Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens affecting the human race in our time. In spite of recent medical advances, our therapeutic choices for MRSA infections remain limited due to the propensity of this organism to develop resistance to antimicrobials. Therefore, there is a continuing need to develop newer methods of treating MRSA infections. This dissertation examines the effects of bacteriophages 88 and 92 on ten clinical isolates of MRSA from the central Florida area. . For the majority of the MRSA isolates, bacteriophages 88 and 92 were unable to induce lysis. However, bacteriophage 88 was found to lyse MRSA Sample 94. Reduced cytotoxicity and apoptosis due to MRSA Sample 94 was also observed. This protective effect was most notable in the 1:10-6 concentration of MRSA 94 and bacteriophage 88. In addition, this effect was observable with both immediate inoculation of the cell culture with the MRSA concurrent with the bacteriophage and with bacteriophage applied one hour after initial inoculation of the MRSA. This effect was likely due to the increased replication of the bacteriophage in the actively growing bacteria found in the 1:10-6 samples. The bacteria in the 1:10-6 concentration were likely more able to replicate in comparison to the higher bacterial concentrations because of less competition between the bacteria for the limited nutrients in the 1:10-6 concentration. The long-term goal of this study is the development of a bacteriophage-containing ointment for the control of MRSA nasal carriage. In addition, the concept of bacteriophage therapy may open a new horizon in controlling infections such as those caused by MRSA. Finally, as for future studies, it would be informative to be able compare these results with other MRSA isolates and bacteriophages samples to examine the effects across a wider sample of bacteria and bacteriophages. In addition, it would be interesting to examine the possibility of being able to modify the bacteriophage in order to allow lysis of the previously resistant bacterial strains.

Les biofilms sont des communautés structurées de micro-organismes enrobées dans une matrice extracellulaire. Les biofilms sont impliqués dans la persistance de plusieurs maladies infectieuses et la matrice extracellulaire du biofilm protège les bactéries contre les cellules du système immunitaire de l'hôte, les antibiotiques et les désinfectants. Récemment notre laboratoire a démontré que le zinc inhibe la formation de biofilm chez Actinobacillus pleuropneumoniae, une bactérie pathogène du porc. Le but de cette étude est d'évaluer l'effet du zinc sur la croissance et la formation du biofilm chez différentes bactéries pathogènes du porc, telles que Bordetella bronchiseptica, Escherichia coli, Haemophilus parasuis, Salmonella, Staphylococcus aureus et Streptococcus suis. Les bactéries ont été cultivées dans des plaques de 96 puits sous condition optimale de formation de biofilm et les biofilms ont été colorés au cristal violet. La présence du biofilm a été confirmée par microscopie confocale à balayage laser à l’aide du marqueur fluorescent FilmTracerTM FM ® 1-43. À des concentrations micromolaires, le zinc inhibe faiblement la croissance bactérienne et bloque d'une manière dose-dépendante la formation de biofilm d’A. pleuropneumoniae, Salmonella Typhimurium et H. parasuis. De plus, la formation de biofilm de E. coli, S. aureus et S. suis a été faiblement inhibée par le zinc. Nos résultats indiquent que le zinc a un effet inhibiteur sur la formation de biofilm de la plupart des pathogènes bactériens d'origine porcine. Cependant, le mécanisme sous-jacent de l'activité anti-biofilm du zinc reste à être caractérisé. / Biofilms are structured communities of microorganisms enclosed in a self-produced extracellular matrix. Biofilms are responsible for the persistence of most infectious diseases, because the biofilm matrix acts as a form of protection for the bacteria against the host immune system, antibiotic and disinfectants. Recent work in our laboratory demonstrated that zinc could inhibit biofilm formation of Actinobacillus pleuropneumoniae, a swine pathogen. The aim of this study was to evaluate the effect of zinc on growth and biofilm formation of other bacterial swine pathogens, such as Bordetella bronchiseptica, Escherichia coli, Haemophilus parasuis, Salmonella, Staphylococcus aureus, and Streptococcus suis. Bacteria were grown on 96-well plates under optimal biofilm forming conditions and the biofilms were stained with crystal violet. The presence of biofilms was confirmed by confocal laser scanning microscopy with FilmTracerTM FM® 1-43. At micromolar concentrations, zinc weakly inhibited bacterial growth and effectively blocked biofilm-formation by A. pleuropneumoniae, Salmonella Typhimurium, and H. parasuis in a dose-dependent manner. Additionally, biofilm formation of E. coli, S. aureus and S. suis was slightly inhibited by zinc. Our results indicate that zinc has an inhibitory effect on biofilm formation of most bacteria of porcine origin. However, the mechanism behind the antibiofilm activity of zinc has yet to be characterized.

