Le diagnostic, la caractérisation et l'identification rapides et précis des agents pathogènes sont essentiels pour guider le traitement, détecter les événements de transmission ou les échecs de traitement. Cependant le monde biomédical est confronté à des pathogènes émergents et ré-émergents. Ainsi certaines souches bactériennes cliniques présentent des spécificités de virulence, contagiosité et/ou de résistance aux antibiotiques. Le séquençage génomique à haut débit et l’analyse comparative des génomes bactériens constituent une bonne stratégie pour étudier rapidement les caractéristiques de ces pathogènes émergents. En à peine un peu plus de 20 ans, la génomique a connu un développement considérable grâce aux nouvelles technologies de séquençage à haut débit et à l’intérêt des scientifiques, qui ont permis l’augmentation exponentielle du nombre de génomes bactériens séquencés et disponibles dans les bases de données publiques. La génomique en temps-réel consiste en une analyse rapide du génome d’une souche bactérienne clinique pour identifier les déterminants génétiques de ses caractéristiques phénotypiques inhabituelles. C’est ainsi que les objectifs de ce projet de thèse étaient : d’exploiter rapidement les données de séquençage de génomes complets pour déterminer les répertoires de résistance et de virulence ; de comparer les génomes provenant des bactéries cliniques atypiques à ceux d’autres bactéries des mêmes espèces pour identifier leurs caractéristiques spécifiques ; d’utiliser les génomes comme outil taxonomique pour décrire rapidement les nouvelles espèces bactériennes isolées dans le laboratoire par culturomique. / Rapid and accurate diagnosis, characterization and identification of pathogens are essential to guide treatment and detect transmission events or treatments failures. However, the biomedical field is confronted with emerging and re-emerging pathogens. Some of these clinical bacterial strains exhibit specificities concerning the virulence, contagiousness and / or resistance to antibiotics. High-throughput sequencing and comparative analysis of bacterial genomes is a reliable strategy enabling the rapid study of the characteristics of these emerging pathogens. In a short period, not exceeding 20 years, genomics has known a considerable revolution. In effect the introduction of the new high-throughput sequencingtechnologies and the increased concern of the scientist into this field, led to an exponential increase of number of available sequenced bacterial genomes in public databases. Real-time genomics is a strategy consisting on rapid analysis of the genome of a clinical bacterial strain in order to identify the genetic determinants justifying its unusual phenotypic characteristics. Thus, the objectives of this thesis project were: to rapidly exploit whole-genome sequencing data for identification of the virulence or resistance repertoire; to compare genomes from atypical clinical bacteria to those of other bacteria of the same species in order to identify their specific features; to use genomes as a taxonomic tool to rapidly describe the new bacterial species isolated in the laboratory by culturomics approach.

Escherichia coli foi isolado de amostras de água de lastro, água de regiões portuárias e de bivalves. 49,6% (164/331) apresentaram múltipla resistência variando de 2 a 8 antibióticos. Dos sete fatores associados à virulência pesquisados: Toxina termoestável (ST), Toxina termolábil (LT), Adesão agregativa (EAEC), Fator de invasão (INV), Toxina Shiga-like I (stx-1), Toxina Shiga-like II (stx-2), e o gene intimina (eae): 4 isolados continham genes homólogos para EAEC, 3 para eae, 3 para ST e uma para stx-2. Um total de 80,0% (24/30), 72,3% (68/94) e 75,3% (55/73) dos isolados de E. coli de amostras de água de lastro, água de regiões portuárias e moluscos bivalves apresentaram plasmídeos, respectivamente. O método ERIC-PCR apresentou melhor desempenho para a análise de agrupamentos. Os isolados de E. coli, com as características encontradas, nos permitirá avaliar o perigo de sua presença no ambiente marinho costeiro e na água de lastro e programas de vigilância sanitária devem ser implementadas para proteger a saúde humana, animal e do ecossistema marinho. / Escherichia coli was isolated from ballast water, port areas water and bivalves samples. 49.6% (164/331) had multiple antibiotics resistant varied from 2 to 8 antibiotics. From seven virulence associated factors investigated: heat stable toxin (ST), heat labile toxin (LT), aggregative adhesion (EAEC), invasion factor (INV), Shiga-like I toxin (STx-1), Shiga-like II toxin (STx-2), and the gene that codify for intimin (eae): 4 isolates had homology to the EAEC, 3 for eae gene, 3 for ST and one for stx2. A total of 80.0% (24/30), 72.3% (68/94) and 75.3% (55/73) of E. coli isolates from ballast water, port area water and bivalves samples had plasmids, respectively. The ERIC-PCR was more efficiency to analyze the groups. The presence of E. coli isolates with the characteristics found will allow evaluate the hazard present at the coast area ecosystem and ballast water samples and sanitary surveillance programs must be implemented for human, animal and aquatic ecosystem health protection.

