Recentemente, o bis-(3\',5\')-di-guanosina monofosfato cíclico (c-di-GMP) surgiu como uma importante molécula sinalizadora nas bactérias. Essa molécula foi identificada como uma das responsáveis pelo controle do comportamento bacteriano e está relacionada com a patogenicidade e a adaptação de diversas bactérias, coordenando a expressão de genes envolvidos com virulência, motilidade e formação de biofilme. O mecanismo pelo qual c-diGMP atua vem sendo motivo de estudo de vários grupos de pesquisa nos últimos anos. Já foi demonstrado o papel dessa molécula em diferentes etapas do controle da expressão gênica. Acredita-se que a manipulação dos níveis de c-di-GMP pode ser uma nova abordagem terapêutica contra bactérias patogênicas. Pseudomonas aeruginosa é uma proteobactéria do grupo gama, que atua como um patógeno oportunista, causando infecções em pacientes imunocomprometidos, sendo o maior causador de infecções crônicas em pacientes portadores de fibrose cística. O genoma de P. aeruginosa PA14 apresenta vários genes que codificam proteínas envolvidas no metabolismo e/ou ligação de c-di-GMP, o que pode indicar um amplo papel regulatório deste nucleotídeo nessa bactéria. Uma associação infundada entre níveis elevados de c-di-GMP e a resistência aos antibióticos é geralmente assumida, já que altos níveis de c-di-GMP levam à formação de biofilme, que é comprovadamente um modo de crescimento mais resistente. Nesse trabalho, utilizando uma abordagem proteômica, mostramos que Pseudomonas aeruginosa PA14 regula a expressão de cinco porinas em resposta a variações nos níveis de c-di-GMP, independentemente dos níveis de mRNA. Uma dessas porinas, OprD, é responsável pela entrada do antibiótico β-lactâmico imipenem na célula e é menos abundante em condições de alto c-di-GMP. Também demonstramos que linhagens com altos níveis de c-di-GMP apresentam uma vantagem competitiva de crescimento em relação a linhagens com níveis mais baixo de c-di-GMP quando crescidas em meio contendo imipenem. Em contraste, observamos que células planctônicas com elevados níveis c-di-GMP são mais sensíveis a tobramicina. Em conjunto, estes resultados mostram que c-di-GMP pode regular a resistência a antibióticos em sentidos opostos, e independentemente do crescimento em biofilme / Following the genomic era, a large number of genes coding for enzymes predicted to synthesize and degrade 3\'-5\'-cyclic diguanylic acid (c-di-GMP) was found in most bacterial genomes and this dinucleotide emerged as an important intracellular signal molecule controlling bacterial behavior. Diverse molecular mechanisms have been described as targets for c-di-GMP, but several questions remain to be addressed. An association between high c-di-GMP levels and antibiotic resistance is largely assumed, since high c-di-GMP upregulates biofilm formation and the biofilm mode of growth leads to enhanced antibiotic resistance; however, a clear understanding of this correlation is missing. Pseudomonas aeruginosa is a versatile gamma-proteobacterium that behaves as an opportunistic pathogen to a broad range of hosts. The ability of P. aeruginosa to form biofilms contributes to its virulence and adaptation to different environments. The P. aeruginosa PA14 genome presents several genes encoding proteins involved in metabolism or binding to c-di-GMP, which may indicate a wide regulatory role of this nucleotide in this bacterium. Here, using a proteomic approach, we show that Pseudomonas aeruginosa PA14 regulates the amount of five porins in response to c-di-GMP levels, irrespective of their mRNA levels. One of these porins is OprD, decreased in high c-di-GMP conditions, which is responsible for the uptake of the β-lactam antibiotic imipenem. We also demonstrate that this difference leads strains with high c-di-GMP to be more resistant to imipenem even when growing as planktonic cells, giving them a competitive advantage over cells with low c-di-GMP. Contrastingly, we found that planktonic cells with high c-di-GMP levels are more sensitive to aminoglycosides antibiotics. Together, these findings show that c-di-GMP levels can regulate the antibiotic resistance to different drugs in opposite ways and irrespective of a biofilm mode of growth.

