Thesis (M. Med. Sc.)--University of Hong Kong, 2007.

Made available in DSpace on 2015-12-06T22:54:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / O presente estudo teve como objetivo determinar as β)lactamases envolvidas na resistência às cefalosporinas de amplo espectro em uma coleção de Pseudomonas aeruginosa isoladas de hemoculturas de pacientes internados em um complexo hospitalar universitário na cidade de São Paulo durante o ano de 2005. No primeiro trabalho descrevemos a produção de CTX)M)2 em um isolado que apresentava o estranho fenótipo de sensibilidade à ceftazidima e resistência à cefepima. O gene que codificava esta enzima estava localizado no cromossomo bacteriano, em um contexto genético idêntico àquele encontrado em plasmídeos que carregam blaCTX)M)2, que encontram)se disseminados entre enterobactérias. No segundo trabalho, descrevemos as β)lactamases envolvidas na resistência à ceftazidima em 43 isolados de P. aeruginosa da referida coleção, assim como o contexto e suporte no qual estavam inseridos os genes que codificavam as enzimas identificadas. Além disso, realizamos a tipagem molecular dos isolados estudados e pesquisamos os prontuários médicos dos pacientes infectados pelas amostras estudadas. A hiperprodução de AmpC foi considerada a única β)lactamase relacionada à resistência a ceftazidima em quatro isolados (9,3 por cento). Nove isolados (20,9 por cento) apresentaram a produção de β)lactamase de espectro estendido (ESBL), sendo que sete (16,3 por cento) apresentavam a enzima GES)1 e dois isolados (4,6 por cento) apresentavam a enzima CTX)M)2. A atividade hidrolítica contra os carbapenens foi detectada em trinta isolados (69,7 por cento), nos quais as enzimas IMP)1, GES) 5 e SPM)1 foram identificadas em 1, 2 e 27 isolados, respectivamente. Nenhum isolado apresentou produção simultânea de metalo)β)lactamase e ESBL. Os genes blaSPM)1 e blaCTX)M)2 estavam associados às seqüências de inserção ISCR4 e ISCR1, respectivamente, enquanto que os genes blaGES)1, blaGES)5 e blaIMP)1 estavam localizados em integrons da classe 1. Todos os genes codificadores de β)lactamases identificados apresentavam localização cromossomal. A tipagem molecular dos isolados estudados evidenciou a existência de sete genótipos distintos; porém, isolados produtores de uma mesma enzima freqüentemente apresentavam relação clonal. A análise dos prontuários médicos revelou que metade dos pacientes que apresentaram infecção da corrente sanguínea pelos isolados de P. aeruginosa estudados receberam terapia inadequada. Este estudo permitiu identificar a diversidade de genes codificadores de β)lactamases de amplo espectro hidrolítico que foram adquiridos por isolados clínicos de P. aeruginosa. Estes genes foram inseridos no DNA cromossomal destes isolados e, posteriormente, disseminados por transmissão cruzada.. / The aim of this study was to identify the β-lactamases involved in broad-spectrum cephalosporin resistance in P. aeruginosa isolates recovered from blood culture of patients hospitalized at a Brazilian teaching hospital located in São Paulo, between January and December 2005. In the first manuscript we have described the production of CTX-M-2 causing ceftazidime susceptibility and cefepime resistance in a P. aeruginosa clinical isolate. The CTX-M-2-encoding gene was located at the bacterial chromosome, and its vicinities were identical to those observed in blaCTX-M-2-carrying plasmids from enterobacterial isolates. In the second manuscript we have evaluated 43 ceftazidime-resistant P. aeruginosa isolates from the referred collection. We have described the β-lactamases involved in ceftazdidme resistance, as well as the genetic context and support of β-lactamaseencoding genes and we have performed molecular typing of isolates. The medical records of patients infected with isolates studied were also analyzed. AmpC overproduction was found to be the only β-lactamase-mediated mechanism responsible for ceftazidime resistance in four isolates (9.3%). Nine isolates (20.9%) produced an extended-spectrum β-lactamase (ESBL), either GES-1 (n = 7, 16.3%) or CTX-M-2 (n = 2, 4.6%). Carbapenemase activity was detected in 30 (69,7%) isolates, in which two (4.6%) produced the ESBL GES-5, a single isolate (2.3%) produced the metallo-β-lactamase (MBL) IMP-1; and 27 isolates produced the MBL SPM-1 (62.8%). None of the isolates coproduced both ESBL and MBL. Insertion sequence elements ISCR4 and ISCR1 were associated with blaSPM-1 and blaCTX-M-2 genes, respectively, whereas the blaGES and blaIMP-1 genes were part of class 1 integron structures. All β- lactamase-encoding genes identified were chromosomally located. Molecular typing showed the existence of seven distinct genotypes, in which producers of the same β- lactamase often belonged to a single clone. Clinical data revealed that half of the patients infected with isolates studied have received inadequate therapy, suggesting that empirical treatment protocols should be updated in the hospital studied. In this study we have identified a variety of broad-spectrum β-lactamase-encoding genes that have been initially acquired by P. aeruginosa clinical isolates, inserted on its chromosomal DNA and then spread between patients by cross-transmition. / BV UNIFESP: Teses e dissertações