Pseudomonas aeruginosa est un pathogène opportuniste impliqué dans les infections nosocomiales. Sa multi résistance aux antibiotiques s’exerce notamment grâce à l’activation de pompes d’efflux membranaires. Il s’agit de systèmes tripartites composés d’une porine de la famille OMF (Outer Membrane Factor) ancrée dans la membrane externe, d’un transporteur de la famille des RND (Resistance Nodulation Division) localisé dans la membrane interne et d’un adaptateur périplasmique de la famille des MFP (Membrane Fusion Protein) qui consolide l’ensemble. Le travail réalisé au cours de cette thèse apporte une contribution à la compréhension des mécanismes d’assemblage et d’ouverture des pompes d’efflux ainsi qu’à leur régulation grâce au développement de nouveaux outils empruntés à la physique, à la biochimie et à la microbiologie. Une première étude a permis de déterminer la stoechiométrie d’interaction entre MexA et OprM par gel bleu natif (Ferrandez, Monlezun et al. 2012). Une deuxième étude a été consacrée, dans le cadre d’une collaboration avec l’équipe de B. Le Pioufle (ENS Cachan), à la caractérisation par électrophysiologie de l'ouverture de la porine OprM, insérée dans une membrane artificielle reconstituée sur une biopuce (Wang, Monlezun et al. 2012). Puis, afin d’étudier cette fois ci, le mécanisme d’ouverture de la porine OprM in vivo, une étude fonctionnelle par complémentation chez Pseudomonas aeruginosa a été initiée. Enfin, dans le cadre d'une collaboration avec l’équipe de P. Plésiat (Laboratoire de Bactériologie, Besançon), deux analyses de mutants cliniques par modélisation ont été réalisées sur le régulateur MexZ de la pompe MexXY/OprM et de la porine d’influx des carbapénèmes OprD. / Pseudomonas aeruginosa is an opportunistic pathogen involved in nosocomial infections. This bacteria has developed various strategies to resist antibiotics treatments, one of them being the activation of membrane efflux pumps. These tripartite systems consist of an OMF (Outer Membrane Factor) family porin, localized in the outer membrane, an active transporter in the inner membrane, belonging to the RND (Resistance Nodulation Division) family and a periplasmic adaptator protein, member of the MFP (Membrane Fusion Protein) family which consolidates the whole complex. Results obtained during this thesis contribute to a better understanding of efflux pumps’ assembly and opening thanks to the development of new research tools borrowed from physic, biochemistry and microbiology. The first study describes the binding stoechiometry of MexA with its cognate partner OprM by Blue Native Polyacrylamide gel Electrophoresis (Ferrandez, Monlezun et al. 2012). Secondly, a study, in collaboration with B. Le Pioufle’s team (ENS Cachan), was dedicated to the electrophysiologic caracterization of OprM opening using a microfluidic device incorporated with a miniaturized artificial bilayer membrane (Wang, Monlezun et al. 2012). Then, to complete this analysis in vivo, in the third part of this thesis, complementation experiments were initiated in a Pseudomonas aeruginosa strain deleted of its chromosomal oprM gene. Finally, in collaboration with P. Plésiat’s team (Laboratoire de Bactériologie, Besançon), modelling of MexZ, the MexXY/OprM pump’s regulator and modelling of the carbapenems’ porin OprD were made in order to link structural modifications to mutations observed in clinical strains.

