Orientador: James Venturini / Resumo: Devido ao crescente isolamento de espécimes de Klebsiella pneumoniae resistentes a praticamente todas as classes de drogas antimicrobianas, a busca por novas drogas que sejam alternativa terapêutica para o tratamento das infecções por eles causadas se torna relevante. Nesse contexto, a complexação de íons metálicos a drogas antimicrobianas é uma das abordagens empregadas, uma vez que é possível gerar novas drogas com atividade superior as drogas já existentes. No presente estudo, foi realizada a síntese de metalofármaco por reação de coordenação entre sulfato de polimixina B e cobre (II). O produto desta reação foi caracterizado e sua atividade antimicrobiana frente a espécimes de K. pneumoniae resistentes aos carbapenêmicos e à polimixina B foi avaliada. Os resultados demonstraram que as concentrações inibitórias mínimas (MIC) do complexo sintetizado foram menores em relação aos MICs de polimixina B para 44,44% dos espécimes avaliados; para 33,33% dos espécimes os MIC’s foram equivalentes, e para 22,23% dos espécimes os MIC’s do complexo foram superiores aos MIC’s da polimixina B. Esses resultados são promissores, uma vez que houve um incremento na atividade bacteriana da polimixina complexada ao metal para quase metade dos espécimes avaliados, mostrando que a síntese de novas drogas antimicrobianas através da complexação de íons metálicos é uma técnica que deve ser mais explorada. Além disso, nossos resultados devem conduzir a novos estudos que visem a melhor compreensão da... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Due to the increasing isolation of Klebsiella pneumoniae specimens resistant to virtually all classes of antimicrobial drugs, the research for new drugs that are alternative therapeutics for the treatment of infections caused by them becomes relevant. In this context, the complexation of metal ions to antimicrobial drugs is one of the approaches used, since it is possible to generate new drugs with higher activity than existing drugs. In the present study, metallodrugs synthesis was performed by a coordination reaction between polymyxin B sulfate and copper (II). The product of this reaction was characterized and its antimicrobial activity against specimens of K. pneumoniae resistant to carbapenems and polymyxin B was evaluated. The results showed that the minimum inhibitory concentrations (MIC) of the synthesized complex were lower than the polymyxin B MICs for 44.44% of the evaluated specimens; for 33.33% of the specimens the MICs were equivalent, and for 22.23% of the specimens the MICs of the complex were superior to the MICs of polymyxin B. These results are encouraging, since there was an increase in the bacterial activity of metal complexed polymyxin for almost half of the evaluated specimens, showing that the synthesis of new antimicrobial drugs through the complexation of metallic ions is a technique that should be further explored. In addition, our results should lead to further studies aiming to a better understanding of the structure, mechanisms of action, toxicit... (Complete abstract click electronic access below) / Mestre

As part of a health survey of New Zealand sea lions (Phocarctos hookeri) on Enderby Island, Auckland Islands (50°30’S, 166°17’E), neonatal mortality was continuously monitored at the Sandy Bay Beach rookery, from 1998/1999 to 2004/2005. The primary causes of death were categorised as trauma (35%), bacterial (24%) and hookworm (13%) infections, starvation (13%) and stillbirth (4%). During the 2001/2002 and 2002/2003 breeding seasons, bacterial epidemics caused by Klebsiella pneumoniae increased mortality by three times the mean in non-epidemic years. Uncinaria spp. from New Zealand sea lion (NZSL) pups was described for the first time using morphometric criteria. It differed from the two species already described in pinnipeds, Uncinaria lucasi and Uncinaria hamiltoni, suggesting the existence of a different morphotype in NZSLs. A study on the epidemiology of hookworm infection showed that all pups up to at least three months of age harboured adult hookworms in their intestines and transmammary transmission was identified as the route of infection of NZSL pups. Uncinariosis as a primary cause of mortality was generally associated with anaemia, haemorrhagic enteritis and frank blood in the lumen. The relationship between hookworm burden and clinical disease could not be clearly established. The 2001/2002 and 2002/2003 bacterial epidemics at Sandy Bay Beach rookery were caused by a clonal strain of Klebsiella pneumoniae as verified by pulse-field gel electrophoresis and antimicrobial testing. Suppurative arthritis was the most common post-mortem diagnosis during the two epidemic seasons. Internal lesions were consistent with septicaemia, which explained the wide range of organs from which the pathogen was grown in pure culture. A serological test investigating the exposure of NZSLs to Klebsiella spp. showed that the large majority of pups up to two months of age did not have any anti-Klebsiella antibodies, even after the epidemics, but that almost all the adults were seropositive. In addition, passive immunoglobulin (Ig) transfer from lactating females to neonates was examined by measuring IgG levels in pups and was very low compared to terrestrial mammals although similar to other pinniped neonates.

