Suite à la découverte des antibiotiques, les succès thérapeutiques ont laissé présager un avenir où les maladies infectieuses d’origine bactérienne seraient éradiquées. Cependant, en moins d’un siècle, l’utilisation massive des antibiotiques à large spectre a conduit à l’émergence de résistances réduisant ainsi les options thérapeutiques. Mon projet de recherche vise à comprendre les altérations métaboliques et morphologiques bactériennes induites précocement par les antibiotiques et à contribuer au développement de tests diagnostiques rapides et fiables pour favoriser la mise en place d’antibiothérapies plus ciblées. Grâce au suivi des modifications des divers paramètres métaboliques et morphologiques des bactéries après traitement aux antibiotiques, nous avons montré l’intérêt des marqueurs de viabilité tels que le DiBAC4(3), le TOPRO®-3 ou encore l’Alexa FluorTM Hydrazide pour la détection rapide (<3h) de la sensibilité des bactéries aux antibiotiques. Nous avons notamment montré, pour la première fois, que la carbonylation des protéines, qui est induite dans des conditions de stress oxydatif et de vieillissement cellulaire, est un marqueur précoce universel de la sensibilité aux antibiotiques bactéricides. Suite à cette première partie de l’étude, nous avons souhaité comprendre les mécanismes mis en jeu par les bactéries en réponse au stress létal causé pas les antibiotiques. Au cours de nos expériences, il a été observé que lorsque les conditions ne permettaient plus la survie de l’organisme, un signal de fluorescence intrinsèquement lié à la bactérie permettait de prédire l’issue fatale après seulement 2 heures d’incubation avec l’antibiotique. En effet, suite à un traitement avec un antibiotique bactéricide ciblant la synthèse du peptidoglycane bactérien (ampicilline), nous avons observé une fluorescence maximale des cellules à la dose d’antibiotique correspondant à la Concentration Minimale Inhibitrice (CMI). L’augmentation de la fluorescence des cellules bactériennes a aussi été observé lors du traitement létal avec un agent biocide (hypochlorite de sodium). Cependant, ce phénomène n’est plus observable avec des antibiotiques bactériostatiques ou bactéricides qui inhibent la synthèse protéique indiquant l’importance d’un métabolisme bactérien actif. Les corrélations de propriétés spectrales nous ont permis de suspecter les molécules de flavines comme étant responsables du phénomène d’autofluorescence observé. De plus, nous avons montré une suractivation de la voie de biosynthèse des cofacteurs de type flavines et des flavoprotéines en présence d’ampicilline. Finalement, nous avons effectué des expériences de tri et de survie cellulaire de populations bactériennes traitées à l’ampicilline. Nos résultats ont montré que les cellules très fluorescentes ont une survie moyenne 5 fois supérieure aux cellules peu fluorescentes. Ceci suggère que le signal de fluorescence observé est une réponse cellulaire médiée par les composés flavonoïdes pour tenter de survivre au traitement antibiotique. Des travaux exploratoires suggèrent que le phénomène étudié chez les bactéries est conservé chez les levures et chez les cellules humaines. Ces résultats ouvrent de nouvelles perspectives dans la compréhension de la physiologie bactérienne, l’étude de la réponse bactérienne face à un stress exogène et la surveillance rapide de la viabilité des cellules. / Following the discovery of antibiotics, the therapeutic successes foreshadowed a future where infectious diseases of bacterial origin would be eradicated. However, in less than a century, the massive use of broad-spectrum antibiotics led to the emergence of resistance thus reducing therapeutic options. My research project aims to understand early bacterial metabolic and morphological changes induced by antibiotics and to contribute to the development of rapid and reliable diagnostic tests to promote the implementation of more targeted antibiotic treatments. By monitoring changes in various metabolic and morphological parameters of bacteria after antibiotic treatment, we have shown the interest of viability markers such as DiBAC4(3), TOPRO®-3 or Alexa FluorTM Hydrazide for rapid detection (<3h) of bacterial susceptibility to antibiotics. In particular, we have shown for the first time that protein carbonylation, which is induced under conditions of oxidative stress and cellular aging, is a universal early marker of bactericidal antibiotic susceptibility. Following this first part of the study, we wanted to understand the mechanisms involved in bacterial response to lethal stress caused by antibiotics. Following this first part of the study, we wanted to understand the bacterial mechanisms