TB remains a major health issue worldwide causing around 1.5 deaths each year. The recent phase III clinical trials of shortened TB treatment failed to show superiority compared to the current regimen and this mainly because of relapse. Relapse is thought to be caused by dormant bacteria. Dormancy in Mycobacterium species has been shown to be associated with the accumulation of intracellular lipids, defining two phenotypes: the lipid rich (LR) cells (associated with dormancy) and the lipid poor (LP) cells (non-dormant). LR cells were shown to have a higher phenotypic antibiotic resistance compared to LP cells. Studying these two phenotypes is therefore central in tuberculosis research to understand better the disease and also potentially start to reveal the bacteriology of relapse. We investigated the power of Raman spectroscopy, a label-free and non-destructive technique, to discriminate LR and LP bacteria both in-vitro and ex-vivo. This represents the first Raman spectroscopy study that tries to discriminate the phenotypes of M. tuberculosis and investigate them directly at the site of the disease. Using total lipid extract of M. tuberculosis, we showed the location of the main lipid bands in the Raman spectrum. The two major lipid peaks were located around 1300 cm⁻¹ and 1450 cm⁻¹. Raman spectroscopy can discriminate LR and LP cells with high sensitivity and specificity. The main differences between the two groups are located in the two major Raman lipid peaks, the lipid band A (1300 cm⁻¹) and lipid band B (1440 to 1450 cm⁻¹). The two phenotypes were successfully discriminated in TB infected guinea pig lung tissue sections also from in-vitro culture using wavelength modulated Raman (WMR) spectroscopy combined with fluorescence imaging. We developed a protocol to perform both Raman spectroscopy and immunohistochemistry on the same tissue sample. We studied the evolution of LR and LP proportion in mycobacterial population as the growth conditions changed and showed that LR cells could rapidly convert to LP cells as they face favourable growth conditions. The results presented in this thesis showed that LR M. tuberculosis cells could be predominant at the site of infection. This would suggest that drug sensitivity testing should be performed on culture presenting both LR and LP cells in high proportion.

Legionella bacteria, the causative agent of Legionaries’ disease and Pontiac fever, are ubiquitous in fresh-water environments including man-made water systems. Incidence of legionellosis is increasing in the United States resulting in thousands of cases every year. Infection via aerosols generated by showers, faucets, cooling towers, spas, fountains, and other water fixtures has been identified as the primary source of transmission. Legionella bacteria pose a significant public health threat, particularly in health care and long term care settings as Legionella can readily colonize the plumbing systems and infect the vulnerable patient population. One species, Legionella pneumophila (Lp), is responsible for over 90% of the known cases of Legionnaires’ disease. The importance of genetic diversity of Lp and non-pneumophila strains in human disease remains an area of ongoing research. Little is known in regard to the phylogenetic diversity of environmental strains, particularly strains that colonize facilities with high risk populations such as hospitals. Whole-genome sequencing (WGS) analysis, is an emerging tool used to support epidemiological investigation of cases of legionellosis and can be used to describe and establish phylogenetic relationships between environmental strains and clinical cases. The advantage of this method is the ability to differentiate bacteria down to the level of single nucleotide polymorphisms (SNPs). However, it was unknown whether current WGS methods accurately represent the potential SNP diversity among Lp isolates from the same environmental sample. It is unclear as to why certain strains tend be associated with clinical cases more than others, but certain genes referred to as virulence factors may be related to the relative pathogenicity of Legionella strains. Further investigation into virulence factors and antibiotic resistance factors could be used in future risk assessment of environmental Legionella. Additionally, Legionella have the potential for high genetic diversity due to recombination events, and gene transfer can occur between distinct Legionella species and strains. There is a lack of research on the potential sharing of virulence factor genes between Legionella strains typically associated with disease and those considered to be non-virulent. The goal of the work presented in this thesis is to describe the diversity of phylogenetic relationships between Lp isolates found in hospital premise plumbing systems, to estimate the genetic diversity among Lp found in the same environmental sample, and to identify virulence and antibiotic resistance genes shared between Legionella strains. A better understanding of the genetic diversity of environmental Lp could inform future surveillance and outbreak investigations by demonstrating the need to collect samples from multiple sites within a facility, and identifying shared virulence and antibiotic resistance genes between Legionella species and strains could apprise future risk assessment. WGS was utilized to describe the phylogenetic relationships of 81 Lp isolates from five hospitals. Individual hospitals were found to have distinct strains of Lp. For some strains, highly conserved subpopulations were collected from the same room over time, whereas other strains did not cluster by room. Using prospectively collected isolates from two hospitals, the mean number of SNP differences among isolates from the same environmental sample was found to differ between hospitals (0.4 versus 7.5). The presence of virulence factors and antibiotic resistance genes in Legionella species and strains was described. An analysis of 10 virulence factor genes revealed that Lp likely did not share these genes with Legionella anisa, a species generally considered to be non-virulent. Within Lp strains there was no clear difference between the Lp strains considered to be more virulent and those considered to be less virulent. A few antibiotic resistance genes were also identified. Following an in vitro assay, only the identified genes associated with macrolide resistance, LpeA and LpeB, were found to impact a quantifiable measure of antimicrobial resistance. The results of these studies emphasize the importance of understanding the context of an individual facility in Legionella related studies. Importantly, the observations or trends of one facility should not necessarily be applied to another. Legionella genetic diversity was highly conserved in some facilities, whereas in others there was greater diversity as measured by SNP differences. Within sample SNP differences was also variable between hospitals. The virulence findings gave a clear indication of the limited virulence capacity of L. anisa. These findings could explain the limited potential of L. anisa to cause disease in humans. However, a lack of difference among Lp strains may be cause to reassess the potential risk of these other strains especially in diagnostic practices. Finally, some strains of Lp have genes that may contribute to resistance to the leading antibiotic treatments for Legionnaires’ disease. Overall, this research further demonstrates the power of WGS as multiple questions can be addressed using this methodology.

