Negli ultimi decenni l'utilizzo degli antibiotici a scopo terapeutico o come promotori della crescita nell'allevamento animale ha portato alla comparsa e alla diffusione di microrganismi resistenti. In questo contesto, la presenza di Lattobacilli (LAB) antibiotico resistenti non rappresentano di per sé un rischio clinico. Tuttavia la possibilità che essi ma possono essere veicolo di geni codificanti l'antibiotico-resistenza verso batteri patogeni presenti negli alimenti o nel tratto gastro-intestinale umano (inclusi enterococchi, streptococchi e listeria), costituisce un possibile rischio per la salute umana che deve essere attentamente valutato. Obiettivo di questo lavoro è stato quello di valutare attraverso metodi di indagine fenotipica con le tecniche delle microdiluizioni in brodo, Etest e disc-diffusion, i livelli di antibiotico resistenza per le specie S. thermophilus e L. plantarum verso gli antibiotici tetraciclina, eritromicina, clindamicina, streptomicina, gentamicina, ampicillina. Ceppi atipici appartenenti alla specie S. thermophilus sono stati sottoposti ad analisi genetiche con lo scopo di caratterizzare e localizzare i geni responsabili della resistenza. E' stato inoltre testato il possibile trasferimento orizzontale dei geni di antibiotico resistenza nativi da S. thermophilus verso i batteri Gram-positivi E. faecalis e Listeria monocytogenes. In alcuni ceppi di S. thermophilus resistenti si sono infine osservati e studiati particolari caratteri fenotipici ( fitness ) correlati alla presenza delle determinanti genetiche di antibiotico resistenza nell'ospite batterico. / In the last decades, the use of antibiotics in human therapy or in animal husbandry as growth promoters has induced the development and the diffusion in antibiotic resistant micro-organisms. In this context antibiotic resistant Lactic Acid Bacteria (LAB) do not represent a clinical risk in themselves. However, the possibility that S. thermophilus cultures might transfer antibiotic resistance genes to pathogenic species either present in food or in the gastrointestinal tract (including enterococci, streptococci and listeria) represents a potential clinical risk that needs to be carefully evaluated. The aim of this study was to evaluate by means of phenotypic methods (microdilution, E-test, disc-diffusion) the levels of antibiotic resistance for S. thermophilus and L. plantarum species against the antibiotic tetracycline, erythromycin, clyndamicin, streptomycin, gentamycin and ampicillin. The atypical resistant S. thermophilus strains were subjected to genetic analyses in order to characterise and to localise the antibiotic resistance determinants. Furthermore the ability of the resistant S. thermophilus strains in transferring the antibiotic resistant determinant was assessed in mating experiments using as recipients the Gram-positive bacteria E. faecalis and Listeria monocytogenes. In same resistant S. thermophilus strains, special bacterial fitness related with the presence of the antibiotic resistance determinants in the bacterial hosts were observed and studied.

Thiostrepton (TS: TS; C72H85N19O18S5) is a thiazoline antibiotic that is effective against Gram-positive bacteria and the malarial parasite, Plasmodium falciparum. Tight binding of TS to the bacterial L11-23S ribosomal RNA (rRNA) complex of the large 50S ribosomal unit inhibits protein biosynthesis. The TS producing organism, Streptomyces azureus, biosynthesizes thiostrepton-resistance methyltransferase (TSR), an enzyme that uses S-adenosyl-L-methionine (AdoMet) as a methyl donor, to modify the TS target site. Methylation of A1067 (Escherichia coli ribosome numbering) by TSR circumvents TS binding. The S. azureus tsr gene was overexpressed in E. coli and the protein purified for biochemical characterization. Although the recombinant protein was produced in a soluble form, its tendency to aggregate made handling a challenge during the initial stages of establishing a purification protocol. Different purification conditions were screened to generate an isolation protocol that yields milligram quantities of protein with little aggregation and sufficient purity for crystallographic studies. Enzymological characterization of TSR was carried out using an assay to monitor AdoMet-dependent ([methyl-3H]-AdoMet) methylation of the rRNA substrate by liquid scintillation counting. During the optimization of assay, it was found that, although this method is frequently employed, it is very time and labour intensive. A scintillation proximity assay was investigated to evaluate whether it could be a method for collecting kinetic data, and was found that further optimization is required. Comparative sequence analysis of TSR has shown it to be a member of the novel Class IV SpoUT family of AdoMet-dependent MTases. Members of this class possess a non-canonical AdoMet binding site containing a deep trefoil knot. Selected