Antibiotic resistance is an ever-growing topic of concern within the medical field causing researchers to examine the mechanisms of resistance to develop new antimicrobials. Bacteria’s ability to form biofilms is one mechanism which aids in antimicrobial resistance. Staphylococcus aureus is of special interest as it is one of the most frequent biofilm-forming bacteria found on medical devices causing infections and posing dangerous threats in a clinical setting. A recently developed antimicrobial gel has been shown to have profound effects on treating bacterial infections and wound healing. This research is centered upon examining the antimicrobial effects of this gel on the three different stages of biofilm formation in clinical and laboratory strains of S. aureus. Through a series of experiments examining the effects this gel has on S. aureus at the stages of biofilm attachment, maturation, and dispersion, the gel has shown significant levels of inhibition. These findings indicate that the novel gel disrupts biofilm forming processes of S. aureus, which provides useful information for fighting infections in the medical field. Further research on the uses and effects of this new gel could lead possibility using the antimicrobial compound for a variety of clinical purposes.

Cost containment measures within hospital systems push for earlier discharges on stable patients. Due to patient placement difficulties and costs associated with skilled facilities, antibiotic use in home health care settings is becoming a common occurrence. This trend will likely increase as care continues to shift to outpatient areas. Lack of sufficient serum drug concentrations needed in severe infections and increasing resistance to many of the oral options often necessitates the use of the intravenous (IV) route. Home health care practitioners may have minimal information on patients or limited experience with IV antibiotics that may impact quality of care. This review summarizes key points relevant to IV antibiotics routinely used by home health prescribers, nurses, technicians, and care managers. This review will focus on antibacterial agents including vancomycin, aminoglycosides, beta-lactams, daptomycin, tigecycline, and telavancin. Appropriate dosing, indications, adverse events, monitoring parameters, and feasibility of using IV antibiotics are discussed.

Due to increases in antibiotic resistance stemming from the overuse of commercial antibiotics, the need to discover novel antibacterial compounds is becoming more urgent. A species of Rhodococcus, MTM3W5.2, has been discovered and was found to produce a metabolite with inhibitory activity against closely related species. The aim of this study is to elucidate the structure of the inhibitory metabolite by isolating and purifying it; then characterizing it using spectroscopic techniques. The compound was isolated from MTM3W5.2 RM broth cultures using n-butanol extraction, which yielded an active crude extract. The crude extract was then subjected to fractionation using a Sephedex LH-20 column with a 100% methanol solvent. The inhibitory activity of the fractions was tested through disk diffusion assay using Rhodococcus erythropolis as an indicator. Further preparation was completed using preparative reverse-phase high-performance liquid chromatography. Advanced purification was conducted by multiple rounds of analytical reverse-phase HPLC. Throughout the study the HPLC fractions were characterized and stability was monitored using UV-Visible spectroscopy. Two pure samples at 58.xx and 72.xx minutes from HPLC collections were selected for further structural identification and are currently being studied using spectroscopic techniques, most notably 2D NMR

With the use methods originating from lean philosophy, the thesis focuses on improving health care in the specific process of mixing antibiotics. Value stream maps will be used for describing the current state of mixing antibiotics at an infection department. When viewing mixing processes from a lean perspective, all processes did not give value for the customer, in this case the patient. Through the use of different lean methods, improvements on the current state has been made. These improvements will establish the future state, a description of improved processes.  Conclusions drawn is that the problem can be divided into two categories, flow of information and movements. A machine were designed as a solution to the problems found in the current state. Both the flow of information and movements can then to some extent be automated, creating more value for the patient.