Débutée en 2005, l'ère du pangénome a connu un important essor ces dernières années, notamment grâce aux progrès des techniques de séquençage haut débit. Le pangénome, qui est divisé en deux grandes parties, le core génome et le génome accessoire, offre un grand éventail d'utilisation. Au cours de ces trois dernières années, nous avons étudié cette gamme de possibilités en nous basant sur des pathogènes humains tel que Coxiella burnetii, Kingella kingae et Bacillus anthracis. Ainsi, outre la découverte d'une nouvelle espèce de Kingella et l'étude de quelques génomes spécifiques, nous nous sommes attardés sur le lien entre pangénome et pathogénicité, sur l'importance des SNPs (Single Nucleotide Polymorphism), ainsi que sur la corrélation entre pangénome et taxonomie et donc, par extension, nous avons étudié la notion d'espèce bactérienne. / The pangenome area began in 2005 and had known a huge increase thanks to the improvement of the Next Generation Sequencing methods. The pangenome, which is divided into two parts, the core and the accessory genome, offer a large panel of uses. During the last three years, we have studied all these possibilities. We based our work on human pathogens as Coxiella burnetii, Kingella kingae and Bacillus anthracis. Thus, in addition to the discovery of a new Kingella species and the study of some specific genomes, we studied in details the link between pangenome and pathogenicity, the importance of SNPs (Single Nucleotide Polymorphism) and the correlation between pangenome and taxonomy. Finally, we worked on the bacterial species definition.

Worldwide there is a growing concern of the emergence and evolution of antimicrobial resistance among bacterial pathogens, which poses a threat to human and animal health. The extensive use and misuse of antimicrobials in human and veterinary clinical therapy and agricultural practices have been a major selective force for the emergence, selection, and dissemination of antimicrobial resistant bacteria and resistant genes. Commensal bacteria constitute a reservoir of resistant genes and their level of resistance is considered to be a good indicator for resistance problems to be expected in pathogens. The monitoring of the prevalence of resistance in indicator bacteria such as faecal Escherichia coli and enterococci in different human and animal populations allows the comparison of the prevalence of resistance and to detect transfer between animals and humans and vice versa. Antimicrobial resistance has however, been found in the bacteria of wildlife not exposed to antimicrobials and living in remote areas of this earth. This has implications for resistance control strategies. Previous studies on antimicrobial resistance in wildlife have yielded contrasting results, such as an almost complete absence of resistance in enterobacteria isolated from moose, deer and vole in Finland compared to a high prevalence of resistance in faecal bacteria from wild rodents living in northwest England, which are possibly due to differences in the ecological systems and the proximity to anthropogenic activities. This study further investigates the phenomenon of antimicrobial resistance in wildlife. A previous study conducted in the conservancy area of Kruger National Park (KNP) within South Africa showed that surface water could be a possible source of antimicrobial resistance in unexposed animal populations and that impala (Aepyceros melampus) were good sentinel animals for the documentation of antimicrobial resistance through rivers. This current study followed on this hypothesis and investigated the prevalence of resistance in commensal bacteria isolated from impala and their water sources in KNP. The following four perennial river systems were selected: the Olifants, the Letaba, the Crocodile, the Sabie-Sand Rivers. Samples of river water (n=11) and faeces (n=165) were collected at 11 different sites along these rivers. Samples were directly plated and resistant colonies were selected by means of discs containing antimicrobials (direct plating method). Resistant colonies that grew in the presence of antimicrobials were cultured and identified. Isolates of E. coli (n=12), Enterobacter cloacae (n=49), Pantoea species (n=9), Enterococcus faecalis (n=59), Enterococcus faecium (n=4) and Enterococcus durans (n=64) were tested for susceptibility to a selection of commonly used veterinary antimicrobial drugs. Susceptibility to 18 antimicrobial drugs was determined by means of minimum inhibitory concentrations (MIC) using a commercial MIC test (Sensititre® Bovine/Porcine plate format BOP06F). Our results allow us to give further support to our working hypothesis that antimicrobial resistance, as evidenced in the impala faeces, may have been due to the impala drinking from the polluted rivers, knowing full well that impala are not routinely subjected to any form of antimicrobial treatment. Although the isolates obtained from the water sources were not as many as those obtained from the faecal samples, a degree of resistance was also observed across all the four river systems that we isolated bacteria from, and this was also evident in the faecal samples as well. Our results also further add to the importance of wildlife as sentinels in environmental antimicrobial resistance studies. / Dissertation (MSc)--University of Pretoria, 2013. / gm2014 / Veterinary Tropical Diseases / Unrestricted