As infecções relacionadas à assistência à saúde (IRAS) são um grave problema de saúde pública cujo prognóstico tem sido desfavorecido pela emergência e endemicidade de bactérias multirresistentes (MRs). Neste cenário, seguindo uma tendência mundial, no Brasil, infecções por cepas de Acinetobacter baumannii MRs produtoras de carbapenemases do tipo OXA são atualmente consideradas uma emergência clínica e epidemiológica. Na falta de alternativas terapêuticas efetivas para infecções relacionadas, este trabalho objetivou avaliar efeitos sinérgicos (utilizando checkerboard e time-kill) decorrentes da combinação de 10 antimicrobianos de diferentes classes, contra 8 cepas MRs de A. baumannii, clonalmente não relacionadas, produtoras de carbapenemases do tipo OXA-23, OXA-72, OXA-58 e OXA-143, representativas de diferentes centros hospitalares do Brasil. Como resultado, a combinação amicacina/tigeciclina apresentou atividade sinérgica (S= ΣCIF ≤ 0,5) e parcialmente sinérgica (PS= &#931CIF ;0,5-0,75) contra 4 (50%) cepas produtoras de OXA-143 ou OXA-72, e 2 cepas (25%) produtoras de OXA-23, respectivamente. Por outro lado, a combinação polimixina B/imipenem apresentou atividade S e PS contra 3 (37,5%) isolados OXA-143, OXA-23 ou OXA-72 positivos, e 1 (12,5%) isolado produtor de OXA-58, respectivamente. Já, a combinação amicacina/ampicilina-sulbactam foi S contra 2 (25%) A. baumannii OXA-143 ou OXA-23 positivos, sendo PS contra dois (25%) A. baumannii OXA-58 ou OXA-143/23 positivos. De interesse, foi o efeito S da combinação polimixina B/vancomicina, contra 2 cepas (25%) produtoras de OXA-72 ou OXA-23. Por outro lado, a combinação ampicilina-sulbactam/rifampicina apresentou atividade PS contra 6 (75%) cepas produtoras das variantes OXA-23, OXA-143, OXA-72 ou OXA-58. Da mesma forma, rifampicina combinada com polimixina B foi sinérgica para uma cepa OXA-23 (12,5%) e PS para 5/8 (62,5%) cepas produtoras de OXA-72, OXA-58, OXA-23/-OXA143 ou OXA-143. O efeito sinérgico da combinação polimixina B/imipenem foi confirmado, in vivo, no modelo murino de infecção, tanto por avaliação histopatológica como por redução das UFC/g pulmão ou baço (p ≤ 0,05). Finalmente, foi avaliada a atividade, in vitro, do lípide catiônico brometo de dioctadecildimetilamônio (DDA), individualmente e em combinação com tigeciclina. DDA possui efeito bactericida, e potencializou sinergicamente a tigeciclina contra 2 (25%) cepas OXA-143 ou OXA-23 positivas. A atividade do DDA, assim como a atividade da sua combinação com tigeciclina foram efetivas já na segunda hora de interação, como avaliado pelas curvas de morte. Em resumo, o efeito sinérgico decorrente do uso combinado de amicacina, tigeciclina, polimixina B, imipenem, rifampicina ou ampicilina/sulbactam, pode constituir uma alternativa terapêutica para o tratamento de infecções produzidas por cepas de A. baumannii MRs produtoras de oxacilinases, sendo que nanofragmentos catiônicos de bicamada do lipídeo sintético de DDA tem potencial para consolidar um produto de aplicação clínica. / Healthcare-associated infections (HAIs) are a serious public health issue, which have been related with an unfavorable prognosis due to the emergence and endemicity of multidrug-resistant (MDR) bacteria. In this scenario, following a worldwide trend, in Brazil, infections produced by MDR OXA-type carbapenemase-producing Acinetobacter baumannii are currently considered a clinical and epidemiological urgency. In the absence of effective therapeutic alternatives for related infections, this study aimed to evaluate synergistic effects (by using time-kill and checkerboard assays) achieved by the combination of 10 different classes of antimicrobial against 8 strains of MDR, clonally unrelated, A. baumannii strains producing OXA-23, OXA-72, OXA-58 and OXA-143 carbapenemases, being representatives of different medical centers in Brazil. As a result, the combination of amikacin / tigecycline showed synergistic (S = ΣFIC ≤ 0.5) and partially synergistic (PS = 0.5 to 0.75 ΣFIC) activity against 4 (50%) OXA-72 or OXA-143 producing