O presente estudo visou determinar a prevalência de bactérias Gram-negativas produtoras de produzem b-lactamases de amplo espectro (ESBL) e resistência adquirida a quinolonas mediada por plasmídeos (PMQR) em animais de estimação, investigando o potencial papel destes hospedeiros como portadores assintomáticos. Em 2012, foram coletadas 216 amostras (fezes e saliva) de 108 animais de companhia (29 gatos e 79 cães) abrigados em casas de família, um centro de acolhimento de animais abandonados, e no Centro de Controle de Zoonoses da Cidade de São Paulo. Do total de cepas estudadas, 85% apresentaram fenótipo sugestivo de PMQR; enquanto que 62% dos isolados exibiram um fenótipo característico e sugestivo para produção de ESBL, sendo na sua maioria identificadas como E. coli. Dentre os isolados, 14 carregaram variantes do gene blaCTX-M, 9 foram positivos para o gene blaTEM, e 6 foram positivos para blaSHV. Em relação às cepas resistentes às Q/FQ, 56% (n= 43) foram positivas para a presença do gene qnr, o qual foi identificado em 11 espécies diferentes. Os resultados apresentados demostram que animais de companhia podem ser portadores assintomáticos de cepas produtoras de ESBL e PMQR. / The present study aimed to determine the prevalence of Gram-negative bacteria producing b-lactamases producing broad-spectrum (ESBL) and acquired resistance to quinolones mediated by plasmids (PMQR) in pets, investigating the potential role of these hosts as asymptomatic carriers. In 2012, 216 samples (feces and saliva) of 108 companion animals (29 cats and 79 dogs) housed in shelters or a Zoonosis Control Center were collected from São Paulo city. Of the total strains studied, 85% had a phenotype suggestive for PMQR; while 62 % of the isolates exhibited a characteristic phenotype and suggestive for ESBL-producing genes, with the most identified as E. coli. Among the isolates, 14 carried variants blaCTX -M gene 9 were positive for blaTEM gene, and 6 were positive for blaSHV. Regarding resistant Q/FQ isolates, 56% (n = 43) were positive for the presence of qnr gene, which was identified on 11 different species. The results presented demonstrate that pets can be asymptomatic carriers of ESBL producing strains and PMQR.

A resistência aos antibióticos é um problema de saúde pública global com sérias consequências para o tratamento de várias infecções bacterianas. Os fatores de transcrição da família MarR têm sido descritos controlando resistência a antibióticos e vários outros processos em bactérias. Neste trabalho, estudamos mecanismos de resistência a antibióticos em Chromobacterium violaceum, uma bactéria Gram-negativa ambiental que pode atuar como um patógeno oportunista em humanos. A estratégia envolveu a varredura de um painel de treze linhagens mutantes de fatores de transcrição da família MarR de C. violaceum disponíveis, por testes de susceptibilidade a 24 antibióticos. Estes ensaios revelaram que apenas o mutante ?emrR apresentou resistência aumentada ao antibiótico ácido nalidíxico em relação à linhagem selvagem. Esta resistência aumentada do mutante ?emrR ao ácido nalidíxico foi revertida em uma linhagem complementada deste mutante, conforme verificado por ensaios de viabilidade, ensaios de difusão em disco e concentração inibitória mínima (MIC). O fenótipo de diminuída produção de violaceína deste mutante, observado em meio líquido, também foi complementado. Além disso, foi realizado o isolamento de mutantes espontâneos de C. violaceum resistentes a ácido nalidíxico com mutação pontual em emrR. Os ensaios de microarranjo de DNA mostraram que EmrR reprime algumas dezenas de genes, incluindo o operon emrCAB, o qual codifica a bomba de efluxo EmrCAB. Os ensaios de Northern blot confirmaram que o EmrR reprime o operon emrCAB, e que a expressão desta bomba é induzida por salicilato, mas não outros compostos, como ácido nalidíxico ou brometo de etídeo. Os ensaios de alteração de mobilidade eletroforética (EMSA) mostraram que a proteína EmrR purificada se liga diretamente às 8 regiões promotoras de emrR, emrCAB e vários outros genes do regulon EmrR, para exercer uma regulação negativa direta sobre esses genes. Um mutante nulo ?emrCAB foi obtido, mas a ausência desta bomba de efluxo não tornou C. violaceum mais susceptível ao ácido nalidíxico, sugerindo que ela é importante somente em condições nas quais é induzida. Estas condições indutoras talvez incluam estresse oxidativo, uma vez que enzimas antioxidantes são parte do regulon de EmrR e a proteína EmrR formou dímeros covalentes na presença de agentes oxidantes in vitro. Portanto, nossos dados revelam que mutações pontuais ou moléculas como salicilato abolem a atividade repressora do fator de transcrição EmrR sobre o operon