<p>The emergence of multidrug resistant bacteria world wide is a serious problem, and very few new drugs are under development. The selection of resistant bacteria is affected by factors such as mutation rate, biological fitness cost and the rate of fitness compensation. This thesis is focused on how mutation rate affects resistance to fluoroquinolones and on exploring a dosing strategy that might slow resistance development. </p><p>In a set of urinary tract <i>Escherichia coli</i> isolates MIC values above the breakpoint for the fluoroquinolones norfloxacin and ciprofloxacin carried at least three resistance-associated mutations. In these isolates the number of resistance mutations correlated with the mutation rate. During step-wise selection for decreased susceptibility to fluoroquinolones, the accumulation of mutations in <i>E. coli</i> was associated with an increasing biological cost both <i>in vitro</i> and <i>in vivo</i>. However, in some lineages an additional selection step for resistance was associated with a partial restoration of fitness. During step-wise selections we found, as expected, that reduced ciprofloxacin susceptibility frequently hitchhiked with a strong mutator phenotype. More surprisingly, we also found that reduced susceptibility was frequently associated with the emergence of rifampicin-resistant populations. We hypothesise that this correlation reflects selection for fitness-compensating mutations in RNA polymerase.</p><p>Mutant prevention concentration (MPC) dosing has been proposed as a strategy to reduce the selection of resistant bacterial populations. Based on limited data it had been thought that MPC might be a simple multiple of MIC, which can easily be determined. However, we showed for a collection of susceptible urinary tract <i>E. coli </i>that MPC could not be predicted from MIC and must be measured directly for relevant populations. Using an <i>in vitro</i> kinetic model we also showed that the pharmacodynamic index that best predicted prevention of resistance development in wild type <i>E. coli</i> was an AUC/MPC of > 22 for ciprofloxacin.</p>

The emergence of multidrug resistant bacteria world wide is a serious problem, and very few new drugs are under development. The selection of resistant bacteria is affected by factors such as mutation rate, biological fitness cost and the rate of fitness compensation. This thesis is focused on how mutation rate affects resistance to fluoroquinolones and on exploring a dosing strategy that might slow resistance development. In a set of urinary tract Escherichia coli isolates MIC values above the breakpoint for the fluoroquinolones norfloxacin and ciprofloxacin carried at least three resistance-associated mutations. In these isolates the number of resistance mutations correlated with the mutation rate. During step-wise selection for decreased susceptibility to fluoroquinolones, the accumulation of mutations in E. coli was associated with an increasing biological cost both in vitro and in vivo. However, in some lineages an additional selection step for resistance was associated with a partial restoration of fitness. During step-wise selections we found, as expected, that reduced ciprofloxacin susceptibility frequently hitchhiked with a strong mutator phenotype. More surprisingly, we also found that reduced susceptibility was frequently associated with the emergence of rifampicin-resistant populations. We hypothesise that this correlation reflects selection for fitness-compensating mutations in RNA polymerase. Mutant prevention concentration (MPC) dosing has been proposed as a strategy to reduce the selection of resistant bacterial populations. Based on limited data it had been thought that MPC might be a simple multiple of MIC, which can easily be determined. However, we showed for a collection of susceptible urinary tract E. coli that MPC could not be predicted from MIC and must be measured directly for relevant populations. Using an in vitro kinetic model we also showed that the pharmacodynamic index that best predicted prevention of resistance development in wild type E. coli was an AUC/MPC of &gt; 22 for ciprofloxacin.