involved in response to lethal stress caused by antibiotics. In our experiments, it was observed that when the conditions no longer allowed the organism survival, a fluorescence signal intrinsically linked to the bacterium allowed to predict the fatal outcome after only 2 hours of incubation. Indeed, following a treatment with a bactericidal antibiotic targeting the synthesis of bacterial peptidoglycan (ampicillin), we observed a maximum fluorescence of the cells at the dose of antibiotic corresponding to the Minimum Inhibitory Concentration (MIC). The fluorescence increase of bacterial cells was also observed during the lethal treatment with a biocidal agent (sodium hypochlorite). However, this phenomenon is no longer observable with bacteriostatic or bactericidal antibiotics that inhibit protein synthesis indicating active bacterial metabolism importance. The correlations of spectral properties allowed us to suspect the flavin molecules as responsible for the observed autofluorescence phenomenon. In addition, we showed an overactivation of the biosynthesis pathway of flavin-type cofactors and flavoproteins occurring during ampicillin treatment. Finally, we performed cell sorting and cell survival experiments of ampicillin-treated bacterial populations. Our results showed that highly fluorescent cells have an average survival 5 times higher than low fluorescent cells. This suggests that the fluorescence signal observed is a cellular response mediated by flavonoid compounds in an attempt to survive to antibiotic treatment. Exploratory work suggests that the phenomenon studied in bacteria is conserved among yeasts and human cells. These results open new perspectives in bacterial physiology understanding, the study of bacterial response to exogenous stress and the rapid monitoring of cell viability.

Bacterial resistance to non-antibiotic agents is being increasingly studied. Plasmid-mediated resistance to cationic agents, which are important biocides, has been described in antibiotic-resistant Staphylococcus aureus. Multi-resistant Staphylococcus aureus (MRSA) are often found to express resistance to a range of cationic biocides including quaternary ammonium compounds (QACs), biguanides, diamidino compounds, cationic dyes and nuclear stains. Three resistance determinants, qacA, qacB and smr genes, have been identified that confer resistance to cationic biocides in staphylococci. These genes encode multi-drug efflux pumps that remove the cationic biocides from the cytoplasm using a membrane bound pumping mechanism dependent on the cell's proton-motive force (PMF). This prevents the build up of lethal concentrations of cationic compounds within the cytoplasm avoiding cell death.This research project has focused on the S. aureus strain WBG4364, a transcipient strain carrying the cationic biocide resistant plasmid pWBG1773. The plasmid encodes resistance to several QACs, including benzalkonium chloride and CTAB, and cationic dyes rhodamine 6G, crystal violet and safranin O but not to the dye ethidium bromide and therefore differing from other cationic biocide resistant plasmids previously identified in staphylococci (Emslie et al. 1986). This unique phenotype was further classified in this study alongside those strains carrying the qac gene families, qacA/B and smr.Plasmid pWBG1773 was cloned, sequenced and analysed to reveal a unique plasmid of 2,916 bp in length. Plasmid pWBG1773 was placed with the pC194 family of rolling-circle replicating plasmids. This family appear to be largely composed of interchangeable cassette structures.The plasmid was found to carry three ORFs, designated ORF1, ORF2 and ORF3. ORF1 was homologous to rep genes of small staphylococcal ++ / plasmids belonging to the pC194 rolling-circle replication family and has been redefined as repWBG1773. ORF2 was found to have no similarity to any proteins of known function in the GenBank database whereas ORF3 was found to have homology to the marR gene, a regulator of the multiple antibiotic resistance (mar) operon of Gram-negative organisms. MIC analysis of these ORFs found both ORF2 and ORF3 were essential for expression of resistance to cationic biocides. The exact ORF2 sequence required for resistance to be expressed was reduced to only 141 nt in size. This translated to a 47 aa sequence that contained a hydrophobic C-terminus indicating ORF2 to be a membrane-bound protein. The aa sequence of ORF3 contained a helix-turn-helix motif characteristic of the DNA binding domains of MarR-like proteins. Further analysis of pWBG1773 identified a putative 'marbox', a binding site for the homologous transcriptional activators of mar, within the ORF2 sequence. This