emrCAB, levando a superexpressão da bomba de efluxo EmrCAB e aumentando a resistência ao ácido nalidíxico em C. violaceum. / Antibiotic resistance is a global public health problem with serious consequences for the treatment of various bacterial infections. MarR family transcription factors have been described controlling antibiotic resistance and several other processes in bacteria. In this work, we studied mechanisms of antibiotic resistance in Chromobacterium violaceum, an environmental Gramnegative bacterium that can act as a human opportunistic pathogen. The strategy involved a screening of an available collection of thirteen C. violaceum mutant strains of MarR family transcription factors, by susceptibility testing for 24 antibiotics. These assays revealed that only the ?emrR mutant showed increased resistance to the antibiotic nalidixic acid in relation to the wild-type strain. This increased resistance of the ?emrR mutant to nalidixic acid was reversed in a complemented strain of this mutant, as verified by viability, disk diffusion, and minimal inhibitory concentration (MIC) assays. The phenotype of decreased violacein production of this mutant, observed in a liquid medium, was also complemented. In addition, it was performed the isolation of spontaneous mutants of C. violaceum resistant to nalidixic acid with a point mutation in emrR. DNA microarray assays showed that EmrR represses a few dozen of genes, including the emrCAB operon, which encodes the EmrCAB efflux pump. Northern blot assays confirmed that EmrR represses the emrCAB operon and that the expression of this pump is induced by salicylate, but not other compounds, such as nalidixic acid or ethidium bromide. Electrophoretic mobility shift assays (EMSA) showed that the purified EmrR protein binds directly to the promoter regions of emrR, emrCAB and several other genes of the EmrR regulon, to exert a direct negative regulation of these genes. A ?emrCAB null mutant strain was obtained, but the absence of this efflux pump did not make C. violaceum more susceptible to nalidixic acid, suggesting that it is important only under conditions in which it is induced. These inducing conditions may include 10 oxidative stress since antioxidant enzymes are part of the EmrR regulon and the EmrR protein has formed covalent dimers in the presence of oxidizing agents in vitro. Therefore, our data reveal that point mutations or molecules such as salicylate abolish the repressive activity of the EmrR transcription factor on the emrCAB operon, causing overexpression of the EmrCAB efflux pump and increasing the resistance to nalidixic acid in C. violaceum.

La résistance aux antibiotiques est devenue un problème majeur de santé publique à travers le monde pouvant conduire à l’impasse thérapeutique. L’utilisation abusive et inappropriée des antibiotiques en médecine humaine mais également en médecine vétérinaire est en grande partie responsable de la multiplication et de la propagation des bactéries multirésistantes (BMR). Les entérobactéries, hôtes naturels du tube digestif de l’homme et des animaux, ont particulièrement subi ces pressions de sélection antibiotiques et ont pu, grâce à leur capacité à échanger du matériel génétique, acquérir de plus en plus de mécanismes de résistance aux antibiotiques. L’environnement joue un rôle de diffuseur par l’intermédiaire des déchets humains et animaux qu’il reçoit mais est également un pourvoyeur de gènes de résistance grâce aux bactéries naturellement résistantes qu’il héberge. En Guadeloupe, à l’exception des données de surveillance hospitalière des BMR, aucune étude portant sur la résistance aux antibiotiques n’avait été réalisée. Les objectifs de ce travail de thèse étaient donc (i) d’évaluer l’importance de la résistance en milieu communautaire en étudiant la résistance aux antibiotiques des entérobactéries isolées des infections urinaires communautaires et (ii) d’étudier la diffusion environnementale des entérobactéries résistantes aux antibiotiques (ERAs) dans les rivières et les eaux de mer recevant des effluents de stations d’épuration (STEPs) mais également au sein de la faune sauvage terrestre de Guadeloupe.Nous avons donc pu grâce à ce travail mettre en évidence une diffusion environnementale de souches d’ERAs en lien avec les activités humaines. Les rejets de STEPs ont été identifiés comme une des sources d’ERAs et en particulier d’EBLSEs dans l’environnement. Néanmoins, nos résultats montrent que d’autres activités humaines, qui feront l’objet de futures investigations, peuvent être des sources potentielles d’ERAs. La prévention passe donc par une amélioration globale de la gestion des déchets avec notamment une remise à niveau des STEPs et le