A. baumannii strains, and two strains (25%) producing OXA-23, respectively. Moreover, the combination of polymyxin B / imipenem showed S and PS activity against 3 (37.5%) OXA-143, OXA-23 and OXA-72 positive isolates, and 1 (12.5%) OXA-58 producer, respectively. On the other hand, the combination amikacin / ampicillin-sulbactam was S against 2 (25%) OXA-143 and OXA-23 positive strains, being PS against two (25%) OXA-58- and OXA-143/23-producing A. baumannii. Of interest was the synergistic effect achieved by polymyxin B plus vancomycin against two strains (25%) producing OXA-72 and OXA-23, respectively. Furthermore, the ampicilina-sulbactam / rifampicin combination displayed a PS activity against six (75%) strains producing OXA-23, OXA-143, OXA-72 or OXA-58-type enzymes. Likewise, rifampicin combined with polymyxin B was S against 1 (25%) OXA-23-positive A. baumannii being PS to 5/8 (62.5%) strains producing OXA-72, OXA-58, OXA-23/-OXA143 or OXA-143. The synergistic effect of the combination polymyxin B / imipenem was confirmed, in vivo, in the murine model of infection, by using both histopathological studies and bacterial clearance from the lungs and spleen (CFU/g, p≤ 0.05). Finally, we evaluated the in vitro activity of the cationic lipid dioctadecyldimethylammonium bromide (DDA), alone and in combination with tigecycline. DDA display a bactericidal effect, enhancing synergistically the activity of tigecycline against 2 (25%) OXA-143 and OXA-23 positive strains, respectively. DDA activity alone and in combination with tigecycline was effective on the second hour of interaction, as evaluated by time-kill assays. In summary, the synergistic effect resulting from the combined use of amikacin, tigecycline, polymyxin B, imipenem, rifampicin or ampicillin / sulbactam, could be an alternative therapy for the treatment of infections caused by MDR A. baumannii strains producing oxacilinases. On the other hand, cationic bilayer nanofragments of DDA has potential for consolidating a product for medical application.

As infecções relacionadas à assistência à saúde (IRAS) são um grave problema de saúde pública cujo prognóstico tem sido desfavorecido pela emergência e endemicidade de bactérias multirresistentes (MRs). Neste cenário, seguindo uma tendência mundial, no Brasil, infecções por cepas de Acinetobacter baumannii MRs produtoras de carbapenemases do tipo OXA são atualmente consideradas uma emergência clínica e epidemiológica. Na falta de alternativas terapêuticas efetivas para infecções relacionadas, este trabalho objetivou avaliar efeitos sinérgicos (utilizando checkerboard e time-kill) decorrentes da combinação de 10 antimicrobianos de diferentes classes, contra 8 cepas MRs de A. baumannii, clonalmente não relacionadas, produtoras de carbapenemases do tipo OXA-23, OXA-72, OXA-58 e OXA-143, representativas de diferentes centros hospitalares do Brasil. Como resultado, a combinação amicacina/tigeciclina apresentou atividade sinérgica (S= ΣCIF ≤ 0,5) e parcialmente sinérgica (PS= &#931CIF ;0,5-0,75) contra 4 (50%) cepas produtoras de OXA-143 ou OXA-72, e 2 cepas (25%) produtoras de OXA-23, respectivamente. Por outro lado, a combinação polimixina B/imipenem apresentou atividade S e PS contra 3 (37,5%) isolados OXA-143, OXA-23 ou OXA-72 positivos, e 1 (12,5%) isolado produtor de OXA-58, respectivamente. Já, a combinação amicacina/ampicilina-sulbactam foi S contra 2 (25%) A. baumannii OXA-143 ou OXA-23 positivos, sendo PS contra dois (25%) A. baumannii OXA-58 ou OXA-143/23 positivos. De interesse, foi o efeito S da combinação polimixina B/vancomicina, contra 2 cepas (25%) produtoras de OXA-72 ou OXA-23. Por outro lado, a combinação ampicilina-sulbactam/rifampicina apresentou atividade PS contra 6 (75%) cepas produtoras das variantes OXA-23, OXA-143, OXA-72 ou OXA-58. Da mesma forma, rifampicina combinada com polimixina B foi sinérgica para uma cepa OXA-23 (12,5%) e PS para 5/8 (62,5%) cepas produtoras de OXA-72, OXA-58, OXA-23/-OXA143 ou OXA-143. O efeito sinérgico da combinação polimixina B/imipenem foi confirmado, in