Fluoroquinolones are a class of antibiotics used clinically to treat a wide array of bacterial infections. These therapeutics act by targeting a bacterial enzyme required for cell viability, bacterial type-II topoisomerases. Fluoroquinolones act by forming a ternary complex with bacterial type II topoisomerases and cleaved DNA; religation of DNA is subsequently blocked, therefore leading to bacterial cell death. In ternary complex the keto-acid moiety of the fluoroquinolone is complexed with a divalent magnesium ion, forming a drug-magnesium-water bridge to a serine and an aspartate (or glutamate) residue on helix-4 of the topoisomerase enzyme. A major issue with fluoroquinolones is the rise in bacterial resistance. Resistance arises through substitutions of the serine or aspartate/glutamate residue, therefore preventing formation of the magnesium-water bridge and dramatically diminishing the overall antibiotic activity of the fluoroquinolone. Quinazoline-2,4-diones are structurally similar to fluoroquinolones; diones also form a ternary complex similar to fluoroquinolones, however, these complexes are less active due to lack of a potent magnesium-water bridge interaction in helix-4. While quinazoline-2,4-diones are therefore less potent antibiotics, their non-reliance on the magnesium water bridge generally affords equipotent activity with wild-type and fluoroquinolone-resistant strains of bacteria. The first objective of this work was to probe the helix-4 interaction of the bacterial type-II topoisomerase by quinazoline-2,4-dione modification, specifically at the N3 and C4 positions of the quinazoline-2,4-dione scaffold to afford potentially new binding contacts. These modified quinazoline-2,4-diones will provide deeper understanding of the helix-4 interaction and potentially afford potent novel quinazoline-2,4-dione scaffolds, against both wild-type and resistant bacteria, for iterative drug design. Metabolism is one of the primary sources of detoxification, inactivation, and clearance of drugs from the body and is a critical consideration for all early stage therapeutic development. Clinically used fluoroquinolones, i.e. Moxifloxacin and Ciprofloxacin, historically are metabolically stable, and are not known to be metabolized by Phase I and/or Phase II drug metabolizing enzymes. However, major modifications to the Moxifloxacin and Ciprofloxacin scaffolds, due to the development of next generation antibiotics, may display different metabolic stability profiles. Moreover, metabolism of quinazoline-2,4-diones, developed for fluoroquinolone-resistant bacteria, is not extensively studied and may be subject to different metabolic liabilities that may render the quinazoline-2,4-dione an ineffective potential antibiotic. The second objective of this work was to determine the in vitro Phase I and Phase II metabolic stabilities of fluoroquinolone and quinazoline-2,4-dione scaffolds to determine any structural features that render the potential therapeutic a metabolic liability. The results from these two objectives have led to the discovery of a novel bacterial type-II topoisomerase catalytic inhibitor and the acquisition of initial metabolic stability data of fluoroquinolone and quinazoline-2,4-dione scaffolds. These findings further promote research into quinazoline-2,4-diones as bacterial topoisomerase targets, and provide metabolic considerations for both fluoroquinolone and quinazoline-2,4-dione therapeutic development, which is severely underrepresented in the field of quinolone antibiotics.

Carbohydrates on the cell surface conjugates to proteins and lipids and participates in biological processes as glycoconjugates. Carbohydrate functionalized nanoparticles (glyconanoparticles) constitute a good bio-mimetic model of carbohydrate presentation at the cell surface and are currently centered on many glycobiological and biomedical applications. The most of the applications have been reported using gold glyconanoparticles. A brief review of gold glyconanoparticles and some of their applications will be discussed in Chapter I. Although metallic, semiconductor and magnetic glyconanoparticles have been reported, no polyacrylate glyconanoparticles have yet to be described. Chapter II describes the first preparation of carbohydrate functionalized polymer nanoparticles by microemulsion polymerization and their characterization using scanning electron microscopy, dynamic light scattering and 1H NMR spectroscopy. This methodology can generate a large number of furanose and pyranose nanoparticle derivatives with an average particle size of around 40 nm with the protected carbohydrate hydroxyl functionality as acetyl or dimethylacetal groups. Formation of larger glyconanoparticles of around 80 nm with 3-O-acryloyl-D-glucose and 5-O-acryloyl-1-methoxy-beta-D-ribofuranose reveals the influence of free hydroxyl groups in the monomer on the particle size during polymerization, a feature which is also apparently dependent on the amount of carbohydrate in the matrix. Preparation of glyconanoparticle antibiotics, or glyconanobiotics, by microemulsion of antibiotic-conjugated carbohydrate monomers demonstrates for the first time the use of glyconanoparticles as drug delivery vehicles in Chapter III. The conjugation of an acrylated hydrophobic carbohydrate moiety to the lipophilic antibiotic makes it even more lipophilic and suitable as a co-monomer in microemulsion polymerization with styrene/butyl acrylate. Novel carbohydrate-based acrylated acyl chlorides synthesized from glucose afford antibiotic monomers with enhanced lipophilicity in a one step procedure. These drug monomers and the corresponding glyconanobiotics prepared by conjugating antibiotics such as N-thiolated-beta-lactam, ciprofloxacin, and penicillin shows biological activity against S. aureus, MRSA and B. anthracis microbes. Glyconanoparticles prepared by microemulsion polymerization of 3-O-acryloyl-D-glucose and styrene/butyl acrylate may be potentially used as recognition units in carbohydrate ligand mediated targeted drug delivery. The binding capability of the surface-exposed carbohydrates on the nanoparticle can be detected by fluorescence spectroscopy utilizing pyranine and 4,4'-N,N-bis(benzyl-2-boronic acid)-bipyridinium dibromide as described in Chapter IV.