rejet au large des eaux usées. / Antibiotic resistance has become a major public health concern worldwide that could lead to therapeutic impasse. The overuse and misuse of antibiotics in human medicine but also in veterinary medicine is largely responsible for the proliferation and spread of multi-drug resistant (MDR) bacteria. Enterobacteriaceae are subject to this selective pressure, as the digestive tract is their main reservoir. Moreover, thanks to their ability to exchange genetic material, they can acquire new antibiotic resistance determinants. Through human and animal waste, antimicrobial resistant bacteria can spread in the environment. However, the environment is also a supplier for antibiotic resistance since environmental bacteria naturally harbor antibiotic resistance determinants.In Guadeloupe, except for data from MDR bacteria surveillance in the hospital, no studies concerning antibiotic resistance had been carried out. The objectives of this thesis were (i) to evaluate the antimicrobial resistance in the community by studying antimicrobial susceptibility of Enterobacteriaceae strains isolated from community-acquired urinary tract infection and (ii) to study the environmental spread of antimicrobial resistant Enterobacteriaceae (AREs) in river and sea waters receiving effluents from wastewater treatment plants but also in terrestrial wildlife.Our work highlighted the environmental spread of AREs linked to human activities. WWTPs discharge has been identified as a source of AREs, especially ESBLEs, in the environment. Nevertheless, other human activities may release ARB in the environment, and some will be explored in further studies. Thus, prevention requires an overall improvement in waste management, and wastewater discharge should occur in open sea as often as possible

Secretion is the passage of macromolecules across cellular membranes. In bacteria, secretion is essential for virulence and survival. Gram-negative bacteria use specialized envelope-spanning multiprotein complexes to secrete macromolecules called type IV secretion system (T4SS). T4SSs mediate the secretion of monomeric proteins, multisubunit protein toxins and nucleoprotein complexes. Also, they contribute to the horizontal spread of plasmid-encoded antibiotic resistance genes. Consequently, they are potential targets for antivirulence drugs. Gram- negative bacteria have two membranes that the secretion complex spans. As a result, the T4SS consists of proteins inserted in the membranes and of soluble proteins that face into or out of the bacterial cell. The details of channel assembly and structure are not known, although recent advances have revealed the structure of the core secretion channel. VirB8 is an inner membrane protein of the complex that interacts with many other T4SS subunits and works as nucleation factor for T4SS channel assembly. Biophysical studies and NMR experiments in particular were conducted to characterize the structural aspects of VirB8 interactions. Dynamic regions of VirB8 during monomer-to-dimer transition were identified by NMR spectroscopy. X-ray crystal and NMR analyses revealed structural differences at the helical regions (α-1 and α-4) of wild-type VirB8 and its monomeric variant VirB8M102R. Fragment screening identified small molecules binding to the wild-type and monomeric variant. In silico docking analyses suggested that the surface groove in the VirB8 structure is important for effective binding of the small molecules. NMR experiments and biochemical assays demonstrated that the β-sheet domain (β1 in particular) is the binding interface of VirB8 for the interaction with VirB10. The identified interface has functional importance for T4SS-mediated conjugation. In addition, I used NMR spectroscopy to identify changes in the structure of VirB8 upon interaction with VirB5. Altogether, structural and biochemical studies on periplasmic and full length VirB8 enabled us to characterize the sequence of interactions between VirB8 and other VirB proteins during T4SS complex assembly and function. The results of this research may lead to an innovative strategy for the development of novel antimicrobial drugs. / La sécrétion est le passage de macromolécules à travers les membranes cellulaires. Chez les bactéries, la sécrétion est essentielle pour la virulence et la survie. Les bactéries à Gramnégatif utilisent le système de sécrétion de type IV (SST4) pour la sécrétion de toxines et de nucléoprotéines. Les SST4 contribuent notamment à la propagation des gènes de résistance aux antibiotiques. Pour cette raison, les composants du SST4 sont des cibles potentielles pour le développement de médicaments antivirulence. Le SST4 est un complexe protéique