indicated that ORF3 was binding to the 'marbox' sequence and activating transcription. Induction studies have not been able to ascertain any compounds capable of interacting with the ORF3 regulatory protein resulting in induction of cationic biocide resistance. Each ORF when analysed alone had no effect on the expression of cationic biocide resistance and it is thought that a efflux pump was not involved. This is further corroborated by the CCCP efflux experiments performed in an attempt to determine the mechanism of resistance. The unique ORFs of plasmid pWBG1773 appears to encode a novel cationic biocide resistance phenotype and mechanism.MRSA strains from all around the world were analysed to determine if they possessed sequences homologous to ORF2 and ORF3. Sequences sharing a high degree of homology to ORF2 and/or ORF3 were detected in several MRSA strains including strains sensitive to all cationic ++ / biocides tested. These findings suggest that the appearance of ORF2 and ORF3 sequences in MRSAs was not an isolated event and the fact that some MRSAs do not carry both ORF2 and ORF3 sequences simultaneously indicates that these genes have another role that does not involve expression of resistance to cationic biocides.Bacteria are noteworthy for their remarkable ability to adapt to changes in their environments and possess an impressive set of tools with which to adjust the blueprint of the cell to this change. The acquisition of a single system that may decrease a potential pathogenic organisms susceptibility to a wide range of cationic biocides, such as seen in pWBG1773, poses a clinical threat, one that needs to be thoroughly investigated.

This study was conducted to examine the rate of contamination and molecular characteristics of enteric bacteria isolated from a selection of food sources in Vietnam. One hundred and eighty raw food samples were tested and 60.8% of meat and 18.0% of shellfish samples were found to be contaminated with Salmonella spp. which belonged to variety of serogroups and serotypes. More than 90% of all food sources contained Escherichia coli and 32% of 50 shellfish samples were contaminated with Vibrio parahaemolyticus. PFGE was used to determine the degree of relatedness of Salmonella spp. There were 33 distinct PFGE patterns from 51 Salmonella spp. isolates tested, indicating that PFGE could be used as an alternative method for serotyping for use in epidemiology of Salmonella spp. Susceptibility of the isolates to 15 antimicrobial agents was investigated. Moderate to high frequencies of resistance to antibiotics were observed in Salmonella spp. and E. coli isolates and multi-resistance, defined as resistance to at least 4 antibiotics, was observed. All of the V. parahaemolyticus isolates were resistant to ampicillin/amoxicillin but not to other antibiotics. Betalactam TEM gene and tetracycline resistance tetA, tetB genes were widely distributed in both E. coli and Salmonella spp. isolates. Other resistance genes, including sulI, cmlA, aadA, aphA1, dhfrV, and aac(3)-IV were also present at high to moderate levels. Identification and characterisation of the mobile genetic elements, including identification of class 1 integrons and plasmids were carried out for multi-resistance isolates. The integrons harboured varying gene cassettes, including aadA1, aadA2, aadA5, aacA4, dhfrXII, drfA1 and dhfrA17, blaPSE1 and catB3. Thirty-five percent of Salmonella spp. isolates and 76% of E. coli isolates harboured plasmids of more than 95 kb. Transfer of resistance phenotypes between the isolates via conjugation and phage transduction was also demonstrated. Salmonella genomic island 1 (SGI1), a 43-kb genomic region contains a 13-kb antibiotic resistance gene cluster, has been identified in an isolate of S. Albany from chicken. The presence of Salmonella spp. virulence genes was investigated to examine the pathogenicity potential of the isolates. The invA gene was present in all Salmonella spp. isolates and the plasmid virulence gene spvC was detected in one S. Typhimurium isolate only, on a 95 kb virulence plasmid. Invasion assays performed in vitro demonstrated that all Salmonella isolates were capable of invading human intestine INT407 cells. In addition, the investigation for the presence of 58 selected virulence genes showed that all the tested isolates contained at least one virulence gene and there were 16 genes which are associated with different pathotypes detected. The data obtained in this study indicates that raw food in Vietnam is a potential reservoirs for many pathogenic organisms, and confirms the role of food animals as a reservoir of multidrug resistant E. coli and Salmonella spp.