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Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Biology, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND SCIENCE / Vita. / Bibliography: leaves 211-223. / by Douglas Elliott Koshland. / Ph.D.

Thesis (Ph. D.)--Miami University, Dept. of Chemistry and Biochemistry, 2003. / Title from first page of PDF document. Document formatted into pages; contains xi, 150 p. : ill. Includes bibliographical references.

This thesis assessed the prevalence, patterns of antibiotic resistance, and molecular characteristics of ESBL-, AmpC-, and carbapenemase-producing Escherichia coli (EC) and Klebsiella pneumoniae (KPN) isolated from Canadian hospitals. Bacterial isolates were collected as part of the CANWARD national surveillance study. The prevalence of ESBL-EC [2007: 3.4%, 2012: 7.6%], AmpC-EC [2007: 0.7%, 2012: 2.2%], and ESBL-KPN [2007: 1.5%, 2012: 3.6%] increased between 2007 and 2012. Antimicrobials demonstrating the greatest activity against isolates in this study were colistin, amikacin, ertapenem, and meropenem, while 78.8%, 34.9%, and 66.7% of ESBL-EC, AmpC-EC, and ESBL-KPN, respectively, were multidrug resistant. Isolates were generally unrelated by PFGE; however, ST-131 was identified among 56.9% and 31.7% of ESBL-EC and AmpC-EC, respectively. CTX-M-15 was the dominant genotype in ESBL-EC (66.5%) and ESBL-KPN (48.1%), while the dominant genotype in AmpC-EC was CMY-2 (53.2%). Carbapenemase production was identified in 0.03% of EC and 0.05% of KPN, all of which produced KPC-3.

The spread of resistance to the cephalosporins in the Enterobacteriaceae and more specifically within E. coli is a continuing cause of public health concern, with such resistance increasingly seen in community- and nosocomial-acquired infections. Extended-spectrum ß-lactamase (ESBL) and AmpC ß-lactamase (AmpC) enzymes cause most cephalosporin resistance in E. coli by hydrolysis of the antimicrobial and continue to jeopardize patient outcome. The purpose of this thesis was to determine the prevalence of ESBL-producing Enterobacteriaceae and to molecularly characterize ESBL and AmpC producers found to be associated with the increasing cephalosporin resistance among E. coli within Canadian hospitals from 2005 to 2009. Isolates were collected as part of the Canadian Intensive Care Unit and Canadian Ward surveillance studies. ESBL and AmpC producers were molecularly characterized for resistance genes, virulence factors and phylogenetic groups. All strains were typed using PFGE and ESBL-producing E. coli were further typed by MLST. Plasmids bearing the ESBL and AmpC genes were characterized by BglII RFLP analysis and a multiplex PCR for replicon typing. ESBL-producing E. coli and K. pneumoniae and AmpC-producing E. coli were found to be firmly established in Canadian hospitals; whereas, ESBL-producing K. oxytoca and P. mirabilis have yet to emerge. Increasing resistance to several unrelated antimicrobials leading to multi-drug resistance among these pathogens is concerning. The successful dissemination of ESBL-producing E. coli in Canada occurs through a diversity of different mechanisms and does not correspond to a single ESBL determinant, or a single clone, or a single plasmid but rather through the combination of clonal spread of virulent strains and the acquisition of diverse ESBL-bearing plasmids. However, the predominance of CTX-M-15-producing E. coli in this study was mainly due to the virulent ST131 clone and the diverse IncFII plasmids bearing the blaCTX-M-15 gene. Whereas, horizontal transfer of genetically similar IncI1, IncA/C and IncK/B plasmids bearing blaCMY-2 and the clonal spread of virulent strains, including ST131 with ampC promoter/attenuator mutations, appears to be playing a role in the spread of AmpC-producing E. coli isolates in Canadian hospitals. The increasing prevalence of these multi-drug resistant pathogens in Canadian hospitals demonstrates the need for increased surveillance and understanding of these emerging pathogens. The continued surveillance will help guide proper infection control procedures and identify optimal treatment of these clinically important pathogens in Canadian hospitals.