qui s’étend entre la double membrane de la bactérie à Gram-négatif. Les protéines qui le composent sont insérées dans les membranes cellulaires ou solubles. Bien que la structure du pore central du SST4 ait été résolue récemment, les détails de l'assemblage et la structure de ce complexe ne sont pas connus. VirB8 est une protéine de la membrane interne qui interagit avec de nombreuses autres sous-unités du SST4. Il s’agit d’un acteur central de l'assemblage du SST4. Des études biophysiques, et notamment des expériences de RMN ont ainsi été réalisées pour caractériser les aspects structuraux des interactions avec VirB8. Des regions dynamiques dans la structure de VirB8 ont été identifiées par spectroscopie RMN lors de la transition entre la forme monomérique et dimérique. Les analyses de cristallographie et de RMN ont révélé des différences structurales dans les régions hélicoïdales (α1 et α4) de VirB8 wild-type et du variant monomérique VirB8M102R. Le criblage de fragments a permis d’identifier de petites molécules capables de se lier à VirB8 ainsi qu’au variant monomérique. Les analyses d’arrimage moléculaire in silico suggèrent que la rainure de surface dans la structure VirB8 est importante pour laliaison de ces petites molécules. Les expériences de RMN et les essais biochimiques révèlent que le feuillet β (β1 en particulier) constitue l'interface d’interaction entre VirB8 et VirB10. Cette interface d’interaction est d’ailleurs importante pour la conjugaison du SST4. De plus, j'ai identifié des changements dans la structure de VirB8 lors de l'interaction avec VirB5. Les études sur la protéine VirB8 nous ont permis de caractériser la séquence d'événements entre VirB8 et d'autres protéines VirB, régulant l'assemblage et la fonction du SST4.

The introduction of antibiotics in healthcare is one of the most important medical achievements with regard to reducing human morbidity and mortality. However, bacterial pathogens have acquired antibiotic resistance at an increasing rate, and due to a high prevalence of resistance to some antibiotics they can no longer be used therapeutically. The antibiotic mecillinam, which inhibits the penicillin-binding protein PBP2, however, is an exception since mecillinam resistance (MecR) prevalence has remained low. This is particularly interesting since laboratory experiments have shown that bacteria can rapidly acquire MecR mutations by a multitude of different types of mutations. In this thesis, I examined mechanisms and dynamics of mecillinam resistance in clinical and laboratory isolates of Escherichia coli. Only one type of MecR mutations (cysB) was found in the clinical strains, even though laboratory experiments demonstrate that more than 100 genes can confer resistance Fitness assays showed that cysB mutants have higher fitness than most other MecR mutants, which is likely to contribute to their dominance in clinical settings. To determine if the mecillinam resistant strains could compensate for their fitness cost, six different MecR mutants (cysB, mrdA, spoT, ppa, aspS and ubiE) were evolved for 200-400 generations. All evolved mutants showed increased fitness, but the compensation was associated with loss of resistance in the majority of cases. This will also contribute to the rarity of clinical MecR isolates with chromosomal resistance mutations. How MecR is mediated by cysB mutations was previously unclear, but in this thesis I propose and test a model for the mechanism of resistance. Thus, inactivation of CysB results in cellular depletion of cysteine that triggers an oxidative stress response. The response alters the intracellular levels of 450 proteins, and MecR is achieved by the increase of two of these, the LpoB and PBP1B proteins, which rescue the cells with a mecillinam-inhibited PBP2. Mecillinam is used for UTI treatments and to investigate mecillinam resistance in a more host-like milieu, MecR strains were grown in urine and resistance was examined. Interestingly, this study showed that neither laboratory, nor clinical cysB mutants are resistant in urine, most likely because the cysteine present in the urine phenotypically reverts the bacteria to susceptibility. These findings suggest that mecillinam can be used to treat also those clinical strains that are identified as MecR in standard laboratory tests, and that testing of mecillinam susceptibility in the laboratory ought to be performed in media that mimics urine to obtain clinically relevant results. In summary, the work described in this thesis has increased ourgeneral knowledge of mecillinam resistance and its evolution. Hopefully this knowledge can be put to good use in clinical settings to reduce the negative impact of antibiotic resistance.