Normally present in water, soil and waste water, Acinetobacter baumannii has become an important nosocomial pathogen, as causal agent of pneumonias, septicemias and urinary tract infections, among other complications in compromised patients from hospital’s intensive care units. One of its last acquired abilities is the resistance to colistin (polymixin E), the last therapeutic option for its infections. In this thesis, descriptive and quantitative differential expression proteomics is used in the study of acquired colistin resistance. As result of this research, 1,097 proteins belonging to the Acinetobacter genus have been identified by combined application of bidimensional gel electrophoresis (2DE), differential gel electrophoresis (DIGE), and peptide labeling with stable isobaric isotopes tags (iTRAQ). Analyses have been performed on the global expressed proteome of a reference, colistin-sensible strain (A. baumannii ATCC 19606) and, for comparative purposes, on a derived strain on which colistin resistance has been induced in vitro. The resistant phenotype shows reduced fitness, with significant differences in expression found in outer membrane proteins, membrane active transporters, diverse metabolic enzymes (fatty acids, citrate, phenylacetate, piruvate and nitrogen), proteins involved in stress response and biofilm formation, as well as in protein synthesis and folding pathways. The work has allowed to assess the strengths and weaknesses of the different techniques currently used in this type of proteomic analysis. / Acinetobacter baumannii, normalmente aislado en suelos y aguas (corrientes o residuales), se ha convertido en importante patógeno nosocomial, siendo agente causal de, entre otras complicaciones, neumonías, septicemias e infecciones del tracto urinario de pacientes comprometidos en unidades hospitalarias de cuidados intensivos. La más reciente de sus capacidades adquiridas es la resistencia a colistina (polimixina E), antibiótico peptídico considerado la última opción terapéutica en contextos clínicos. Esta tesis doctoral emplea la proteómica descriptiva y de expresión diferencial cuantitativa para investigar la resistencia adquirida por A. baumannii a dicho antibiótico. Los resultados han supuesto la identificación de 1.097 proteínas de Acinetobacter mediante el empleo combinado de electroforesis bidimensional convencional (2DE), 2DE diferencial (DIGE) y marcaje peptídico mediante isótopos isobáricos estables (iTRAQ). Los análisis se han realizado en el proteoma expresado por una cepa de referencia sensible a colistina (A. baumannii ATCC 19606), así como en una cepa derivada de ésta en la que se ha inducido, a efectos comparativos, resistencia a colistina in vitro. El fenotipo resistente manifestó reducida adaptabilidad biológica, encontrándose las principales diferencias en la estructura de la membrana externa, en la expresión de transportadores activos de membrana, en diversos enzimas metabólicos (ácidos grasos, citrato, fenilacetato, piruvato, nitrógeno) y de respuesta a condiciones de estrés, así como en la expresión de proteínas participantes en la formación de biopelículas y en el proceso de síntesis y plegamiento de proteínas. Además, el trabajo ha permitido evaluar los puntos fuertes y débiles de las técnicas empleadas actualmente en este tipo de análisis proteómicos.

Sabe-se que a grande maioria dos fitopatógenos depende quase que exclusivamente de vetores para disseminarem-se para novos hospedeiros, porém pouco foi estudado no que se refere aos efeitos dos micro-organismos sobre seus insetos vetores. Sendo Bemisia tabaci uma praga de elevada importância e vetora de inúmeros vírus para plantas cultiváveis, é de extrema relevância estudar os efeitos provocados pelos vírus sobre seu desempenho biológico. Assim, esta pesquisa objetivou: a) avaliar os efeitos direto e indireto dos begomovírus Tomato severe rugose vírus (ToSRV) e Tomato yellow leaf curl virus (TYLCV) sobre parâmetros biológicos de B. tabaci biótipo B e Q respectivamente, dos quais: duração e viabilidade do período ninfal; razão sexual; fecundidade; fertilidade e longevidade. Os resultados encontrados variam de positivos, neutros a negativos, dependendo do parâmetro, efeito e espécie do vírus estudado. Sendo assim, observou-se que há efeito direto de ambos os vírus na duração do período ninfal, sendo menor em insetos virulíferos que em sadios. Ademais, há um incremento no número médio de ovos depositados por insetos virulíferos com ToSRV (225,2 ovos/fêmea) quando comparado com insetos sadios (180,1 ovos/fêmea). Já TYLCV afetou diretamente a longevidade de machos os quais tiveram a duração da fase adulta incrementada quando virulíferos (30 dias) e 24 dias quando sadios. Há um efeito indireto negativo de ToSRV sobre a viabilidade ninfal de seu vetor, sendo de 52% quando estes são mantidos em plantas infectadas e 86% em plantas sadias de tomate. A razão sexual também foi afetada por este vírus, favorecendo as fêmeas, sendo de 2:1 a proporção entre fêmeas e machos em plantas infectadas. Ademais, a longevidade de machos foi reduzida drasticamente quando em plantas infectadas com ToSRV. Também foi detectado um efeito indireto positivo do TYLCV sobre a fecundidade de fêmeas de B. tabaci biótipo Q, as quais depositaram em média maior quantidade de ovos em plantas infectadas que em plantas sadias de tomate, sendo 52,8 e 33,2 ovos respectivamente. Tais resultados permitem concluir que, nas condições em que os ensaios foram realizados, ToSRV afeta diretamente de forma positiva seu vetor, enquanto possui