SpoUT family proteins were used as templates to develop a TSR homology model for monomeric and dimeric forms. Validation of the homology models was performed with structural validation servers and the model was then used as the basis of ongoing mutagenesis experiments. The X-ray crystal structure of TSR bound with AdoMet (2.45 Å) was elucidated by our collaborators, Drs. Mark Dunstan and Graeme Conn (University of Manchester). This structure confirms TSR MTase’s membership in the SpoUT MTase family with a deep trefoil knot in the catalytic domain. The AdoMet bound in the crystal structure is in an extended conformation not previously observed in SpoUT MTases. RNA docking simulations revealed some features that may be relevant to binding and recognition of TSR to the L11 binding domain of the RNA substrate. Two structure-activity studies were conducted to investigate the TS-rRNA interaction and TS solubility. Computational analyses of TS conformations, molecular orbitals and dynamics provided insight into the possible modes of TS binding to rRNA. Single-site modification of TS was attempted, targeting the dehydroalanine and dehydrobutyrine residues of the antibiotic. These moieties were modified using the polar thiol, 2-mercaptoethanesulfonic acid (2-MESNA). Similar modifications had been previously used to improve solubility and bioavailability of antibiotics. The resulting analogue was structurally characterized (NMR and mass spectrometry) and showed antimicrobial activity against Bacillus subtilis and Staphylococcus aureus.

Thiostrepton (TS: TS; C72H85N19O18S5) is a thiazoline antibiotic that is effective against Gram-positive bacteria and the malarial parasite, Plasmodium falciparum. Tight binding of TS to the bacterial L11-23S ribosomal RNA (rRNA) complex of the large 50S ribosomal unit inhibits protein biosynthesis. The TS producing organism, Streptomyces azureus, biosynthesizes thiostrepton-resistance methyltransferase (TSR), an enzyme that uses S-adenosyl-L-methionine (AdoMet) as a methyl donor, to modify the TS target site. Methylation of A1067 (Escherichia coli ribosome numbering) by TSR circumvents TS binding. The S. azureus tsr gene was overexpressed in E. coli and the protein purified for biochemical characterization. Although the recombinant protein was produced in a soluble form, its tendency to aggregate made handling a challenge during the initial stages of establishing a purification protocol. Different purification conditions were screened to generate an isolation protocol that yields milligram quantities of protein with little aggregation and sufficient purity for crystallographic studies. Enzymological characterization of TSR was carried out using an assay to monitor AdoMet-dependent ([methyl-3H]-AdoMet) methylation of the rRNA substrate by liquid scintillation counting. During the optimization of assay, it was found that, although this method is frequently employed, it is very time and labour intensive. A scintillation proximity assay was investigated to evaluate whether it could be a method for collecting kinetic data, and was found that further optimization is required. Comparative sequence analysis of TSR has shown it to be a member of the novel Class IV SpoUT family of AdoMet-dependent MTases. Members of this class possess a non-canonical AdoMet binding site containing a deep trefoil knot. Selected SpoUT family proteins were used as templates to develop a TSR homology model for monomeric and dimeric forms. Validation of the homology models was performed with structural validation servers and the model was then used as the basis of ongoing mutagenesis experiments. The X-ray crystal structure of TSR bound with AdoMet (2.45 Å) was elucidated by our collaborators, Drs. Mark Dunstan and Graeme Conn (University of Manchester). This structure confirms TSR MTase’s membership in the SpoUT MTase family with a deep trefoil knot in the catalytic domain. The AdoMet bound in the crystal structure is in an extended conformation not previously observed in SpoUT MTases. RNA docking simulations revealed some features that may be relevant to binding and recognition of TSR to the L11 binding domain of the RNA substrate. Two structure-activity studies were conducted to investigate the TS-rRNA interaction and TS solubility. Computational analyses of TS conformations, molecular orbitals and dynamics provided insight into the possible modes of TS binding to rRNA. Single-site modification of TS was attempted, targeting the dehydroalanine and dehydrobutyrine residues of the antibiotic. These moieties were modified using the polar thiol, 2-mercaptoethanesulfonic acid (2-MESNA). Similar modifications had been previously used to improve solubility and bioavailability of antibiotics. The resulting analogue was structurally characterized (NMR and mass spectrometry) and showed antimicrobial activity against Bacillus subtilis and Staphylococcus aureus.