Unregulated use of growth promoting antibiotics like Tetracyclines in agricultural feeds is becoming an increasing problem in antibiotic resistance. Undigested antibiotics leads to significant concentrations in livestock waste. These concentrations provide continuous selection pressure for the development of antibiotic resistance genes in the environment. Antibiotic resistance related deaths are projected to surpass cancer related deaths by 2050 making antibiotic resistance a pressing public health issue. The purpose of this study is to determine the abundance and persistence of tetracycline (tet) resistance genes in swine waste over a period of 100 days in an anaerobic digester system. Tet(A), tet(B), tet(G), tet(M), tet(O), tet(Q), and tet(W) were quantified by quantitative polymerase chain reaction after DNA extraction. Primers that target ribosomal protection proteins and efflux proteins were used. Antibiotic resistance genes decreased from day one but were found to be present throughout the study.

In urban karst areas, such as the City of Bowling Green, Kentucky and the Tampa Bay Metropolitan Area, groundwater quality faces a variety of threats. The development of residential, commercial, and industrial landuse types allows for a wide variety of groundwater pollutants to enter the karst groundwater systems. Various different models and indices have attempted evaluative approaches to identify issues in urban karst areas, but the methods vary by location and lack a focus on urban karst groundwater quality. There also exists a lack of a data-driven approach that is able to capture short- and long-term changes in threats to groundwater quality as a result of urbanization. The overall purpose of this study was to develop a holistic, data-driven evaluation toolbox with threat, vulnerability, and monitoring assessment tools for urban karst groundwater systems to better determine the possible threats, data collection needs, monitoring parameters, and analytical approaches needed to ensure groundwater quality is maintained in urban karst regions. This study focused on: 1) determining what indicators, parameters, resolution, and data quality need to be prioritized to create an effective, holistic monitoring framework for urban karst groundwater, and 2) developing an effective assessment and evaluative tools for urban karst groundwater quality sites using historic and modern data in an urban karst setting. The outcomes include an Urban Karst Aquifer Resource Evaluation (UKARE) Toolbox with a Threat, Vulnerability, and Monitoring evaluation tools that were applied and validated through application of the Toolbox using case studies in the City of Bowling Green, Kentucky and the Tampa Bay Metropolitan Area in Florida. The results demonstrate the universal applicability of the UKARE Toolbox to different urban karst sites and its effectiveness at scoring for threats and vulnerabilities, as well as identifying potential monitoring sites through primary data collection of water quality parameters and emerging pathogens at over 150 sites between both study areas. The final results of this study are useful to develop monitoring and management plans through a standardized scoring and evaluation tool in order to influence urban karst groundwater monitoring and management.

Parmi les stratégies d'amélioration des traitements des infections bactériennes chroniques, visant à accroître l'activité bactéricide ou à limiter la sélection de résistances, le développement de combinaisons d'antibiotiques existants constitue une stratégie prometteuse. L'objectif de cette thèse était d'évaluer l'efficacité d'une combinaison d'antibiotiques sur un biofilm bactérien dans un système in vitro dynamique qui permet de simuler les concentrations d'antibiotiques observées chez les patients traités. Nous avons montré que pour des infections complexes dues à de fortes charges bactériennes ou à la présence d'un biofilm, les études dans le système in vitro dynamique menées sur plusieurs jours apportaient plus d'informations sur l'efficacité d'une combinaison d'antibiotiques que des techniques standardisées menées avec des concentrations d'antibiotiques stables au cours du temps. Nous avons aussi montré que sur un biofilm, même si certaines associations n'ont pas d'impact sur la biomasse du biofilm elles permettent en revanche de maintenir des populations moins sensibles aux antibiotiques à des seuils relativement bas, alors que les mêmes antibiotiques utilisés seuls favorisent l'émergence de résistances au cours du traitement. Enfin, des essais préliminaires pour mimer des infections comme les mammites bovines ou les cystites ont montré que ce système pouvait être plus largement utilisé pour l'optimisation des schémas thérapeutiques en médecine humaine et en médecine vétérinaire. / Among strategies to improve the treatment of chronic bacterial infections by increasing the bactericidal activity or by limiting the selection of resistance, the development of combinations of existing drugs is a promising strategy. The aim of this thesis was to evaluate the efficacy of a combination of antibiotics on a bacterial biofilm in a dynamic in vitro system which allows to simulate the concentrations observed in patients. We have shown that for complicated infections due to large bacterial loads or to biofilms, in vitro dynamic studies over several days provided more information on the efficacy of a combination of antibiotics than classical methods conducted with constant antibiotic concentrations over time. We have also shown that on a biofilm, even if associations do not have an impact on the overall size of the biofilm, they maintain less-susceptible populations at relatively low levels, whereas the same antibiotics promote the emergence of resistance during treatment when used alone. Finally, preliminary trials to mimic infections such as bovine mastitis or cystitis have shown that this system could be more widely used for the optimization of dosage regimens in human medicine and veterinary medicine.