Neonatal septicaemia and nosocomial infection are major causes of morbidity in neonatal intensive care units (NICU) in both developed and developing countries. This study documents infective episodes at two resource disparate NICUs; the Grantley Stable Neonatal Unit (GSNU), Royal Brisbane and Women’s Hospital (RBWH), Australia 1997-2006 and Danang NICU, Vietnam. The specific aims are: 1. To compare the incidence of neonatal septicaemia at RBWH and Danang NICU. 2. To compare of the epidemiological characteristics of nosocomial infections in the two NICUs. 3. To study risk factors associated with nosocomial infection in the two NICUs (including staff numbers, infant numbers and nursing workload). 4. To review published guidelines on healthcare physical environments and staffing levels and to survey the GSNU & Danang NICU in relation to these. 5. To develop a prospective surveillance system to monitor infection episodes in Danang NICU 6. To recommend strategies for the control of neonatal sepsis in Danang NICU. The GSNU at the RBWH, Australia is a 71 bed neonatal care facility with an established infection surveillance system in a well resource environment. Danang NICU, Vietnam provides care to a high risk neonatal population with no established infection surveillance system in a developing country with more limited resources. This study found the GSNU had a low rate of neonatal septicaemia, during the ten year period from 1997 to 2006 with 253 babies (2.1%) diagnosed with septicaemia. In Danang NICU, in the year 2007 alone, there were 52 cases (2.9%) of septicaemia documented but the incidence of neonatal infection is likely to have underestimated due to (i) the failure to collect blood culture before commencing antibiotic treatment. (ii) Difficulties associated with data retrieval from maternal and neonatal records and (iii) lack of a systematic surveillance system with prospectively collected data. The organisms causing early onset and late onset septicaemia were substantially different in the two NICUs. Group B streptococcus (GBS) and Escherichia coli were the major organisms causing early onset sepsis (EOS) at the GSNU, accounting for 37.8% and 29.7% respectively, whilst coagulase-negative staphylococcus (CONS) was the commonest organism (25.7%) for late onset sepsis (LOS). In Danang NICU, Klebsiella spp was the major pathogen and was responsible for 75% of neonatal septicaemia in both early and late onset sepsis. The isolation of Klebsiella spp in a high proportion of infants at less than 48 hours may suggest nosocomial or maternal route of acquisition. The rate of GBS infections in Danang Hospital, Vietnam, is hard to estimate and interpret due to limited microbiologic data. The anti-serum used to classify the Streptococcal types is not readily available in Danang Hospital. In some cases, organisms that are isolated are suspected to be GBS however, this is not confirmed microbiologically. The study identifies a high prevalence of neonatal septicaemia in Danang NICU. It identifies a close relationship between rates of infection and poor nursing care practices and limited resources. The standard care system used at the GSNU as well as the international literature was studied in relation to infection control practices. This was then used to develop the following recommendations that specifically target a reduction in infection rates in Danang NICU: 1. Implement an infection surveillance system 2. Report regularly from the database and embed discussion of the data into unit management policy 3. Revise neonatal and pathology practice in relation to blood cultures 4. Use shorter duration of antibiotics course based on culture results 5. Modify care practices that expose infants to cross infection 6. Identify specific staff with particular responsibilities in maintenance of standards