efeitos indiretos principalmente negativos sobre parâmetros biológicos de B. tabaci biótipo B. Igualmente TYLCV possui efeitos diretos positivos sobre o biótipo Q da espécie de mosca-branca. Já indiretamente este vírus, diferentemente de ToSRV, afeta positivamente a biologia de seu vetor B. tabaci biótipo Q, favorecendo a fecundidade dos indivíduos que se desenvolveram em plantas infectadas de tomate. / It is known that the vast majority of pathogens relies almost exclusively vector for spreading to new hosts, but little has been studied regarding the effects of micro-organisms on its insect vectors. Bemisia tabaci is a pest of high importance vector of numerous virus to cultivated plants, it is extremely important to study the effects caused by viruses on its biological performance. Thus, this study aimed to: a) evaluate the direct and indirect effects of the begomovirus Tomato severe rugose virus (ToSRV) and Tomato yellow leaf curl virus (TYLCV) on biological parameters of B. tabaci biotype B and Q respectively, of which duration and viability of nymphal development; sex ratio; fecundity; fertility and longevity. The results range from positive, neutral to negative, depending on the parameter, effect and species of the virus studied. Thus, it was observed that there is a direct effect of the both virus in the duration of nymphal development, being less than viruliferous insects in healthy individuals. Moreover, there is an increase in the average number of eggs laid by viruliferous insects with ToSRV (225,2 eggs / female) when compared with healthy insects (180,1 eggs / female). Already TYLCV directly affected the longevity of males which lasted adulthood increased when viruliferous (30 days and 24 when healthy). There is an indirect negative effect on the viability of ToSRV nymphal of its vector, and 52% when they are kept in infected plants and 86% in healthy tomato plants. The sex ratio was also affected by this virus, favoring females, with a ratio of 2:1 between females and males in infected plants. Furthermore, the longevity of males was reduced dramatically when plants infected with ToSRV. We also detected a positive indirect effect of TYLCV on fertility of female B. tabaci biotype Q, which placed greater average number of eggs in infected plants than on healthy plants of tomato, 52,8 and 33,2 eggs respectively. These results indicate that, under conditions in which the tests were performed, ToSRV directly affects positively its vector, while indirect effects has mostly negative on biological parameters of B. tabaci biotype B. TYLCV also has positive direct effects on the Q biotype of the whitefly species. Already indirectly this virus, unlike ToSRV, positively affects the biology of its vector B. tabaci biotype Q, favoring the fecundity of individuals that developed in infected tomato plants.

Sabe-se que a grande maioria dos fitopatógenos depende quase que exclusivamente de vetores para disseminarem-se para novos hospedeiros, porém pouco foi estudado no que se refere aos efeitos dos micro-organismos sobre seus insetos vetores. Sendo Bemisia tabaci uma praga de elevada importância e vetora de inúmeros vírus para plantas cultiváveis, é de extrema relevância estudar os efeitos provocados pelos vírus sobre seu desempenho biológico. Assim, esta pesquisa objetivou: a) avaliar os efeitos direto e indireto dos begomovírus Tomato severe rugose vírus (ToSRV) e Tomato yellow leaf curl virus (TYLCV) sobre parâmetros biológicos de B. tabaci biótipo B e Q respectivamente, dos quais: duração e viabilidade do período ninfal; razão sexual; fecundidade; fertilidade e longevidade. Os resultados encontrados variam de positivos, neutros a negativos, dependendo do parâmetro, efeito e espécie do vírus estudado. Sendo assim, observou-se que há efeito direto de ambos os vírus na duração do período ninfal, sendo menor em insetos virulíferos que em sadios. Ademais, há um incremento no número médio de ovos depositados por insetos virulíferos com ToSRV (225,2 ovos/fêmea) quando comparado com insetos sadios (180,1 ovos/fêmea). Já TYLCV afetou diretamente a longevidade de machos os quais tiveram a duração da fase adulta incrementada quando virulíferos (30 dias) e 24 dias quando sadios. Há um efeito indireto negativo de ToSRV sobre a viabilidade ninfal de seu vetor, sendo de 52% quando estes são mantidos em plantas infectadas e 86% em plantas sadias de tomate. A razão sexual também foi afetada por este vírus, favorecendo as fêmeas, sendo de 2:1 a proporção entre fêmeas e machos em plantas infectadas. Ademais, a longevidade de machos foi reduzida drasticamente quando em plantas infectadas com ToSRV. Também foi detectado um efeito indireto positivo do TYLCV sobre a fecundidade de fêmeas de B. tabaci biótipo Q, as quais depositaram em média maior quantidade de ovos em plantas infectadas que em plantas sadias de tomate, sendo 52,8 e 33,2 ovos respectivamente. Tais resultados permitem concluir que, nas condições em que os ensaios foram realizados, ToSRV afeta diretamente de forma positiva seu vetor, enquanto possui efeitos indiretos principalmente negativos sobre parâmetros biológicos de B. tabaci biótipo B. Igualmente TYLCV possui efeitos diretos positivos sobre o biótipo Q da espécie de mosca-branca. Já indiretamente este vírus, diferentemente de ToSRV, afeta positivamente a biologia de seu vetor B. tabaci biótipo Q, favorecendo a fecundidade dos indivíduos que se desenvolveram em plantas infectadas de tomate. / It is known that the vast majority of pathogens relies almost exclusively vector for spreading to new