Multi-drug resistance in bacterial pathogens has become a global health crisis. Each year, millions of people worldwide are infected with bacterial strains that are resistant to currently available antibiotics. Diseases such as tuberculosis, pneumonia, and gonorrhea have become increasingly more difficult to treat. It is essential that novel drugs and cellular targets be identified in order to treat this resistance. Bacterial topoisomerase IA is a novel drug target that is essential for cellular growth. As it has never been targeted by existing antibiotics, it is an attractive target. Topoisomerase IA is responsible for relieving torsional strain on DNA by relaxing supercoiled DNA following processes such as replication and transcription. The aim of this study is to find novel compounds that can be developed as leads for antibiotics targeting bacterial type IA topoisomerase. Various approaches were used in order to screen thousands of compounds against bacterial type IA topoisomerases, including mixture-based screening and virtual screening. In the mixture-based screen, scaffold mixtures were tested against the M. tuberculosis topoisomerase I enzyme and subsequently optimized for maximum potency and selectivity. The optimized compounds were effective at inhibiting the enzyme at low micromolar concentrations, as well as killing the tuberculosis bacteria. In a virtual screen, libraries with hundreds of thousands of compounds were screened against the E. coli and M. tuberculosis topoisomerase I crystal structures in order to find new classes of drugs. The top hits were effective at inhibiting the enzymes, as well as preventing the growth of M. smegmatis cells in the presence of efflux pump inhibitors. Organometallic complexes containing Cu(II) or Co(III) were tested as well against various topoisomerases in order to determine their selectivity. We discovered a poison for human type II topoisomerase that has utility as an anticancer agent, as it killed even very resistant cell lines of breast and colon cancer. The Co(III) complexes were found to inhibit the bacterial topoisomerase I very selectively over other topoisomerases. The various methods of drug discovery utilized here have been successful at identifying new classes of compounds that may be further developed into antibiotic drugs that specifically target bacterial type IA topoisomerases.