Cyanide is a known toxic chemical, the production of plastics, electroplating, tanning, chemical syntheses, etc. At short-term exposure, cyanide causes rapid breathing, tremors, and long-term exposure to cyanide cause weight loss, thyroid effects, nerve damage and death. Although chemical and physical processes can be employed to degrade cyanide and its related compounds, they are often expensive and complex to operate. A proven alternative to these processes is biological treatment, which typically relies upon the acclimation and enhancement of indigenous microorganisms. Biological degradation of cyanide has often been offered as a potentially inexpensive and environmentally friendly alternative to conventional processes. The aims of first part of study were to evaluate the biodegradability of tetracyanonickelate (TCN) by Klebsiella oxytoca under anaerobic conditions. Results reveal that TCN can be biotransformed to methane by resting cells of K. oxytoca. Results also show that TCN biodegradation was inhibited by the addition of nitrate, nitrite, or ammonia at higher concentrations (5 and 10 mM). Moreover, it was found that the optimum pH for TCN conversion by K. oxytoca was about 7.1. Results from the fermenter experiment show that TCN can be completely degraded within 14 days. K. oxytoca is capable of using TCN as the nitrogen source under anaerobic conditions. TCN could be biotransformed to non-toxic end product (methane) by resting cells of K. oxytoca. Those studies provide us insight into the characteristics of TCN conversion by K. oxytoca under anaerobic conditions. In second part of this study, the technology of immobilized cells can be applied in biological treatment to enhance the efficiency and effectiveness of biodegradation. In this study, potassium cyanide (KCN) was used as the target compound and both alginate (AL) and cellulose triacetate (CT) gels were applied for the preparation of immobilized cells. The free suspension systems reveal that the cell viability was highly affected by initial KCN concentration and pH. Results show that immobilized cell systems could tolerate a higher level of KCN concentration and wider ranges of pH. In the batch experiments, the maximum KCN removal rates using alginate and cellulose triacetate immobilized beads were 0.108 and 0.101 mM h-1 at pH 7, respectively. Results also indicate that immobilized system can support a higher biomass concentration. Complete KCN degradation was observed after the operation of four consecutive degradation experiments with the same batch of immobilized cells. This suggests that the activity of immobilized cells can be maintained and KCN can be used as the nitrogen source throughout KCN degradation experiments. The maximum KCN removal rates using AL and CT immobilized beads in continuous-column system were 0.224 and 0.192 mM h-1 with initial KCN concentration of 3 mM, respectively. In third part of this study, a microbial process for the degradation of propionitrile by K. oxytoca was studied. The free and immobilized cells of K. oxytoca were then examined for their capabilities on degrading propionitrile under various conditions. The efficiency and produced metabolic intermediates and end-products of propionitrile degradation were monitored in bath and continuous bioreactor experiments. Results reveal that up to 100 mM and 150 mM of propionitrile could be removed completely by the free and immobilized cell systems, respectively. Furthermore, AL and CT immobilized cell systems show higher removal efficiencies in wider ranges of temperature (20-40¢XC) and pH (6-8) compared with the free cell system. Results also indicate that immobilized cell system could support a higher cell density to enhance the removal efficiency of propionitrile. Immobilized cells were reused in five consecutive degradation experiments, and up to 99% of propionitrile degradation was observed in each batch test. This suggests that the activity of immobilized cells can be maintained and reused throughout different propionitrile degradation processes. A two-step pathway was observed for the biodegradation of propionitrile. Propionamide was first produced followed by propionic acid and ammonia. Results suggest that nitrile hydratase and amidase were involved in the degradation pathways of K. oxytoca. In the continuous bioreactor, both immobilized cells were capable of removing 150 mM of propionitriles completely within 16 h, and the maximum propionitriles removal rates using AL and CT immobilized beads were 5.04 and 4.98 mM h-1, respectively. Comparing the removal rates obtained from batch experiments with immobilized cells (AL and CT were 1.57 and 2.18 mM h-1 at 150 mM of propionitrile, respectively), the continuous-flow bioreactor show higher potential for practical application. These findings would be helpful in designing a practical system inoculated with K. oxytoca for the treatment of cyanide-containing wastewater.