Antibiotic resistance in bacteria is acquired through spontaneous chromosomal mutations or horizontal gene transfer. In the absence of antibiotics, resistant mutants generally show reduced fitness due to compromised growth rate, competitive ability and virulence compared to their antibiotic-sensitive ancestors. The focus of my research is to dissect the molecular underpinnings of the variations in the fitness cost of chromosomal antibiotic resistance using a systems-level approach. From an evolutionary perspective, my research aims are to understand how the fitness cost influences adaptation in resistant populations in an antibiotic-free environment. Using rifampicin resistance in Pseudomonas aeruginosa as a model, my work shows that most of the variation in the fitness cost of rifampicin resistance can be attributed to the direct effect of rifampicin resistance mutations on transcriptional efficiency. Through RNA-Seq transcriptome profiling, I demonstrate that global changes in gene expression levels associated with resistance mutations are surprisingly subtle, suggesting that the transcriptional regulatory network of P. aeruginosa is robust against compromised transcriptional efficiency. Using experimental evolution and whole-genome sequencing, my work reveals a systematic difference in the genetic basis of adaptation in mutants that were propagated in the absence of antibiotics. During compensatory adaptation, resistant mutants can recover the fitness cost of resistance by fixing second-site mutations that directly offset the deleterious effects of resistance mutations. Amongst resistant mutant populations with low fitness costs, general adaptation limits compensatory adaptation, which is most likely to be due to the rarity of compensatory mutations and clonal interference. Far from being the most ubiquitous mechanism in the evolution of resistance, compensatory adaptation is the exception that is more likely to be observed in resistant mutants with high fitness costs. In addition, I applied key elements of the integrative experimental approach developed in this work to dissect the molecular basis of the fitness cost associated with carriage of the pNUK73 small plasmid in P. aeruginosa, which carries the rep gene encoding a plasmid replication protein. My results confirmed that rep expression generates a significant fitness cost in P. aeruginosa and demonstrate how the molecular origins of the fitness cost of resistance can be dissected in a different biological context.

Les bovins sont porteurs de souches d'Escherichia coli entérohémorragiques (EHEC), pathogènes pour l'homme et également de souches d'E. coli résistantes aux antibiotiques. Dans un premier temps, nous avons évalué la fréquence de ces souches dans les effluents de station d'épuration des eaux usées de deux abattoirs, l'un de bovins adultes et l'autre de veaux de boucherie. Les pourcentages d'E. coli antibiorésistantes et porteuses d'intégrons de résistance de classe 1 étaient significativement plus élevés dans les effluents et boues d'abattoirs de veaux (87,5%, 56,2%) par rapport aux bovins adultes (5,0%, 0%). Ces pourcentages n'étaient pas modifiés par le traitement épuratoire. Le traitement épuratoire n'a également eu aucun impact sur les pourcentages de souches d'E. coli productrices de shigatoxines (STEC). Une souche STEC O157:H7 hautement pathogène a été isolée des boues destinées à l'épandage agricole dans la station d'épuration d'abattoir de bovins adultes. Ces résultats ont confirmé qu'il existe des risques de dissémination environnementale d'E. coli antibiorésistantes et/ou pathogènes via les effluents d'abattoir de bovins et ont mis en évidence que ce risque était différent selon la catégorie de bovins abattus. Dans un deuxième temps, nous avons évalué la résistance de souches STEC du top 5 (O26:H11, O103:H2, O111:H8, O145:H28 et O157:H7) isolées de fèces de bovins adultes. Sept des 39 souches STEC testées étaient résistantes, dont 6 à au moins 3 classes d'antibiotiques. Les souches non-STEC et aEPEC du top 5 d'E. coli de la flore fécale de ces mêmes bovins étaient toutes sensibles, indiquant un possible lien génétique entre gènes de résistance et virulence. Nous avons mis en évidence que le gène ehxA, marqueur fiable du plasmide de virulence des EHEC, et les gènes de résistance blaTEM, strA-strB, tet(A), sulII étaient localisés