This thesis assessed the prevalence, patterns of antibiotic resistance, and molecular characteristics of ESBL-, AmpC-, and carbapenemase-producing Escherichia coli (EC) and Klebsiella pneumoniae (KPN) isolated from Canadian hospitals. Bacterial isolates were collected as part of the CANWARD national surveillance study. The prevalence of ESBL-EC [2007: 3.4%, 2012: 7.6%], AmpC-EC [2007: 0.7%, 2012: 2.2%], and ESBL-KPN [2007: 1.5%, 2012: 3.6%] increased between 2007 and 2012. Antimicrobials demonstrating the greatest activity against isolates in this study were colistin, amikacin, ertapenem, and meropenem, while 78.8%, 34.9%, and 66.7% of ESBL-EC, AmpC-EC, and ESBL-KPN, respectively, were multidrug resistant. Isolates were generally unrelated by PFGE; however, ST-131 was identified among 56.9% and 31.7% of ESBL-EC and AmpC-EC, respectively. CTX-M-15 was the dominant genotype in ESBL-EC (66.5%) and ESBL-KPN (48.1%), while the dominant genotype in AmpC-EC was CMY-2 (53.2%). Carbapenemase production was identified in 0.03% of EC and 0.05% of KPN, all of which produced KPC-3.

The spread of resistance to the cephalosporins in the Enterobacteriaceae and more specifically within E. coli is a continuing cause of public health concern, with such resistance increasingly seen in community- and nosocomial-acquired infections. Extended-spectrum ß-lactamase (ESBL) and AmpC ß-lactamase (AmpC) enzymes cause most cephalosporin resistance in E. coli by hydrolysis of the antimicrobial and continue to jeopardize patient outcome. The purpose of this thesis was to determine the prevalence of ESBL-producing Enterobacteriaceae and to molecularly characterize ESBL and AmpC producers found to be associated with the increasing cephalosporin resistance among E. coli within Canadian hospitals from 2005 to 2009. Isolates were collected as part of the Canadian Intensive Care Unit and Canadian Ward surveillance studies. ESBL and AmpC producers were molecularly characterized for resistance genes, virulence factors and phylogenetic groups. All strains were typed using PFGE and ESBL-producing E. coli were further typed by MLST. Plasmids bearing the ESBL and AmpC genes were characterized by BglII RFLP analysis and a multiplex PCR for replicon typing. ESBL-producing E. coli and K. pneumoniae and AmpC-producing E. coli were found to be firmly established in Canadian hospitals; whereas, ESBL-producing K. oxytoca and P. mirabilis have yet to emerge. Increasing resistance to several unrelated antimicrobials leading to multi-drug resistance among these pathogens is concerning. The successful dissemination of ESBL-producing E. coli in Canada occurs through a diversity of different mechanisms and does not correspond to a single ESBL determinant, or a single clone, or a single plasmid but rather through the combination of clonal spread of virulent strains and the acquisition of diverse ESBL-bearing plasmids. However, the predominance of CTX-M-15-producing E. coli in this study was mainly due to the virulent ST131 clone and the diverse IncFII plasmids bearing the blaCTX-M-15 gene. Whereas, horizontal transfer of genetically similar IncI1, IncA/C and IncK/B plasmids bearing blaCMY-2 and the clonal spread of virulent strains, including ST131 with ampC promoter/attenuator mutations, appears to be playing a role in the spread of AmpC-producing E. coli isolates in Canadian hospitals. The increasing prevalence of these multi-drug resistant pathogens in Canadian hospitals demonstrates the need for increased surveillance and understanding of these emerging pathogens. The continued surveillance will help guide proper infection control procedures and identify optimal treatment of these clinically important pathogens in Canadian hospitals.

Thesis (M.Phil.)--University of Hong Kong, 2005. / Title proper from title frame. Also available in printed format.