Aquaculture is the fastest growing food industry in the world and it accounts for roughly half of the world's fish supply. The majority of global aquaculture production occurs in freshwater systems that are increasingly subject to multiple uses by different stakeholders. Given the overall scarcity of freshwater on a global scale, freshwater aquaculture will face increasing environmental constraints that will demand an ever better understanding of its potential impacts on the aquatic environment and human health. This thesis consists of a series of studies that, collectively, contribute to further our understanding on the effects of freshwater aquaculture effluents on aquatic ecosystems, on the effects and environmental safety of antibiotics used in freshwater aquaculture on aquatic bacterial communities and on the link between antibiotic pollution and antibiotic resistance. Chapter 2 reviews the effects of freshwater aquaculture effluents on stream ecosystems using land-based salmonid farms as a case study. In this chapter I discuss relevant considerations related to the temporal and spatial scales of effluent discharge and ecological effects that highlight the need to characterize the patterns of stressor discharge when assessing environmental impacts and designing ecological effects studies. I also discuss the potential role of multiple stressors - with an emphasis on veterinary medicines - in disrupting ecosystem structure and function. Overall, the critical analysis presented in this chapter indicates that further research on the effects of veterinary medicines using relevant exposure scenarios would significantly contribute to our understanding of their impact in relation to other effluent stressors. Chapter 3 is a general methods chapter that describes the stream microcosm system used to assess the effects of erythromycin thiocyanate (ERT) and florfenicol (FFC) on bacterial communities of stream biofilms. This chapter presents the results of preliminary experiments whose results provided relevant information on the overall operation of the microcosms and on the variability of major physical and biological variables. This information guided the experimental designs used to assess the effects of FFC and ERT on the bacterial community structure of stream biofilms. Chapter 4 presents the results of the experiment conducted to assess the effects of FFC on the bacterial community structure of developing biofilms. The objective was to assess changes in bacterial community structure along a gradient of FFC concentrations that could provide insight into the type and magnitude of effects that could be expected from episodic exposure of stream biofilms to FFC in headwater streams. At 10 and 20 days of biofilm development, bacterial community structure differentiated in a pattern consistent with the FFC concentration gradient and there was a positive relationship between bacterial richness and bacterial diversity with FFC concentration. At 15 days of biofilm development there was also a positive relationship between FFC concentration and the surface coverage of bacteria and extracellular polymeric substances. These trends declined as the biofilm developed a more complex architecture, in terms of thickness and in the surface coverage of algae. The results are consistent with an initial stimulatory effect of FFC on biofilm formation that triggered changes in bacterial community structure that were gradually compressed as the development of a complex biofilm architecture increased the relative importance of autogenic ecological processes. The results suggest that the co-occurrence of FFC with bacterial pathogens in effluents and wastewaters may favour their persistence in the environment by enhancing biofilm formation. Chapter 5 presents the results of the experiment conducted to assess the effects of ERT on the bacterial community structure of developing biofilms. Currently, Aquamycin® 100 - a Type A medicated article (i.e., Premix) containing 100 g ERT lb-1 and used to produce a Type C medicated feed - is a candidate drug for approval by the US FDA to control mortality associated with bacterial kidney disease in freshwater salmonids. The objective of this experiment was to assess the effects of ERT on the bacterial community structure of stream biofilms using an exposure period consistent with the 28-day treatment regime suggested for Aquamycin® 100. The results provide no evidence to suggest that a 30-day exposure to ERT concentrations in the range of 10 μg L-1 (i.e., 7.3 ± 3.9 μg L-1) would lead to changes in the bacterial community