Background: Multidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and morbidity of affected individuals. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population. Methods: We performed cross-sectional point-prevalence testing with 12 months follow-up and selected testing of relatives in an out-patient HD cohort of n = 77 patients by using microbiological cultures from fresh stool samples, combined with Matrix Assisted Laser Desorption Ionization—Time of Flight Mass Spectrometry (MALDI-TOF-MS) and antimicrobial susceptibility testing. Results: We detected MDRGN in 8 out of 77 patients (10.4%) and 1 out of 22 relatives (4.5%), indicating only colonization and no infections. At follow-up, 2 patients showed phenotypic persistence of MDRGN colonization, and in 6 other patients de-novo MDRGN colonization could be demonstrated. Pathogens included Escherichia coli and Klebsiella pneumoniae (with extended-spectrum beta-lactamase [ESBL]-production as well as fluoroquinolone resistance), Stenotrophomonas maltophilia and Enterobacter cloacae. Conclusions: In a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively. Reasons for this could be high hygiene standards and a strict antibiotic stewardship policy with evidence of low consumption of fluoroquinolones and carbapenems in our HD unit and the affiliated hospital.

Neonatal sepsis caused by resistant bacteria is a worldwide concern due to the associated high mortality and increased hospitals costs. Bacterial pathogens causing neonatal sepsis and their antibiotic resistance patterns vary among hospital settings and at different points in time. This study aimed to determine the antibiotic resistance patterns of pathogens causing neonatal sepsis and to assess trends in antibiotic resistance. The study was conducted among neonates with culture proven sepsis at the University Hospital of Leipzig between November 2012 and September 2020. Blood culture was performed by BacT/ALERT 3D system. Antimicrobial susceptibility testing was done with broth microdilution method based on ISO 20776-1 guideline. Data were analyzed by SPSS version 20 software. From 134 isolates, 99 (74%) were gram positive bacteria. The most common gram positive and gram negative bacteria were S. epidermidis, 51 (38%) and E. coli, 23 (17%), respectively. S. epidermidis showed the highest resistance to penicillin G and roxithromycin (90% each) followed by cefotaxime, cefuroxime, imipenem, oxacillin, and piperacillin-tazobactam (88% each), ampicillin-sulbactam (87%), meropenem (86%), and gentamicin (59%). Moreover, S. epidermidis showed raising levels of resistance to amikacin, gentamicin, ciprofloxacin, levofloxacin, moxifloxacin, and cotrimoxazol. Gram positive bacteria showed less or no resistance to daptomycin, linezolid, teicoplanin, and vancomycin. E. coli showed the highest resistance to ampicillin (74%) followed by ampicillin-sulbactam (52%) and piperacillin (48%). Furthermore, increasing levels in resistance to ampicillin, ampicillin-sulbactam, piperacillin, and cefuroxime were observed over the years. Encouragingly, E. coli showed significantly declining trends of resistance to ciprofloxacin and levofloxacin, and no resistance to amikacin, colistin, fosfomycin, gentamicin, imipenem, piperacillin-tazobactam, and tobramycin. In conclusion, this study demonstrates that gram positive bacteria were the leading causes of neonatal sepsis. Bacterial isolates were highly resistant to first and second-line empiric antibiotics used in this hospital. The high levels of antibiotic resistance patterns highlight the need for modifying empiric treatment regimens considering the most effective antibiotics. Periodic surveillance in hospital settings to monitor changes in pathogens, and antibiotic resistance patterns is crucial in order to implement optimal prevention and treatment strategies.