Delay to antibiotic treatment of community-acquired pneumonia (CAP) greater than 4 hours following hospital admission is associated with a 15% increase in mortality. Paper-based guidelines have been widely introduced to improve CAP care, but these interventions have under-performed due to poor compliance in complex clinical workflows. Unlike passive paper-based guidelines, alerting systems based on computer-based decision support systems (CDSS) have the capacity to actively draw attention to delayed clinical processes. Formal consideration of local workflow is key to the design and successful implementation of CDSS. I used workflow analysis techniques to develop an evidence-based alerting system designed to reduce the delay to treatment of CAP in the emergency department (ED) of an Australian tertiary hospital. A sample of 6 CAP patients were observed during October 2001 to derive a structural process flow model, which was refined via stakeholder interview. A deterministic process flow model was then developed using an existing retrospectively compiled CAP database, consisting of 246 patients admitted June-December 1998 and 146 patients admitted May-December 2000. A stratified control sample presenting with respiratory symptoms (n=74, January-December 2003) was collected for the assessment of diagnosis and chest x-ray (CXR) accuracy. Treatment delay greater than 4 hours was associated with failure to diagnose CAP in the ED, the absence of CXR evidence, low triage score, delayed CXR, and failure to treat in the ED. ED physicians only identified 54-57% of those discharged with CAP. Radiologists only reported CAP features in 47% - 67% of initial CXRs for these patients. I hypothesised that a CDSS-based alerting system, composed of a CAP early diagnosis model (EDM) and a simple risk model (CRB-65), would identify enough CAP patients to reduce the percentage treated after 4 hours. I constructed an evidence-based naïve Bayesian EDM (sensitivity = 36%, specificity = 93%). It was able to identify 24% of CAP patients that died in hospital, 38% of those with antibiotics delayed greater than 4 hours, and 26% of those with CXR delayed greater than 4 hours. CAP-specific risk models were equivalent to the Australasian Triage Score (ATS) in predicting mortality. I simulated alerting policy by combining the CDSS with the deterministic process flow model. Alerting for treatment at triage or initial physician assessment, when the EDM was positive, approximately halved the median treatment time of 5.53 hours, and decreased the number treated after 4 hours (62%) by 1/3. Treating EDM-positive patients as ATS category 2 produced a similar effect. Current triage practices, embodied mainly by the disease-independent, sign and symptom based ATS are too coarse to deal with conditions such as CAP, where there is high diagnostic uncertainty and delays in diagnosis and treatment are critical determinants of outcomes. Better outcomes may be achieved with quicker diagnostic and treatment workflows via: analysis of current diagnosis and treatment workflows, analysis and correlation of a comprehensive set of patient symptoms, signs and risk factors for the specific disease, and improving triaging and subsequent workflow through a disease-specific CDSS based on early diagnostic models derived from the previous analyses. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1374804 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2009

<p>With the studies performed in this theses the local drug delivery technique FibMat developed by the biotech company AddBIO, was shown to be applicable to other plasma proteins and drugs than the fibrinogen-bisphosphonate combination that is today being commercialized. Hence the potential for a broader field of application was demonstrated. The application targeted today is as a surface modification giving improved strength to bone around screws used in bone implants. The effect of changing protein and manufacturing conditions was studied with null ellipsometry. It was demonstrated that with changes in incubation temperature, pH and salinity the fibrinogen could be successfully exchanged for the plasma proteins human serum albumin and immunoglobulin G. With liquid scintillation counting it was shown that the developed protein multilayers were able to absorb and release the bone strengthening drug alendronic acid in levels comparable to that of the fibrinogen based ditto. Disk susceptibility tests with the bacteria S. Aureus showed a potential for antibacterial functionalization with gentamicin. The release was, in the case of the fibrinogen multilayer, detectable up to 48 hours. Similar test revealed an inability of silver nanoparticle incorporated protein multilayers to achieve inhibitory levels.</p>