The genus Salmonella, comprised of 2400 serotypes, is one of the leading causes of foodborne illnesses in the US and has been used for the deliberate contamination of food. A rapid system for detection, isolation, typing and antibiotic susceptibility profiling is essential for diagnosis and source tracking in natural outbreaks or a bioterrorism event. Pure culture is essential for molecular typing and antibiotic resistance testing. The virulence and the resistance mechanisms of Salmonella are rapidly evolving and many are still unexplained. The first aim of the study was to rapidly detect and isolate Salmonella from intentionally contaminated food. The second aim was to build a DNA fingerprinting database for accurate identification of the subtype. The third objective was to study the antibiotic susceptibility patterns and the underlying mechanisms of resistance. A correlation between the DNA subtypes and antibiograms was hypothesized. An association between the resistance determinants and pathogenicity genes was expected. A total of 114 isolates including environmental and clinical sources were tested. General and selective enrichments and immunomagnetic separation (IMS) were tested for rapid detection and isolation of Salmonella from eight food groups. Isolates were subtyped by pulsed field gel electrophoresis (PFGE) and automated RiboPrinter®. Resistance to 31 drugs was tested by the Sensititre® system and integrons were identified by PCR. The association between virulence and resistance was verified by Southern hybridization. Of the three genes tested, ompF was found to be the most reliable target for identifying Salmonella subspecies I, III and IV. Detection by real time PCR after enrichment in buffered peptone water and isolation by IMS provided the fastest results. Sixty two ribotypes and 74 pulsotypes were observed for the 100 isolates subtyped. Sixty isolates were resistant to one or more antimicrobials and 12 had class-1 integrons. In conclusion, pure culture was achieved in 25 hours by IMS. Ribotyping, a comparatively rapid technique was found to be ideal for initial identification. PFGE, which was more discriminatory, was appropriate for source tracking. Contrary to the original hypothesis, no correlation between subtyping and antibiograms was observed and no association of integrons with the virulence genes tested was demonstrated

<p>The essay investigates the economic burden of skin, soft tissue, bone and lung infections in Sweden 2003. The cost-of-illness method, based on the human capital theory, is used in the estimation. A prevalence approach and a top-down method were chosen for direct as well as indirect costs. Also there is a discussion concerning health economic aspects of antibiotic resistance and evidence of the increasing costs because of it. The lack of data leads to a result within a large interval of uncertainty; the direct costs are estimated to 1 072 million SEK and indirect costs are estimated to 4 655 million SEK.</p>

The essay investigates the economic burden of skin, soft tissue, bone and lung infections in Sweden 2003. The cost-of-illness method, based on the human capital theory, is used in the estimation. A prevalence approach and a top-down method were chosen for direct as well as indirect costs. Also there is a discussion concerning health economic aspects of antibiotic resistance and evidence of the increasing costs because of it. The lack of data leads to a result within a large interval of uncertainty; the direct costs are estimated to 1 072 million SEK and indirect costs are estimated to 4 655 million SEK.

The study of protein evolution and adaptation resides at the junction between the disciplines of biological chemistry and evolutionary biology. We chose the B. thetaiotaomicron tetracycline resistant enzyme TetX2, as our model system to study the biophysical basis for adaptation to antibiotics; a phenomenon that continuously poses global health challenges. In the work presented here, experimental evolution and biophysical characterization were used to identify and link the physicochemical properties of TetX2 and its adaptive mutants to increased resistance to minocycline. Bacteroides thetaiotaomicron TetX2 was previously identified as a novel oxidoreductase with broad activity against tetracyclines. Experimental evolution of E. coli expressing a chromosomal copy of tet(X2) was used to identify an adaptive mutation (TetX2 T280A ) that confers higher resistance to minocycline and tigecycline. In addition to TetX2 T280A , a family of variants of TetX2 with single amino acid changes in TetX2 sequence that conferred equal or higher resistance towards MCN was identified by error-prone mutagenesis. Changes in fitness of E. coli carrying a single chromosomal copy of either wild-type or one of the mutant alleles were assessed by growth rate assays over a range of minocycline concentrations. Despite similar in vivo performances of TetX2 T280A and two other variants (TetX2 N371I and TetX2 N371T ), TetX2 T280A was the only successful mutant in the adaption experiment suggesting that mutational supply may play an important role in evolutionary dynamics of populations undergoing adaptation. The most surprising result is that the differences in growth rates among TetX2 variants arise from small changes in in vitro catalytic activity and in vivo protein expression. The steady-state kinetic studies with minocycline and NADPH suggest a binary mechanism for antibiotic inactivation by TetX2 which is supported by the structural characteristics of the enzyme. The atomic structures of the best adaptive mutant TetX2 T280A in complex with minocycline and tigecycline reveal the details of substrate recognition and show that the site of the mutation is ∼18 Å away from the active site suggesting an indirect mechanism for improved catalysis. Taken together, our data show that very small changes in the in vitro biochemical properties and expression levels can have surprisingly large fitness effects and are important during adaption. In addition, a promising preliminary mathematical model suggests that based on kinetic activity and in vivo expression levels the success of bacteria undergoing adaptation to antibiotics can be predicted.