Globally disseminated bacterial pathogens frequently cause epidemics that are of major importance in public health. Of particular significance is the capacity for some of these bacteria to switch into a new environment leading to the emergence of pathogenic clones. Understanding the evolution and epidemiology of such pathogens is essential for designing rational ways for prevention, diagnosis and treatment of the diseases they cause. Whole-genome sequencing of multiple isolates facilitating comparative genomics and phylogenomic analyses provides high-resolution insights, which are revolutionizing our understanding of infectious diseases. In this thesis, a range of population genomic analyses are employed to study the molecular mechanisms and the evolutionary dynamics of bacterial pathogen niche adaptation, specifically between humans, animals and the environment. A large-scale population genomic approach was used to provide a global perspective of the host-switching events that have defined the evolution of Staphylococcus aureus in the context of its host-species. To investigate the genetic basis of host-adaptation, we performed genome-wide association analysis, revealing an array of accessory genes linked to S. aureus host-specificity. In addition, positive selection analysis identified biological pathways encoded in the core genome that are under diversifying selection in different host-species, suggesting a role in host-adaptation. These findings provide a high-resolution view of the evolutionary landscape of a model multi-host pathogen and its capacity to undergo changes in host ecology by genetic adaptation. To further explore S. aureus host-adaptive evolution, we examined the population dynamics of this pathogen after a simulated host-switch event. S. aureus strains of human origin were used to infect the mammary glands of sheep, and bacteria were passaged in multiple animals to simulate onward transmission events. Comparative genomics of passaged isolates allowed us to characterize the genetic changes acquired during the early stages of evolution in a novel host-species. Co-infection experiments using progenitor and passaged strains indicated that accumulated mutations contributed to enhanced fitness, indicating adaptation. Within-host population genomic analysis revealed the existence of population bottlenecks associated with transmission and establishment of infection in new hosts. Computational simulations of evolving genomes under regular bottlenecks supported that the fitness gain of beneficial mutations is high enough to overcome genetic drift and sweep through the population. Overall, these data provide new information relating to the critical early events associated with adaptation to novel host-species. Finally, population genomics was used to study the total diversity of Legionella longbeachae from patient and environmental sources and to investigate the epidemiology of a L. longbeachae outbreak in Scotland. We analysed the genomes of isolates from a cluster of legionellosis cases linked to commercial growing media in Scotland and of non-outbreak-associated strains from this and other countries. Extensive genetic diversity across the L. longbeachae species was identified, associated with intraspecies and interspecies gene flow, and a wide geographic distribution of closely related genotypes. Of note, a highly diverse pool of L. longbeachae genotypes within compost samples that precluded the genetic establishment of an infection source was observed. These data represent a view of the genomic diversity of this pathogen that will inform strategies for investigating future outbreaks. Overall, our findings demonstrate the application of population genomics to understand the molecular mechanisms and the evolutionary dynamics of bacterial adaptation to different ecological niches, and provide new insights relevant to other major bacterial pathogens with the capacity to spread between environments.

Thesis (Ph.D. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

Thesis (Ph.D. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2010.