structure or overall bacterial abundance of stream biofilms, while they suggest that these effects may occur at concentrations in the range of 100 μg L-1 (i.e., 87.2 ± 31.1 μg L-1). Chapter 6 attempts to determine whether environmental concentrations of antibiotics and concentrations representing action limits used in environmental risk assessment may exert a selective pressure on clinically relevant bacteria in the environment. In this chapter I use bacterial inhibition as an assessment endpoint to link antibiotic selective pressures to the prevalence of resistance in bacterial populations. Species sensitivity distributions were derived for three antibiotics by fitting log-logistic models to endpoints calculated from minimum inhibitory concentration (MIC) distributions based on worldwide data collated by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Bacteria represented in these distributions were placed in a broader context by performing a brief phylogenetic analysis. The potentially affected fraction of bacterial genera at measured environmental concentrations of antibiotics and environmental risk assessment action limits was used as a proxy for antibiotic selective pressure. Measured environmental concentrations and environmental risk assessment action limits were also directly compared to wild-type cut-off values. Results suggest that measured environmental concentrations of antibiotics and concentrations representing environmental risk assessment action limits are high enough to exert a selective pressure on clinically relevant bacteria that may lead to an increase in the prevalence of resistance. Chapter 7 presents the results of an exploratory analysis conducted to assess the abundance of class 1 integrons in stream biofilms exposed to FFC and ERT. There was no pattern in the abundance of intI1 genes consistent with the treatment of FFC and ERT, suggesting either the absence of gene cassettes involved in dealing with selective pressures caused by these antibiotics or that the concentrations tested were below those required to give them a selective advantage. Chapter 8 is a brief general discussion that brings together the findings of the thesis and makes suggestions for future research. Key areas identified for future research include assessing in further detail the stimulatory effect of FFC on biofilm formation in complex bacterial communities, the interactive effects of multiple aquaculture effluent stressors on aquatic bacterial communities and their potential effects on the development of antibiotic resistance, the fate of FFC and ERT in stream ecosystems, and further developing the analysis based on MIC distributions presented in chapter 6 to assess the potential effects of antibiotic pollution on the selection of multi-drug resistance in the environment.

La résistance bactérienne aux antibiotiques est un problème de santé publique mondial principalement lié à un mésusage des antibiotiques (surconsommation et prescription inadéquate).Pour lutter contre cette menace, des recommandations diffusées par les sociétés savantes et des plans d’action ont été mis en place. Même si ils sont nécessaires, ils ne sont pas suffisants pour assurer une amélioration significative de l’usage des antibiotiques. Un fort taux de non-conformité de la prescription antibiotique au regard des recommandations est observé dans les établissements de santé (ES). La mise en place de programmes volontaristes de bon usage antibiotique au sein de chaque ES s’avère essentiel pour améliorer l’usage des antibiotiques : une action sur les comportements des prescripteurs est indispensable, par le biais de différentes stratégies. Qu’elles soient persuasives ou restrictives, celles-ci ont toutes montré leur efficacité, sans entraîner d’effets cliniques néfastes pour les patients (pas d’augmentation de la mortalité ni de la durée de séjour), tout en permettant une réduction des coûts liés aux anti-infectieux.Par le biais de nos travaux, nous avons cherché à étudier le bon usage antibiotique en milieu hospitalier, à l’échelle de différents types d’ES (hôpital local, centre hospitalier régional universitaire, cohorte de 259 ES), et en évaluant l’impact de recommandations nationales ou de programmes et de guides locaux. Ces travaux nous ont permis de constater que la diffusion de recommandations nationales pouvait permettre de réduire les consommations de carbapénèmes, et qu’un programme mené dans un hôpital local pouvait être très efficace pour réduire les consommations de fluoroquinolones, mais également la résistance bactérienne à plus long terme. Des audits