bacilli, aerobic, mobile, glucose non fermenter and oxidase positive, which normally colonizes the digestive and auditory tract of humans. This bacillus has been associated with severe opportunistic infections, especially pneumonia, in immunocompromised individuals, which are generally difficult to control mainly due to virulence factors, mechanisms and exhaust multidrug resistance to antibiotic therapy. Among the conditions that predispose the development of pulmonary infection by A. xylosoxidans, cancer, cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are the most common. These diseases have increased production of various lipid mediators, such as LTB4 and PGE2. PGE2 is an immunosuppressive lipid active in the innate and adaptive immune system that regulates, for example, the release of cytokines and chemokines, activation of T cells and inhibits the effector functions of macrophages. LTB4, on the other hand, is associated with the recruitment of cells to the infection, and the activation of effector mechanisms of macrophages, and increased production of inflammatory mediators. In this study, our aim was to investigate whether these mediators are released during pulmonary infection by A. xylosoxidans and the possible role of the same. Our results demonstrate that treatment with celecoxib, prostaglandin synthesis inhibitor (PGs), at doses of 1mg/kg or 5mg/kg not alter the survival of animals infected with lethal or sublethal inoculum of A. xylosoxidans. However, treatment with MK886, an inhibitor of the production of leukotrienes (LTs) resulted in an increased mortality of the animals infected with lethal or sublethal inoculum, reduce the recruitment of neutrophils on day 1 after infection, reduction in IL-6 day 14 and increased TNF-, IL-1 and MIP-1 at day 7, KC in day 14 and PGE2 in all periods. This treatment also induced in the bronchoalveolar lavage, no significant decrease protein extravasation in the day 1, but significantly increased on day 3. Based on these data, we suggest that treatment with MK886 increases the mortality of animals due to increased vascular permeability, with consequent edema, which leads the animals to respiratory failure. Other experiments will be conducted to determine the role of prostaglandins (PGs) and/or metabolites of arachidonic acid in this phenomenon.

Achromobacter xylosoxidans (A. xylosoxidans) é um bacilo gram negativo, aeróbio, móvel, não fermentador de glicose e oxidase positivo, que coloniza habitualmente o trato digestivo e auditivo de humanos. Este bacilo tem sido associado a infecções oportunistas graves, especialmente pneumonia, em indivíduos imunossuprimidos, que em geral, são de difícil controle devido principalmente a fatores de virulência, mecanismos de escape e mutirresistência a antibióticoterapia. Dentre as condições que predispõem o desenvolvimento de infecção pulmonar por A. xylosoxidans, o câncer, a fibrose cística (FC) e a doença pulmonar obstrutiva crônica (DPOC) são as mais comuns. Essas doenças apresentam produção aumentada de vários mediadores lipídicos, como LTB4 e PGE2. A PGE2 é um lipídeo imunossupressor atuante no sistema imune inato e adaptativo que regula, por exemplo, a liberação de citocinas e quimiocinas, a ativação de células T, além de inibir as funções efetoras dos macrófagos. O LTB4, por outro lado, está associado ao recrutamento de células para o foco infeccioso, a ativação dos mecanismos efetores dos macrófagos, e aumento de mediadores inflamatórios. Neste trabalho, nosso objetivo foi investigar se, esses mediadores são liberados durante a infecção pulmonar por A. xylosoxidans e o possível papel dos mesmos. Nossos resultados demonstram que os tratamentos com celecoxibe, inibidor da síntese de prostaglandinas (PGs), nas doses de 1mg/kg ou 5mg/kg, não alteram a sobrevida dos animais infectados com inóculo letal ou subletal de A. xylosoxidans. No entanto, o tratamento com MK886, um inibidor da produção de leucotrienos (LTs), resultou em aumento da mortalidade dos animais infectados com inóculos letal ou subletal, redução do recrutamento de neutrófilos no dia 1 após infecção, redução de IL-6 do dia 14 e aumento de TNF-, IL-1 e MIP-1 no dia 7, KC no dia 14 e PGE2, em todos os períodos estudados. Este tratamento também induziu no lavado broncoalveolar, a diminuição não significativa do extravasamento de proteínas no dia 1, mas aumento significativo no dia 3. Com base nesses dados, podemos sugerimos que o tratamento com MK886 aumenta a mortalidade dos animais, devido ao aumento da permeabilidade vascular, com consequente edema, que leva os animais a insuficiência respiratória. Outros experimentos serão realizados para determinar o papel das prostaglandinas (PGs) e/ou metabolitos do ácido araquidônico neste fenômeno. / Achromobacter xylosoxidans (A. xylosoxidans) is a gram negative bacilli, aerobic, mobile, glucose non fermenter and oxidase positive, which normally colonizes the digestive and auditory tract of humans. This bacillus has been associated with severe opportunistic infections, especially