Background: Antimicrobial resistance (AMR) is a global public health challenge since infection with resistant organisms may cause death, can spread across the community, and increase health care costs at individual, community and government level as more expensive antimicrobials will have to be made available for the treatment of infections caused by resistant bacteria. This calls for urgent and consolidated efforts in order to effectively curb this growing crisis, to prevent the world from slipping back to the pre-antibiotic era. The World Health Organization made a call in 2011 advocating for strengthening of surveillance and laboratory capacity as one-way of detecting and monitoring trends and patterns of emerging AMR. Knowledge of AMR guides clinical decisions regarding choice of antimicrobial therapy, during an episode of bacteraemia and forms the basis of key strategies in containing the spread of resistant bacteria. The current study focused on Staphylococcus aureus (SA), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA), as they are common hospital acquired infections which are prone to developing resistance to multiple antibiotics. Aim: The aim of this project was to assess and utilize the laboratory information system (LIS) at the National Health Laboratory Services (NHLS), as a tool for reporting AMR and monitoring resistance patterns and trends over time of clinical isolates of SA, KP and PA, cultured from the blood of patients admitted to seven tertiary public hospitals in three provinces in South Africa. Methods: A retrospective and prospective analysis was done on isolates of SA, KP, PA from blood specimens collected from patients with bacteraemia and submitted to diagnostic microbiology laboratories of the NHLS at seven tertiary public hospitals in three provinces in South Africa. These hospitals comprised the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Hospital (CBH), Helen Joseph Hospital (HJH), Steve Biko Pretoria Academic Hospital (SBPAH), Groote Schuur Hospital (GSH), Tygerberg Hospital (TH) and the Universitas Hospital of the Free State (UH). For retrospective analysis, data submitted during the period July 2005 to December 2009 were used and for prospective analysis, data relating to AMR in SA, KP, PA, collected by the Group for Enteric, Respiratory and Meningeal disease Surveillance in South Africa, (GERMS-SA) from July 2010 to June 2011 were used. AMR in these three pathogens to commonly used antimicrobial drugs was systematically investigated. Multivariate logistic regressions models were used to assess factors associated with AMR. In addition, a systematic review of research done to date on AMR in bacterial pathogens commonly associated with hospital-acquired infections was conducted in order to understand the existing antimicrobial surveillance systems and baseline resistance patterns in South Africa. Results: A total of 9969 isolates were reported from the retrospective dataset. These were 3942 (39.5%) SA, 4466 (44.8%) KP and 1561 (15.7%) PA. From the prospective dataset, a total of 3026 isolates were reported, 1494 (49.4%) SA and 1532 (50.6%) KP isolates respectively. The proportion of invasive bacteraemia was higher in the <5 year old children. Nearly all strains of SA in South Africa were resistant to penicillin, and >30% up to as high as 80% were resistant to methicillin-related drugs among~560 invasive SA isolates over the two year period. Methicillin resistant Staphylococcus aureus (MRSA) rates significantly differed between hospitals (p=<0.001). The proportion of MRSA isolates in relation to methicillin-susceptible strains showed a declining trend from 22.2% in 2005 to 10.5% in 2009 (p=0.042). Emerging resistance was observed for vancomycin: 1 isolate was identified in 2006 and 9 isolates between July 2010-June 2011, and all except 1 were from Gauteng hospitals. The study found increasing rates of carbapenem-resisant KP of 0.4% in 2005 to 4.0% in 2011 for imipenem. The mean rate of extended spectrum beta lactamase (ESBL-KP) producing KP was 74.2%, with the lowest rate of 62.4% in SBPAH and the highest rate of 81.3% in UH, showing a significant geographical variation in rates of resistance (p=0.021). PA showed a tendency for multi-drug resistance with resistance rates of >20% to extended spectrum cephalosporins, fluoroquinolones and aminoglycosides respectively. Emerging resistance in PA isolates was observed to colistin, showing a resistance rate of 1.9% over the 5 years period. In the multivariate model, age <5 years, male gender, and hospital location were factors significantly associated with MRSA, while ESBL-KP was significantly associated with age <5 years and hospital location. Concluding remarks: The study has clearly demonstrated that AMR is relatively common in South Africa among children <5 years. Enhancement of continued surveillance of nosocomial infections through use of routine laboratory data should be reinforced as this will facilitate effective interpretation and mapping of trends and patterns of AMR. Therefore, the LIS as a tool for gathering such data should be strengthened to provide reliable AMR data for improved understanding of the extent of the AMR, and present evidence on which future policies and practices aimed at containing AMR could be based. Key words: Laboratory information system, Trends, Patterns, Antimicrobial resistance, Bacterial pathogens, Nosocomial infections, Surveillance, Bacteraemia, Blood culture.