vivo, no modelo murino de infecção, tanto por avaliação histopatológica como por redução das UFC/g pulmão ou baço (p ≤ 0,05). Finalmente, foi avaliada a atividade, in vitro, do lípide catiônico brometo de dioctadecildimetilamônio (DDA), individualmente e em combinação com tigeciclina. DDA possui efeito bactericida, e potencializou sinergicamente a tigeciclina contra 2 (25%) cepas OXA-143 ou OXA-23 positivas. A atividade do DDA, assim como a atividade da sua combinação com tigeciclina foram efetivas já na segunda hora de interação, como avaliado pelas curvas de morte. Em resumo, o efeito sinérgico decorrente do uso combinado de amicacina, tigeciclina, polimixina B, imipenem, rifampicina ou ampicilina/sulbactam, pode constituir uma alternativa terapêutica para o tratamento de infecções produzidas por cepas de A. baumannii MRs produtoras de oxacilinases, sendo que nanofragmentos catiônicos de bicamada do lipídeo sintético de DDA tem potencial para consolidar um produto de aplicação clínica. / Healthcare-associated infections (HAIs) are a serious public health issue, which have been related with an unfavorable prognosis due to the emergence and endemicity of multidrug-resistant (MDR) bacteria. In this scenario, following a worldwide trend, in Brazil, infections produced by MDR OXA-type carbapenemase-producing Acinetobacter baumannii are currently considered a clinical and epidemiological urgency. In the absence of effective therapeutic alternatives for related infections, this study aimed to evaluate synergistic effects (by using time-kill and checkerboard assays) achieved by the combination of 10 different classes of antimicrobial against 8 strains of MDR, clonally unrelated, A. baumannii strains producing OXA-23, OXA-72, OXA-58 and OXA-143 carbapenemases, being representatives of different medical centers in Brazil. As a result, the combination of amikacin / tigecycline showed synergistic (S = ΣFIC ≤ 0.5) and partially synergistic (PS = 0.5 to 0.75 ΣFIC) activity against 4 (50%) OXA-72 or OXA-143 producing A. baumannii strains, and two strains (25%) producing OXA-23, respectively. Moreover, the combination of polymyxin B / imipenem showed S and PS activity against 3 (37.5%) OXA-143, OXA-23 and OXA-72 positive isolates, and 1 (12.5%) OXA-58 producer, respectively. On the other hand, the combination amikacin / ampicillin-sulbactam was S against 2 (25%) OXA-143 and OXA-23 positive strains, being PS against two (25%) OXA-58- and OXA-143/23-producing A. baumannii. Of interest was the synergistic effect achieved by polymyxin B plus vancomycin against two strains (25%) producing OXA-72 and OXA-23, respectively. Furthermore, the ampicilina-sulbactam / rifampicin combination displayed a PS activity against six (75%) strains producing OXA-23, OXA-143, OXA-72 or OXA-58-type enzymes. Likewise, rifampicin combined with polymyxin B was S against 1 (25%) OXA-23-positive A. baumannii being PS to 5/8 (62.5%) strains producing OXA-72, OXA-58, OXA-23/-OXA143 or OXA-143. The synergistic effect of the combination polymyxin B / imipenem was confirmed, in vivo, in the murine model of infection, by using both histopathological studies and bacterial clearance from the lungs and spleen (CFU/g, p≤ 0.05). Finally, we evaluated the in vitro activity of the cationic lipid dioctadecyldimethylammonium bromide (DDA), alone and in combination with tigecycline. DDA display a bactericidal effect, enhancing synergistically the activity of tigecycline against 2 (25%) OXA-143 and OXA-23 positive strains, respectively. DDA activity alone and in combination with tigecycline was effective on the second hour of interaction, as evaluated by time-kill assays. In summary, the synergistic effect resulting from the combined use of amikacin, tigecycline, polymyxin B, imipenem, rifampicin or ampicillin / sulbactam, could be an alternative therapy for the treatment of infections caused by MDR A. baumannii strains producing oxacilinases. On the other hand, cationic bilayer nanofragments of DDA has potential for consolidating a product for medical application.