sur un même plasmide de grande taille pour 4 souches STEC (1 O26:H11, 1 O103:H2 et 2 O111:H8). Cette association génétique soulève la problématique de la sélection clonale de ces souches pathogènes lors du traitement des bovins porteurs avec des antibiotiques. / Cattle are known to be reservoir of enterohemorrhagic Escherichia coli (EHEC), pathogenic for humans and antibiotic resistant E. coli as well. In a first stage, we assessed frequencies of these strains in two bovine slaughterhouse wastewater treatment plants, one slaughtered only adult cattle and the other only veal calves. Percentages of resistant and class 1 integron-bearing E. coli were significantly higher in veal calves effluents and thickened sludges (87.5%, 56.2%) compared to those of adult cattle (5.0%, 0%). These percentages were not impacted by treatment process. The treatment had no impact on percentages of Shiga toxin-producing E. coli (STEC) either. A STEC O157:H7 highly pathogenic for humans was isolated from the thickened sludge of the adult cattle slaughterhouse, intended to be spread on agricultural lands. These results confirmed that bovine slaughterhouse effluents might contribute to the environmental dissemination of antibiotic resistant and/or pathogenic E. coli and underlined that the risks of dissemination differ according to slaughtered bovine category. In a second stage, we assessed the antibiotic resistance of top 5 STEC (O26:H11, O103:H2, O111:H8, O145:H28 and O157:H7) isolated from adult cattle fecal samples. Seven of the 39 top 5 STEC were resistant, of which 6 resistant to at least 3 classes of tested antibiotics. Non-top 5 STEC and aEPEC E. coli strains from fecal flora of the same bovine carriers were all susceptible to the tested antibiotics, indicating a possible link between EHEC-associated virulence genes and antibiotic resistance genes. We showed that ehxA gene, which is a reliable marker of the EHEC virulence plasmid, and antibiotic-resistance genes blaTEM, strA-strB, tet(A), sulII were located on a same large plasmid in 4 antibiotic-resistant top 5 STEC strains (1 O26:H11, 1 O103:H2 and 2 O111:H8). This genetic association raises the concern about the clonal selection of such pathogenic strains by antibiotic use in bovine carriers.

Les infections néonatales tardives (INT, survenant après 3 jours de vie) sont fréquentes et sont associées à une mortalité et une morbidité importantes chez les nouveau-nés prématurés. Dans ce contexte, il a été récemment décrit un clone de Staphylococcus capitis, appelé NRCS-A, impliqué spécifiquement dans ces INT dans différents services de réanimation néonatale (RN) à travers la France, et présentant un profil multirésistant atypique chez cette espèce, incluant notamment une sensibilité diminuée à la vancomycine, qui est pourtant l'antibiotique de première ligne en cas de suspicion d'INT. Dans le cadre de ce travail, nous avons démontré la distribution endémique du clone NRCS-A dans au moins 17 pays à travers le monde, spécifiquement dans les services de RN. De plus des données épidémiologiques issues des services de RN français ont identifié une prévalence élevée du clone dans certains services, illustrant sa capacité à s'implanter puis à persister dans ces services. Une caractérisation génétique du clone NRCS-A a été réalisée afin de mettre en évidence d'éventuels facteurs génétiques pouvant favoriser son implantation dans les services de RN. Cette analyse a démontré le rôle des éléments génétiques mobiles dans l'émergence du phénotype multirésistant du clone NRCS-A. En revanche aucun gène de virulence spécifique du clone n'a pu être mis en évidence. L'analyse des gènes spécifiques du clone a toutefois permis d'identifier le gène nsr codant pour la résistance à la nisine, bactériocine active sur de nombreuses bactéries à Gram positif et sécrétée par les bactéries de la flore commensale digestive. Ce gène pourrait donc conférer un avantage sélectif au clone NRCS-A pour s'implanter dans le microbiote des nouveau-nés prématurés. La persistance du clone dans les services de RN évoque la présence de réservoirs inertes ou humains au sein de ces services. Grâce à la mise au point d'une technique d'identification de S. capitis par gélose chromogénique sélective, nous avons pu démontrer la diffusion et la persistance de S. capitis dans un service de RN, sans toutefois identifier un réservoir