pneumonia, in immunocompromised individuals, which are generally difficult to control mainly due to virulence factors, mechanisms and exhaust multidrug resistance to antibiotic therapy. Among the conditions that predispose the development of pulmonary infection by A. xylosoxidans, cancer, cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) are the most common. These diseases have increased production of various lipid mediators, such as LTB4 and PGE2. PGE2 is an immunosuppressive lipid active in the innate and adaptive immune system that regulates, for example, the release of cytokines and chemokines, activation of T cells and inhibits the effector functions of macrophages. LTB4, on the other hand, is associated with the recruitment of cells to the infection, and the activation of effector mechanisms of macrophages, and increased production of inflammatory mediators. In this study, our aim was to investigate whether these mediators are released during pulmonary infection by A. xylosoxidans and the possible role of the same. Our results demonstrate that treatment with celecoxib, prostaglandin synthesis inhibitor (PGs), at doses of 1mg/kg or 5mg/kg not alter the survival of animals infected with lethal or sublethal inoculum of A. xylosoxidans. However, treatment with MK886, an inhibitor of the production of leukotrienes (LTs) resulted in an increased mortality of the animals infected with lethal or sublethal inoculum, reduce the recruitment of neutrophils on day 1 after infection, reduction in IL-6 day 14 and increased TNF-, IL-1 and MIP-1 at day 7, KC in day 14 and PGE2 in all periods. This treatment also induced in the bronchoalveolar lavage, no significant decrease protein extravasation in the day 1, but significantly increased on day 3. Based on these data, we suggest that treatment with MK886 increases the mortality of animals due to increased vascular permeability, with consequent edema, which leads the animals to respiratory failure. Other experiments will be conducted to determine the role of prostaglandins (PGs) and/or metabolites of arachidonic acid in this phenomenon.

Achromobacter xylosoxidans est un bacille à Gram négatif non fermentaire pathogène opportuniste. Il est de plus en plus fréquemment isolé chez les patients atteints de mucoviscidose, colonisant leur arbre bronchique et pouvant être responsable d’une dégradation de la fonction respiratoire. Il s’agit d’une espèce bactérienne naturellement résistante à de nombreux antibiotiques : aux céphalosporines (hors ceftazidime), à l’aztréonam et aux aminosides. Les résistances acquises sont fréquentes, en particulier dans les souches isolées d’expectorations de patients atteints de mucoviscidose. Ces résistances acquises concernent des molécules antibiotiques très utilisées pour le traitement des exacerbations respiratoires de la maladie, ce qui conduit parfois à de véritables impasses thérapeutiques. Au début de notre travail, seuls quelques mécanismes de résistance acquise aux β-lactamines avaient été décrits, mais aucun mécanisme impliqué dans la multi-résistance naturelle d’A. xylosoxidans.La résistance aux antibiotiques par efflux actif de type Resistance-Nodulation-cell Division (RND) est très répandue chez les bacilles à Gram négatif non fermentaires. Nous avons identifié dans le génome d’A. xylosoxidans trois opérons pouvant coder pour des systèmes d’efflux RND. Par une technique d’inactivation génique nous avons montré que les trois systèmes d’efflux (AxyABM, AxyXY-OprZ et AxyCDJ) pouvaient exporter des antibiotiques. Deux d’entre eux participent à l’antibio-résistance naturelle d’A. xylosoxidans : AxyABM (résistance à l’aztréonam et à plusieurs céphalosporines) et AxyXY-OprZ (résistance aux aminosides) / Achromobacter xylosoxidans is a nonfermentative Gram-negative bacillus considered to be an opportunistic agent. It is an emerging pathogen in cystic fibrosis (CF), increasingly recovered from the respiratory tract of CF patients. It can cause inflammation and therefore might be involved in the decline of the lung function.This species is innately resistant to many antibiotics, including cephalosporins (except ceftazidime), aztreonam, and aminoglycosides. Moreover the isolates recovered from CF patient sputum are often resistant to major antimicrobial components usually prescribed to treat pulmonary infections. There was very little known about acquired resistance and nothing about innate resistance mechanisms when we started this work.Antibiotic resistance mediated by Resistance-Nodulation-cell Division (RND)-type efflux pumps is widespread among nonfermentative Gram-negative bacilli. We have characterized three putative RND operons in A. xylosoxidans genome. By using a gene inactivation technique we have demonstrated that these operons encode efflux systems (AxyABM, AxyXY-OprZ and AxyCDJ) able to export antibiotics. Two of them are strongly involved in A. xylosoxidans innate antibiotic resistance: AxyABM (resistance to aztreonam and various cephalosporins) and AxyXY-OprZ (aminoglycoside resistance).