<p>The worldwide increase in antibiotic resistance is a concern for public health. When the appropriate antibiotic dosage is determined, the priorities are efficacy and toxicity. The aim of this thesis was to gain knowledge about the most efficient dosing regimens in order to minimize the emergence and selection of antibiotic-resistant mutants. We also wanted to assess the impact of antibiotic selective pressure and host to host transmission for the dissemination of resistance.</p><p><i>Escherichia coli </i>bacteria with different levels of cefotaxime susceptibility were competed in an in vitro kinetic model, demonstrating a complex selection of low-level resistance influenced e.g. by the time duration of selective concentrations and the rise of new mutants. We also constructed a mathematical model incorporating biologically relevant parameters and showed its usefulness when assessing the risks of resistance development.</p><p>When <i>E. coli </i>populations with pre-existing fluoroquinolone-resistant mutants were exposed to simulated serum concentrations, several currently used doses of fluoroquinolones clearly enhanced the development and selection of resistance. </p><p>The mutant prevention concentration (MPC) was measured for several <i>E. coli</i> isolates with different fluoroquinolone susceptibilities, and because of fluctuating antibiotic concentrations in the human body, the pharmacokinetics was considered when evaluating MPC. Results indicate that the area under the serum concentration time curve in relation to the MPC may be a useful predictor for emergence of resistance.</p><p>In the commensal flora of healthy human couples we noted a high frequency of trimethoprim-resistant <i>E. coli.</i> There was also an extensive sharing and transmission of <i>E. coli</i> clones. Treating the female with trimethoprim reduced the number of intestinal <i>E. coli</i> which might have facilitated the transmission from the male partner. These findings suggest that the rate of transmission is high and effectively contributes to the spread of both susceptible and antibiotic-resistant <i>E. coli</i> in intrafamilial settings.</p>

A major factor in the ability of Pseudomonas fluorescens Pf-5 to act as a biological control agent is its production of antibiotics, including pyoluteorin (PLT), 2,4-diacetylphloroglucinol (2,4-DAPG) and pyrrolnitrin (PRN). The data provided in this thesis demonstrate that the presence of any of these antibiotics in the extracellular milieu affects production of that same antibiotic, as well as others, by Pf-5. Amending the growth medium with antibiotics had multiple effects on secondary metabolism in Pf-5. i) PLT positively regulated its own production, ii) 2,4-DAPG positively regulated its own production. iii) PLT suppressed 2,4-DAPG production. iv) 2,4- DAPG inhibited PLT production. v) PLT suppressed transcription of a heterologous ferric-pyoverdine uptake gene. vi) PRN exerted a slight inhibitory effect on PLT gene transcription and production. PLT autoinduction by Pf-5 was extensively characterized, and was shown to require concentrations of exogenous PLT in the nanomolar range. These low concentrations are comparable to those of many molecules proposed to function in signaling roles. PLT served as a signal between distinct populations of cells within the rhizosphere, where it prompted autoinduction by those cells. Aside from effects of Pf- 5 antibiotics on one another, I also described the positive effect of exogenous PLT on expression of a set of transport genes flanking the PLT biosynthetic gene cluster. Sequence data and experimental evidence suggests that these genes encode a transport apparatus for PLT. The deduced amino acid sequences for four adjacent open reading frames together resemble Type I secretion apparatuses, which typically function in transport of proteins rather than secondary metabolites. The intact transporter genes are necessary for optimal PLT production. Taken together, the data from the studies described herein demonstrate that i) the production of PLT by Pf-5 can affect the production of PLT by neighboring cells, and ii) PLT and other exogenous secondary metabolites have both autoregulatory and cross-regulatory effects in culture. Because Pf-5 derivatives engaged in PLT crossfeeding in the rhizosphere, it is likely that cross-feeding occurs for other secondary metabolites as well. Thus, production of an antibiotic by one cell can profoundly affect secondary metabolism in neighboring cells occupying natural habitats. / Graduation date: 2004

Determining the properties of mutations is fundamental to understanding the mechanisms of adaptive evolution. The major goal of this thesis is to investigate the mechanisms of bacterial adaptation to new environments using experimental evolution. Different types of mutations were under investigations with a particular focus on genome rearrangements. Adaptive evolution experiments were focused on the development of bacterial resistance to antibiotics. In paper I, we performed stochastic simulations to examine the role of gene amplification in promoting the establishment of new gene functions. The results show that gene amplification can contribute to creation of new gene functions in nature. In paper II, the evolution of β-lactam resistance was studied by evolving S. typhimurium carrying a β-lactamase