unique responsable de cette colonisation. Nous avons également observé une inefficacité partielle des mesures de décontamination. Il n'existe en revanche pas de portage chronique chez le personnel soignant, ni de colonisation vaginale chez les femmes enceintes. Par ailleurs, nous avons pu mettre en évidence par repiquages successifs in vitro une capacité particulière du clone NRCS-A à acquérir de façon rapide et stable une résistance à la vancomycine sous pression de sélection par cet antibiotique. Cette capacité constitue un avantage sélectif majeur pour ce clone et pourrait avoir favorisé son implantation et sa persistance dans les services de RN où la pression de sélection par la vancomycine est élevée. Pour compléter ces résultats, une étude de cohorte prospective menée en RN a permis de démontrer que l'administration de vancomycine constituait un facteur de risque indépendant de survenue d'INT à S. capitis. Au-delà de la problématique spécifique des INT à S. capitis en RN, nos travaux illustrent plus largement un des enjeux majeurs de santé publique qui est l'impact écologique potentiel de l'utilisation des antibiothérapies probabilistes à large spectre sur l'émergence et la sélection de bactéries multirésistantes impliquées secondairement dans des infections nosocomiales. Ces travaux ouvrent de nouveaux axes de recherche concernant d'une part la meilleure compréhension de la physiopathologie des INT à S. capitis, et d'autre part plus largement les modalités de prévention des INT en RN et d'amélioration du diagnostic précoce des INT / Pas de résumé en anglais

Parmi les plus grandes menaces de la santé publique dans le monde entier, la résistance aux antibiotiques est à la pointe. Ceci en partie est dû à l'augmentation des infections causées par des bactéries pathogènes résistantes aux antibiotiques ainsi que la diminution du nombre actuel de nouveaux antibiotiques. Dans le souci de remédier à cette situation malheureuse, il y a eu récemment la ré-surfaçage des antibiotiques anciens et abandonnés comme les polymyxines. Colistine, un membre des antibiotiques de polymyxine, est maintenant considéré comme un antibiotique de «dernier recours» pour le traitement des infections bactériennes à Gram-négatives graves en raison de son action puissante contre ces agents pathogènes. Cependant, la résistance à la colistine parmi ces agents pathogènes a émergé dans plusieurs pays et est actuellement en augmentation. En raison de la nouvelle réintroduction relative de cet antibiotique, il ya un manque d'information complètes sur ses propriétés pharmacologiques ainsi que des mécanismes par lequel les bactéries développent une résistance contre celle-ci.Afin de combler ce manque d'information en ce qui concerne le mécanisme de résistance, nous avons donc entrepris ce projet. Tout d'abord, pour procéder à une surveillance épidémiologique des bactéries résistantes à la colistine chez les humains et les animaux domestiques et d'autre part, de décrypter les mécanismes moléculaires de résistance à la colistine parmi les bactéries résistantes isolées. / Among one of the greatest threats facing public health worldwide, antibiotic resistance is at the forefront. This is partly due to increase in infections caused by antibiotic-resistant pathogenic bacterial as well as the current dwindling number of new antibiotics. In a way to address this unfortunate situation, there have been recent resuscitation of old and abandoned antibiotics such as polymyxins. Colistin, a member of polymyxin antibiotics, is now regarded as a 'last-resort' antibiotic for the treatment of severe Gram-negative bacterial infections owing to its potent action against these pathogens. However, resistance to colistin among these pathogens has emerged in several countries and is currently on increase. Due to the relatively new reintroduction of this antibiotic, there is a lack of comprehensive information on its pharmacological properties as well as mechanisms by which bacteria develop resistance against it.In order to bridge this information gap in relation to the mechanism of resistance, we therefore undertook this project. First, to carry out an epidemiological surveillance of colistin-resistant bacteria in humans and domesticated animals and secondly, to decipher the molecular mechanisms mediating colistin resistance among the isolated resistant bacteria.