hosts, but little has been studied regarding the effects of micro-organisms on its insect vectors. Bemisia tabaci is a pest of high importance vector of numerous virus to cultivated plants, it is extremely important to study the effects caused by viruses on its biological performance. Thus, this study aimed to: a) evaluate the direct and indirect effects of the begomovirus Tomato severe rugose virus (ToSRV) and Tomato yellow leaf curl virus (TYLCV) on biological parameters of B. tabaci biotype B and Q respectively, of which duration and viability of nymphal development; sex ratio; fecundity; fertility and longevity. The results range from positive, neutral to negative, depending on the parameter, effect and species of the virus studied. Thus, it was observed that there is a direct effect of the both virus in the duration of nymphal development, being less than viruliferous insects in healthy individuals. Moreover, there is an increase in the average number of eggs laid by viruliferous insects with ToSRV (225,2 eggs / female) when compared with healthy insects (180,1 eggs / female). Already TYLCV directly affected the longevity of males which lasted adulthood increased when viruliferous (30 days and 24 when healthy). There is an indirect negative effect on the viability of ToSRV nymphal of its vector, and 52% when they are kept in infected plants and 86% in healthy tomato plants. The sex ratio was also affected by this virus, favoring females, with a ratio of 2:1 between females and males in infected plants. Furthermore, the longevity of males was reduced dramatically when plants infected with ToSRV. We also detected a positive indirect effect of TYLCV on fertility of female B. tabaci biotype Q, which placed greater average number of eggs in infected plants than on healthy plants of tomato, 52,8 and 33,2 eggs respectively. These results indicate that, under conditions in which the tests were performed, ToSRV directly affects positively its vector, while indirect effects has mostly negative on biological parameters of B. tabaci biotype B. TYLCV also has positive direct effects on the Q biotype of the whitefly species. Already indirectly this virus, unlike ToSRV, positively affects the biology of its vector B. tabaci biotype Q, favoring the fecundity of individuals that developed in infected tomato plants.

<p>Antibiotic treatment causes an ecological disturbance on the human microflora. Four commensal bacteria: E. coli, enterococci, a-streptococci and coagulase-negative staphylococci, from patients with extensive, high antibiotic usage were investigated with regard to resistance pattern and mutation frequency. Among 193 investigated strains it was found that high antibiotic usage selected for resistant bacteria and enriched for bacteria with a small but significantly increased mutation frequency. </p><p>The relative biological fitness cost of resistance in <i>Staphylococcus epidermidis</i> was assessed in a human in vivo model where the indigenous flora was present. In vitro data of the bacterial growth rate correlated well to in vivo fitness assayed in the competition experiments on skin. </p><p>An in vitro kinetic model was shown to be a useful tool to establish the pharmacokinetic and pharmacodynamic (PK/PD) indices for efficacy of antibiotics. It was confirmed that the time, when the concentration exceeds the minimal inhibitory concentration (MIC), correlates with efficacy for b-lactam antibiotics. To achieve maximal killing for penicillin-resistant pneumococci, with an MIC of 2 mg/L, the peak concentration was also of importance. </p><p>Suboptimal dosing regimen facilitates selection of resistance. Penicillin-resistant pneumococci were easily selected in a mixed population with penicillin-sensitive, -intermediate and -resistant pneumococci in an in vitro kinetic model. The selection of the resistant strain was prevented when the benzylpenicillin concentration exceeded the MIC for approximately 50% of 24 h.</p>

Antibiotic treatment causes an ecological disturbance on the human microflora. Four commensal bacteria: E. coli, enterococci, a-streptococci and coagulase-negative staphylococci, from patients with extensive, high antibiotic usage were investigated with regard to resistance pattern and mutation frequency. Among 193 investigated strains it was found that high antibiotic usage selected for resistant bacteria and enriched for bacteria with a small but significantly increased mutation frequency. The relative biological fitness cost of resistance in Staphylococcus epidermidis was assessed in a human in vivo model where the indigenous flora was present. In vitro data of the bacterial growth rate correlated well to in vivo fitness assayed in the competition experiments on skin. An in vitro kinetic model was shown to be a useful tool to establish the pharmacokinetic and pharmacodynamic (PK/PD) indices for efficacy of antibiotics. It was confirmed that the time, when the concentration exceeds the minimal inhibitory concentration (MIC), correlates with efficacy for b-lactam antibiotics. To achieve maximal killing for penicillin-resistant pneumococci, with an MIC of 2 mg/L, the peak concentration was also of importance. Suboptimal dosing regimen facilitates selection of resistance. Penicillin-resistant pneumococci were easily selected in a mixed population with penicillin-sensitive, -intermediate and -resistant pneumococci in an in vitro kinetic model. The selection of the resistant strain was prevented when the benzylpenicillin concentration exceeded the MIC for approximately 50% of 24 h.