Acinetobacter baumannii is an opportunistic pathogen which has been implicated in a variety of nosocomial infections among immunocompromised patients worldwide. Recently, Multi-drug resistant (MDR) isolates of A. baumannii have been isolated from military personnel returning from service in Iraq and Afghanistan. Antibiotic resistance of A. baumannii has limited the number of active antibacterial, making very difficult to treat these types of infections. This work investigated the role of Resistance-Nodulation-cell Division (RND) efflux pumps in the antibiotic resistance mechanism of A. baumannii. Expression of six different RND pumps was analyzed in clinical isolates of A. baumannii. A novel RND family pump, AdeMNO, was found to be present in a majority of isolates. The adeMNO operon was cloned, sequenced, and characterized using the single copy gene expression system in an efflux sensitized surrogate Pseudomonas aeruginosa strain. Antibiotics, trimethoprim, chloramphenicol, and clindamicin were identified as the substrates of this pump. In order to understand the mechanisms of regulation of adeMNO operon, a putative regulator belonging to the lysR-family was identified, cloned, and sequenced from the upstream region of the operon. Promoter regions of the adeMNO operon were also sequenced from various clinical isolates and sequence polymorphisms identified that could be implicated in the regulation of adeMNO expression. / UOIT

In India, there is no regulation of antibiotics and allegedly the use has doubled since 2006. Indiscriminate use of antibiotics gives rise to development of resistant bacteria. The media has, according to the theories used in this study, a responsibility to educate and empower the people to make personal judgments about health risks. This study focuses on the extent to which two of the largest English-language newspapers in India, the Hindu and Times of India, report on antibiotic resistance; and also, how the journalists and editors on these newspapers look upon their profession and responsibilities when it comes to reporting on health issues. In addition to the quantitative content analysis, which comprises 162 articles about antibiotic resistance published between 2006 and 2012, six in-depth interviews were conducted. The results show that the amount of coverage on antibiotic resistance increased 2010 when the Lancet published a report on new findings of multi-resistant bacteria in India. This indicates that an event was needed to qualify antibiotic resistance for the news pages. Our study also shows that preventive measures which can be taken to reduce the emerge of resistant bacteria are often included in the articles and that they are addressed to doctors as well as to the general public. On the other hand, information on the magnitude of the problem is rarely presented. Scientists are often quoted or referred to, and the journalists of the investigated newspapers state that they have a great confidence in them. Furthermore, the respondents express that they have a responsibility to report on health issues. They believe that their newspapers have a major influence on its readership, and that their reporting can make a difference in the health situation in India. Some of them mention, however, that their overall impact is limited since their newspapers only reach the literate middle-class.

Secondary plant metabolites have recently been gaining interest in livestock production systems following the ban of in-feed antibiotics within the European Union. The rise in antimicrobial resistance found in pathogenic and non-pathogenic bacteria has lead to increased interest in the research community regarding the use of phythochemicals as an alternative to antibiotics. The purpose of this research was to evaluate the impact of including phytochemicals in a livestock production system. Specifically, a high tannin-containing forage, sainfoin (Onobrychis viciifolia), was evaluated in vitro for its antimicrobial effect on Escherichia coli. We determined that phytochemicals alone are not as inhibitory as synthetic antibiotics. Thus, the use of combination therapy to deter the development of antimicrobial resistance was evaluated. A myriad of plant compounds were screened for their synergistic interactions with ciprofloxacin. Geraniol, an essential oil, was identified to possess good antimicrobial activity and synergistic interactions with ciprofloxacin. Therefore the effect of long term exposure to both ciprofloxacin and geraniol were examined. Results demonstrated that once an antimicrobial concentration threshold was reached, resistance to ciprofloxacin increased markedly in the presence of both geraniol and ciprofloxacin. Finally, an in vivo trial was conducted in which forty steers were fed sainfoin or alfalfa over a 9-week period to evaluate its ability to reduce E. coli shedding and its impact on gut microbiota in the context of popular theoretical ecology concepts. Results from the in vivo study indicate that sainfoin was able to promote a slight decrease in generic E. coli shedding which could be maintained throughout the trial. Using high-throughput sequencing, the effect of sainfoin on the microbial ecosystem of the ruminant gut was evaluated. Sainfoin induced a significant shift in the microbial community structure of the rumen and to a lesser extent in the hindgut. Using ecology theories, a hypothesis was formulated regarding the mechanisms that mediate the development of tolerance and the fundamental ecological processes controlling microbial population shifts. Understanding how the gut ecosystem functions and predicting its behaviour in the presence of various fluctuating environmental conditions will enable more efficient manipulation of the rumen and promote best management practices in livestock production.