ciblés sur la prescription des aminosides et l’antibioprophylaxie chirurgicale ont permis de mettre en évidence des non-conformités récurrentes orientant sur des actions d’amélioration ciblées à mener.En conclusion, ce travail souligne l’importance des programmes de bon usage antibiotique au sein de chaque ES, quel que soit le type et le nombre de lits. En effet, ces programmes venant en appui aux recommandations ont démontré leur efficacité pour réduire les consommations et améliorer la qualité des prescriptions antibiotiques, grâce à leur impact positif sur les comportements des prescripteurs. / Bacterial resistance to antibiotics is a worldwide public health issue which is mainly linked to antibiotic misuse (overconsumption and inappropriate prescription).To fight this threat, recommendations from learned societies and national action plans have been set up. Even if they are necessary, they are not sufficient to provide a significant improvement in the antibiotic use. A high rate of non-compliance with the recommendations is observed among healthcare facilities (HCFs). The setting up of proactive antimicrobial stewardship programs (ASP) among every HCF is essential to improve antibiotic use: an action on prescribers’ behavior is necessary, by using various strategies. These strategies, however persuasive or restrictive, have been shown to be effective, with no clinical negative effects for the patients (no increase in mortality and in length of stay), while reducing anti-infective costs.With this work, we aimed to study the appropriateness of antibiotic use in hospitals, at different HCFs levels (local hospital, university hospital, 259 French HCFs cohort), by assessing the impact of national recommendations or local ASP and guidelines. These studies showed that national recommendations could lead to a reduction in carbapenem consumptions, and that an ASP conducted in a local hospital could be very effective to reduce fluoroquinolones consumptions, and bacterial resistance at a longer term. Targeted audits on aminoglycosides prescription and on surgical antibioprophylaxis have permitted to highlight recurrent non-compliances, guiding improvement measures to set up.In conclusion, this work supports the weight of ASPs among each HCF, whatever type and size. Indeed, these ASPs, set up in support of the national recommendations, have demonstrated their effectiveness in reducing antibiotic consumptions and improving prescription appropriateness, by their positive impact on prescribers’ behaviors.

En réanimation, les facteurs de risque d’infection à bactéries résistantes sont nombreux et il est nécessaire d’instaurer une antibiothérapie rapide et adéquate. Cela conduit donc souvent au choix empirique d’antibiotiques à large spectre. Ce travail de thèse regroupant quatre études porte sur les éléments de ce choix. Dans la première étude, les critères de "pneumopathie associée aux soins" sont discutés. Dans la seconde, il est rapporté que le traitement antibiotique prescrit au début du séjour en réanimation est associé à l’acquisition de Pseudomonas aeruginosa. Dans le diagnostic d’une pneumopathie acquise sous ventilation, la troisième étude décrit une technique rapide d’antibiogramme permettant une désescalade antibiotique plus précoce. La néphrotoxicité des aminoglycosides dans le traitement empirique des patients en sepsis sévère est présentée dans la dernière étude. Ces travaux participent à la bonne gestion des antibiotiques à la phase empirique du traitement des infections sévères en réanimation. / Intensive care units (ICU) are a niche for risk factors of infection due to multidrug resistant bacteria. ICU patients are in a need for a rapid and adequate antibiotic therapy. This leads ICU physicians to use empirical broad spectrum antibiotics. This thesis comprises four studies which focus on the empirical step of the treatment. In the first study, the criteria for "health-care-associated pneumonia" are discussed. The second shows that the antibiotic selection pressure administered early during the ICU stay could lead to Pseudomonas aeruginosa acquisition. In the third study, a rapid direct specimen testing method was assessed for ventilator-associated pneumonia diagnosis in order to hasten antibiotic de-escalation. Finally, a review on aminoglycosides’ nephrotoxicity in the severe sepsis setting represents the fourth study. These studies bring a loop forward into the understanding of the antibiotic stewardship of patients with severe sepsis, with particular focus on the empirical antibiotic treatment.

No description available.