Achromobacter xylosoxidans est un bacille à Gram négatif non fermentaire émergent dans la mucoviscidose. A Dijon, la prévalence de patients colonisés est élevée au Centre de Ressources et de Compétences de la Mucoviscidose par rapport à la moyenne nationale, et augmente également chez des patients hospitalisés atteints d’autres pathologies. Les réservoirs et le mode de contamination des patients sont inconnus.Les objectifs de ce travail étaient de décrire la situation épidémiologique dans notre CRCM et de mettre en évidence d’éventuelles sources de contamination pour les malades en Bourgogne.Dans une première étude rétrospective, toutes les souches d’A. xylosoxidans isolées chez les patients du CRCM depuis le début de leur suivi jusqu’en 2010 ont été analysées. Sur 120 patients, 21 ont présenté au moins une culture positive. Le génotypage par électrophorèse en champ pulsé n’a montré que de rares cas de transmissions croisées. Les résistances acquises aux antibiotiques sont fréquentes : ciprofloxacine (dès primocolonisation), ceftazidime et carbapénèmes (colonisations chroniques). Notre protocole de détection d’A. xylosoxidans dans l’environnement a permis d’isoler 50 souches (lavabos, douches, rivières, lacs) : 33 à l’hôpital, 9 à domicile et 8 dans la nature. Ces isolats partagent des caractéristiques avec les souches cliniques : 6 génotypes communs et résistance constante à la ciprofloxacine. Le risque de contamination des patients à domicile ou à l’hôpital est donc réel.D’autres études sont en cours afin de mieux comprendre l’émergence de cette bactérie, ses mécanismes de résistance acquise aux antibiotiques et les facteurs favorisant sa sélection dans l’environnement. / Achromobacter xylosoxidans is an aerobic nonfermentative Gram-Negative rod considered as an important emerging pathogen among cystic fibrosis (CF) patients worldwide. In Dijon (Burgundy), the prevalence of colonised patients is high among CF patients and increasing among non-CF hospitalised patients. The natural habitat of this organism as well as the possible sources of patient contamination remain unknown.The aims of this study were to report the first epidemiological data about A. xylosoxidans in a French CF centre and to identify potential reservoirs of this organism in Burgundy. In a retrospective study, all the isolates recovered from the patients affiliated with our centre in 2010 since their first visit were analysed. Out of 120 patients, 21 (17.5%) had at least one positive culture with A. xylosoxidans. Genotyping analysis by Pulsed Field Gel Electrophoresis revealed that cross-Contamination was very rare. Acquired resistance was frequent to ciprofloxacin (since primocolonisation), to ceftazidime and to carbapenems (in persistent colonisations). Thanks to our protocol designed to detect A. xylosoxidans in environment, a total of 50 strains were isolated in hospital (33 isolates), domestic (9 isolates) and outdoor (8 isolates) samples, mainly in handwashing sinks, showers, and water. These environmental isolates shared characteristics with clinical ones: 6 genotypes in common and a constant resistance to ciprofloxacin. These results reveal potential sources of contamination for the patients at home or in hospital. Further studies are needed to help understanding the emergence of this bacterium and the mechanisms involved in acquired antibiotic resistance.

Achromobacter xylosoxidans est un bacille à Gram négatif non fermentaire pathogène opportuniste. Il est de plus en plus fréquemment isolé chez les patients atteints de mucoviscidose, colonisant leur arbre bronchique et pouvant être responsable d'une dégradation de la fonction respiratoire. Il s'agit d'une espèce bactérienne naturellement résistante à de nombreux antibiotiques : aux céphalosporines (hors ceftazidime), à l'aztréonam et aux aminosides. Les résistances acquises sont fréquentes, en particulier dans les souches isolées d'expectorations de patients atteints de mucoviscidose. Ces résistances acquises concernent des molécules antibiotiques très utilisées pour le traitement des exacerbations respiratoires de la maladie, ce qui conduit parfois à de véritables impasses thérapeutiques. Au début de notre travail, seuls quelques mécanismes de résistance acquise aux β-lactamines avaient été décrits, mais aucun mécanisme impliqué dans la multi-résistance naturelle d'A. xylosoxidans.La résistance aux antibiotiques par efflux actif de type Resistance-Nodulation-cell Division (RND) est très répandue chez les bacilles à Gram négatif non fermentaires. Nous avons identifié dans le génome d'A. xylosoxidans trois opérons pouvant coder pour des systèmes d'efflux RND. Par une technique d'inactivation génique nous avons montré que les trois systèmes d'efflux (AxyABM, AxyXY-OprZ et AxyCDJ) pouvaient exporter des antibiotiques. Deux d'entre eux participent à l'antibio-résistance naturelle d'A. xylosoxidans : AxyABM (résistance à l'aztréonam et à plusieurs céphalosporines) et AxyXY-OprZ (résistance aux aminosides)