gene towards increased resistance against cephalosporins. Our results suggest that gene amplification is likely to provide an immediate solution at the early stage of adaptive evolution and subsequently facilitate further stable adaptation. In paper III, we isolated spontaneous deletion mutants with increased competitive fitness, which indicated that genome reduction could be driven by selection. To test this hypothesis, independent lineages of wild type S. typhimurium were serially passaged for 1000 generations and we observed fixation of deletions that significantly increased bacterial fitness when reconstructed in wild type genetic background. In paper IV, we developed a new strategy combining 454 pyrosequencing technology and a ‘split mapping’ computational method to identify unique junction sequences formed by spontaneous genome rearrangements. A high steady-state frequency of rearrangements in unselected bacterial populations was suggested from our results. In paper V, the rates, mechanisms and fitness effects of colistin resistance in S. typhimurium were determined. The high mutation rate and low fitness costs suggest that colistin resistance could develop in clinical settings. In paper VI, a novel Metallo-β-lactamase (MBL) with low resistance against β-lactam antibiotics was employed as the ancestral protein in a directed evolution experiment to examine how an enzyme evolves towards increased resistance. For most isolated mutants, in spite of their significantly increased resistance, both mRNA and protein levels were decreased as compared with the parental protein, suggesting that the catalytic activity had increased.

Vibrio spp., natural inhabitants of aquatic environments, are one of the most common causes of bacterial gastroenteritis in the world, being spread to humans via the ingestion of seafood, contaminated drinking water or exposure to seawater. The majority of Vibrio spp. are avirulent, but certain strains may sporadically be human pathogenic. Vibrio cholerae may cause cholera and fatal wound infections, Vibrio parahaemolyticus may cause gastroenteritis and Vibrio vulnificus may cause wound infections and sepsis. To expand current knowledge of the occurrence, ecological niche and persistence of potential human pathogenic Vibrio spp. in aquatic environments, occurrence and laboratory studies were performed. The seasonal variation of Vibrio spp. in clams and mussels from Mozambique and Sweden were studied, with isolated strains characterized and compared with those isolated from water samples collected in India. Results showed that the numbers of Vibrio spp. in Mozambican clams peaked during the warmer rainy season and that the dominating species was V. parahaemolyticus. Biochemical fingerprinting and virulence screened by PCR revealed a high similarity among strains from the different aquatic environments. However, isolate functional hemolytic analyses and antibiotic resistance patterns differed between strains; Swedish and Indian strains were less sensitive to the tested antibiotics and had a lower hemolytic capacity than those from Mozambique. Molecular analysis of bacterial DNA from Swedish mussels showed the presence of the three Vibrio spp. most commonly linked with human illness, as well as their associated virulence genes. The strains isolated from marine and clinical environments were equally and highly harmful to the tested eukaryotic cells. The persistence of clinical V. cholerae in aquatic environments was investigated in vivo. Strains were exposed to mussels, with bacterial uptake and elimination then examined. The mussels were able to avoid the most potent strain by complete closure of shells. The less potent strain was accumulated in mussel tissue in low levels and one marine control strain to a higher degree. Mussels eliminated the pathogenic strain less efficiently than they did the marine strain. One clinical and one marine strain were then exposed to 4°C for 21 days, with the temperature then increased to 20°C. The clinical strain was more prone to lose culturability than the marine strain at 4°C, the former performed significantly better in regaining culturability after the temperature up-shift. Subsequently, the persistence of the clinical strain in natural bottom sediment, incubating as above, was studied and results showed a similar decrease in culturable numbers in the sediment as in the water. As the clinical V. cholerae strains did not carry any of the standard set of virulence genes, the ability to change from non-culturable to culturable may be of great importance to strain pathogenicity. The results also show that natural bottom sediment may be a potential reservoir of human pathogenic Vibrio spp.

<p><font face="Tahoma"> <p align="left">The purpose of this study is to evaluate the need for prophylactic antibiotic treatment in third molar surgery and to establish specific guidelines for antibiotic prophylaxis in the department of Maxillo-Facial and Oral Surgery (MFOS) at Tygerberg Academic, Groote Schuur and Mitchells Plain Hospitals.</p> </font></p>