New antibiotics with novel targets or mechanisms of action are needed to counter the steady emergence of bacterial pathogens that are resistant to antibiotics used in the clinic. MraY, a promising novel target for antibiotic development, initiates the lipid cycle for the biosynthesis of peptidoglycan cell wall, which is essential for the survival of most, if-not-all, bacteria. MraY is an enzyme that catalyzes the transfer and attachment of phospho-MurNAc-pentapeptide to a lipid carrier, undecaprenylphosphate. Muraymycins are recently discovered lipopeptidyl nucleoside antibiotics that exhibit remarkable antibiotic activity against Gram-positive as well as Gram-negative bacteria by inhibiting MraY. We conducted a thorough examination of the metabolic profile of Streptomyces sp. strain NRRL 30473, a known producer of muraymycins. Eight muraymycins were isolated and characterized by a suite of spectroscopic methods, including three new members of muraymycin family named B8, B9 and C5. Muraymycins B8 and B9, which differ from other muraymycins by having an elongated fatty acid side chain, showed potent antibacterial activity against Escherichia coli ∆tolC mutant and pM IC50 against Staphylococcus aureus MraY. Muraymycin C5, which is characterized by an N-acetyl modification of the disaccharide’s primary amine, greatly reduced its antibacterial activity, which possibly indicates this modification is used for self-resistance. In addition to the discovery of new muraymycins, eleven enzymes from the biosynthetic pathway were functionally assigned and characterized in vitro. Six enzymes involved in the biosynthesis of amino ribofuranosylated uronic acid moiety of muraymycin were characterized: Mur16, a non-heme, Fe(II)-dependent α-ketoglutarate: UMP dioxygenase; Mur17, an L-threonine: uridine-5′-aldehyde transaldolase; Mur20, an L-methionine:1-aminotransferase; Mur26, a low specificity pyrimidine nucleoside phosphorylase; Mur18, a primary amine-requiring nucleotidylyltransferase; Mur19, a 5-amino-5-deoxyribosyltransferase. A one-pot enzyme reaction was utilized to produce this disaccharide moiety and its 2′′-deoxy analogue. Two muraymycin-modifying enzymes that confer self-resistance were functionally assigned and characterized: Mur28, a TmrB-like ATP-dependent muraymycin phosphotransferase, and Mur29, a muraymycin nucleotidyltransferase. Notably, Mur28 preferentially phosphorylates the intermediate, aminoribofuranosylated uronic acid, in the muraymycin biosynthetic pathway to produce a cryptic phosphorylated-dissacharide intermediate. Mur23 and Mur24 were assigned as two enzymes that modify the cryptic phosphorylated intermediate by attachment of an aminopropyl group. Mur24 catalyzes the incorporation of butyric acid into the phosphorylated-disaccharide. Following the incorporation, Mur23 catalyzes a PLP-dependent decarboxylation. Finally, Mur15, which belongs to the cupin family, is functionally assigned as a non-heme, Fe(II)-dependent α-ketoglutarate dioxygenase that catalyzes the β-hydroxylation of a leucine moiety in muraymycin D1 to form muraymycin C1. Mur15 can also hydroxylate the γ-position of leucine moiety to muraymycins with fatty acid chain in β-position.