Bakgrund: Behandlingen av bakteriella infektioner med antibiotika har lett till ett ökat problem av antibiotikaresistens. Antibiotikaresistensens konsekvenser har resulterat i problem för både individer och sjukvård världen över. Både etiska aspekter och sjuksköterskans roll inom omvårdnaden behöver ses över för att finna lösningar till detta globala hot.   Syfte: Att beskriva sjuksköterskans förebyggande roll vid antibiotikaresistens.  Metod: En litteraturöversikt   Resultat: Sjuksköterskans roll i förebyggandet av antibiotikaresistens ansågs var otydliga. Sjuksköterskor belyste att utbildningen innehöll moment om förebyggande åtgärder för antibiotika resistens lika så i praktiken. Däremot upplevde sjuksköterskor i arbetslivet att de var exkluderade.   Sammanfattning: Författarna fann att det fanns en tydlig koppling mellan betydelsen av sjuksköterskans arbetsroll och det förebyggande arbetet kring antibiotikaresistens. Det fanns även en kunskapsbrist hos sjuksköterskorna kring antibiotikaresistensen och de förebyggande rutinerna samt att vikten av en fungerande kommunikation mellan vårdprofessionerna spelade stor roll. / Background: The treatment of bacterial infections with antibiotics has led to an increased problem with antibiotic resistance. The antibiotic resistance has had consequences that resulted in problems for both individuals as well as health care worldwide. Both ethical aspects and the nurse’s role within nursing needs to be reviewed to find solutions to this global threat.   Aim: To describe the nurse’s preventive roll in antibiotic resistance.  Method: Literature review  Results: The nurse’s role in the prevention of antibiotic resistance was seen as vague. Nurses illustrated that education contained elements on the prevention of antibiotic resistance as well as in practice. On the other hand, in the work life, nurses rather felt that they were excluded.   Summary: The authors found that there was a clear connection between the importance of the nurse’s work role and the preventative work regarding antibiotic resistance. There was a knowledge gap between the nurses when it came to antibiotic resistance and the preventative routines as well as bearing that a functioning communication between the nursing professions was of big importance.

La résistance bactérienne aux antibiotiques est un problème de santé publique majeur, touchant plus particulièrement les enfants dans les pays en développement (PED).Nous avons effectué une revue systématique de la littérature pour quantifier le niveau de résistance aux antibiotiques chez les enfants âgés de moins de 2 ans dans les PED. De manière générale, les données sur la résistance aux antibiotiques dans la population étudiées sont rares. Selon les publications identifiées, Staphylococcus aureus, Escherichia coli, et Klebsiella spp. apparaissent comme les causes les plus fréquentes d’infections néonatales sévères. Chez les enfants âgés de 1 à 24 mois, Streptococcus pneumoniae et Salmonella spp. apparaissent comme les causes les plus fréquentes d’infections bactériennes invasives.Dans une seconde revue systématique, nous avons examiné les méthodologies actuelles utilisées pour mesurer la consommation d’antibiotiques dans les PED.Nos résultats montrent qu’aucunes des méthodologiesne permet, à elle seule, de répondre aux besoins de ces pays en terme de données.Nous avons conduit une enquête en population à Madagascar et au Sénégal afin d’examiner les modalités de consommation d’antibiotiques chez des enfants de moins de 2 ans. Dans les 2 pays, la plupart des antibiotiques étaient achetés en pharmacie sur présentation d’une ordonnance. Une proportion élevée des antibiotiques était utilisée pour le traitement d’infections probablement d’origine virale. Des facteurs tels que la disponibilité de centres de santé, de pharmacies, l’existence de programmes de remboursement ou encore la formation du personnel pourraient influencer la fréquence de consommations d’antibiotiques au niveau national.Les résultats issus de ces travaux de recherche ajoutent des données essentielles à la littérature existante et mettent en évidence des leçons importantes pour la lutte contre la résistance aux antibiotiques dans les PEDs. / Antimicrobial resistance is a growing threat across the world and is likely to disproportionately affect children in low-income countries (LICs).To estimate the burden of antibiotic resistance in the community among children under two in LICs we undertook a review of published literature. Common isolates in neonatal sepsis cases included Staphylococcus aureus, Escherichia coli, and Klebsiella. Among children 1 mo. to 2 yrs., Streptococcus pneumonia and Salmonella were most often reported. Information on antibiotic resistance was sparse and often relied on few isolates.We reviewed methods to measure antibiotic consumption in LICs from published literature and showed that current techniques used in isolation are insufficient to respond to all the data needs in LICs. Integrating study techniques and starting with community surveys may respond more adequately to this issue in LICs and lead to more actionable results.To investigate patterns of antibiotic consumption and related factors among children under two in Madagascar and Senegal we undertook community surveys in two sites in Madagasgar (Antananarvo and Moramanga) and one site in Senegal. Results showed relatively high levels of antibiotic use among children. The majority of antibiotics were purchased in pharmacies with a prescription in both countries. Data suggest a high proportion of use for likely viral infections. Local contexts including the availability of health care facilities, availability of pharmacies, national payment schemes, and provider training seemed to play a role in country usage rates.Results from this work add essential data to the literature where relatively little data exists and reveal important lessons about studying and combating antibiotic resistance in LICs.

No description available.