The global increase in antibiotic resistance levels in bacteria is a growing concern to our society and highlights the need for alternative strategies to combat bacterial infections. Bacterial viruses (phages) are the natural predators of bacteria and are as diverse as their hosts, but our understanding of them is limited. The current levels of knowledge regarding the role that phage play in the control of bacterial populations are poor, despite the use of phage therapy as a clinical therapy in Eastern Europe. The aim of this doctoral thesis is to increase knowledge of the diversity and characteristics of bacterial viruses and to assess their potential as therapeutic agents towards multi-resistant bacteria. Paper I is the product of de novo sequencing of newly isolated phages that infect and kill multi-resistant Klebsiella pneumoniae. Based on similarities in gene arrangement, lysis cassette type and conserved RNA polymerase, the creation of a new phage genus within Autographivirinae is proposed. Paper II describes the genomic and proteomic analysis of a phage of the rare C3 morphotype, a Podoviridae phage with an elongated head that uses multi-resistant Escherichia coli as its host. Paper III describes the study of a pre-made phage cocktail against 125 clinical K. pneumoniae isolates. The phage cocktail inhibited the growth of 99 (79 %) of the bacterial isolates tested. This study also demonstrates the need for common methodologies in the scientific community to determine how to assess phages that infect multiple serotypes to avoid false positive results. Paper IV studies the effects of phage predation on bacterial virulence: phages were first allowed to prey on a clinical K. pneumoniae isolate, followed by the isolation of phage-resistant bacteria. The phage resistant bacteria were then assessed for their growth rate, biofilm production in vitro. The virulence of the phage resistant bacteria was then assessed in Galleria mellonella. In the single phage treatments, two out of four phages showed an increased virulence in the in G. mellonella, which was also linked to an increased growth rate of the phage resistant bacteria. In multi-phage treatments however, three out of five phage cocktails decreased the bacterial virulence in G. mellonella compared to an untreated control. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.</p>

The prevalence of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBLs) and carbapenemases is increasing worldwide. Therapeutic options for infections with these bacteria are limited not only by the production of ESBLs and carbapenemases, which confer resistance to cephalosporins and carbapenems, but also by frequent co-resistance to other antibiotics. The overall aim of this thesis was to obtain a better understanding of multidrug-resistant E. coli and K. pneumoniae in relation to epidemiology, selection and susceptibility to antibiotic therapy. In a prospective study ESBL-producing E. coli was found to spread easily through international travel. Twenty-four of 100 Swedes travelling outside Northern Europe acquired ESBL-producing E. coli in the intestinal flora. The risk was highest for travelers visiting India and those suffering from gastroenteritis during travel. To minimize selection of ESBL-producing K. pneumoniae during a hospital outbreak with these bacteria, an educational antibiotic intervention was performed at Uppsala University Hospital in 2006. The primary aim of the intervention was to reduce the consumption of parenteral cephalosporins. An immediate and radical reduction of cephalosporins was demonstrated with interrupted time series analysis. The outbreak declined during 2007 and no increased resistance to replacement antibiotics was detected. The impact of ESBL production on the antibacterial activity of ertapenem was studied in time-kill experiments. It was shown that porin-deficient subpopulations with reduced susceptibility to ertapenem frequently emerged in ESBL-producing E. coli during exposure to ertapenem at concentrations simulating human pharmacokinetics. Further, the antibacterial effects of antibiotic combinations against four strains of K. pneumoniae producing carbapenemases of the metallo-beta-lactamase type were studied in time-kill experiments. Double and triple combinations of aztreonam, fosfomycin, meropenem, rifampin and colistin at clinically relevant static concentrations were effective despite that the bacteria were frequently resistant to the individual drugs. These results indicate that there is a largely unexplored potential of antibiotic combination therapy for multidrug-resistant K. pneumoniae.

The recent development of culture-independent methods has revolutionized the study of complex microbial communities such as those present in activated sludge treatment systems. DNA probes that hybridize to genes coding for key enzymes that catalyze microbial processes have been widely used. Can such probes be used to quantify target genes and thus quantify the potential of a microbial community to carry out a reaction of interest? / Optimal conditions for DNA extraction, probe validation, hybridization, and activity measurements were determined for the pulp and paper treatment system environment under study. Using gene probes for key denitrification genes (nirS, nirK), the correlation between denitrifiers and denitrification activity in an enrichment culture and activated sludge samples was tested. The same correlation between nitrogen fixation and nitrogen-fixing bacteria in primary clarifiers was assessed using a probe for the gene encoding a component of the nitrogenase enzyme (nifH). This work was successful in establishing the correlation between gene numbers and their corresponding enzymatic activity and thus supports the quantitative hybridization approach for the monitoring of microbial communities. (Abstract shortened by UMI.)

Thesis (M.S.)--Oregon State University, 2008. / Printout. Includes bibliographical references (leaves 78-86). Also available on the World Wide Web.

Thesis (doctoral)--Universiteit van Amsterdam, 1991. / Summary in Dutch. Includes bibliographical references (p. 94-102).

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