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DNA adenine methyltransferase (Dam) plays an important role in different bacterial functions. It has been shown that Dam is required for regulation of bacterial replication initiation and is required for proofreading newly synthesized DNA through methylation directed mismatch repair. Dam is also involved in the regulation of different genes and is required for virulence in several different bacterial genera though its degree of importance depends on the specific bacteria being studied. During this work, a Dam-negative strain (JSM1) was constructed in Klebsiella pneumoniae strain 43816 to ascertain its importance for K. pneumoniae viability and virulence. To test JSM1 for expression of fimbrial virulence factors, agglutinations were used to detect the presence of type three and type one fimbriae, respectively. No differences between 43816 and JSM1 were discernable. Similarly, JSM1 production of capsular material appeared to be unaltered. K. pneumoniae JSM1 virulence in a murine model was examined following intranasal or intraperitoneal inoculation, and it was determined that JSM1 is partially attenuated. Quantitative analysis of 43816 and JSM1 biofilm growth revealed only slight decreases in JSM1 biofilm mass and thickness, but live/dead staining of developed biofilms showed decreased JSM1 biofilm viability over time compared to 43816 biofilms. JSM1 was also examined for alterations in the frequency of spontaneous antibiotic resistance mutations and tested for increased susceptibility to various DNA damaging agents, and statistically significant differences were found for some of the spontaneous antibiotic resistance mutation frequencies tested. Fimbriae in K. pneumoniae are important virulence factors which facilitate respiratory and urinary tract infections in vivo. They also contribute to formation of biofilms which are believed to cause chronic infections and increased antibiotic resistance. Searches for homologous regions within the Klebsiella chromosome using the chaperone and usher components of E. coli type 1 fimbriae revealed five putative fimbrial gene clusters on the Klebsiella chromosome which had not been characterized. Mutations created within select gene clusters did not yield detectable deficiencies in biofilm formation or murine respiratory virulence. However, based on the multiplicity of fimbrial expression observed in Salmonella enterica serovar Typhimurium, combinational mutations may be required prior to detection of a discernable phenotype.

Potassium cyanide (KCN) is an inhibitor that reduces the activity of terminal oxidases in electron transport system of Klebsiella oxytoca. Previous research verified that K. oxytoca could induce cyanide-resistant respiration pathway when cells were grown in KCN condition. To address the role of cyanide-resistant pathway in regulating the respiration of bacterium in KCN incubation, 8-hydroxyquinoline (8-HQ), an inhibitor of cyanide-resistant pathway, was added to the bacterial suspension pretreated with KCN. This experiment was devised into 4 groups as below: (1). TSB (without KCN or 8-HQ), (2). TSB + 1 mM KCN, (3). TSB + 100 £gM 8-HQ, and (4). TSB + 1 mM KCN+ 100 £gM 8-HQ. Our results show 100 £gM 8-HQ exerted it slight toxicity to bacterial growth. However, the bacterial growth was severely impaired when the cells treated with KCN and 8-HQ concurrently as evidenced by the lower oxygen uptake rate of cells in comparison with the control group (without addition of 8-HQ). Furthermore, K. oxytoca grown in growth medium containing 100 £gM 8-HQ produced more significant H2O2. Thus we suggested that cyanide-resistant respiration of K. oxytoca could protect the cells from H2O2 damage. Since cytochrome d has been implicated in having an important role in KCN degradation in the K. oxytoca, we constructed cyd- mutant to explore the possible role in KCN degradation. In this study the sequence of the genes encoding this terminal oxidase (cydAB) of K. oxytoca mutant were deduced. Results showed that cytochrome d oxidase of K. oxytoca is not a cyanide-insensitive oxidase, but playing an important role in KCN degradation.

The cyanide-degradation bacteria Klebsiella oxytoca SYSU-110 was isolated from the waste water of a metal-plating plant in southern Taiwan. K. oxytoca can utilize many nitrile compounds [including acetonitrile (100 mM), benzonitrile (1 mM), butyronitrile (100 mM), glutaronitrile (50 mM), methacrylnitrile (100 mM), phenylacetonitrile (1 mM), propionitrile (25 mM), succinonitrile (25 mM) and valeronitrile (50 mM)] as its sole nitrogen source. In this study, we found out that K. oxytoca was capable of degrading acetonitrile and propionitrile. Frome GC analysis, we recognized amide was an intermediate compound, while the carboxylic acid and ammonia were the final end-products. Therefore, we presume that K. oxytoca biodegraded nitrile compounds by two enzymes, the nitrile hydratase and amidase. We also analyzed the total cell proteins by 2-D polyacrylamide gel electrophoresis after the cells were cultured in medium containing 25mM succinonitrile. There were 23 proteins could be induced or overexpressed by nitrile and we had identified 11 by Mascot Peptide mass Fingerprint and Blast. Six proteins that can protect the cells from oxidative damage are: superoxide dismutase, glutathione s-transferase, dyp-type peroxidase, metal binding protein PsaA (that can transport metal ions into the cells), LraI, and FepA (used to transport inorganic ions into the cells). Three enzymes glutamine synthetase, methylenetetrahydrofolate reductase,¡@and dihydroxyacid dehydratase were used to synthesize amino acids. One protein was identified as ribosomal protein L9. The last identified protein is nucleoside triphosphates kinase which can convert nucleoside diphosphates to nucleoside triphosphates non-specifically. From the activity analysis, superoxide dismutase and glutathione S-transferase activities were escalated when the cells were cultured in 25mM succinonitrile, and the concentration of ROS has rise. These results suggested that succinonitrile could cause oxidative damage to the cells and induce some anti-oxidative damage proteins to protect them.

OBJETIVO: Determinar los factores asociados a producción de betalactamasas de espectro extendido por enterobacterias en pacientes hospitalizados del Hospital Nacional Daniel Alcides Carrión durante Septiembre 2008-Diciembre 2009. MATERIALES Y MÉTODOS: Diseño analítico, observacional, controlado, de casos y control. La población estuvo formada por todo paciente hospitalizado que tuvo registro de cultivo de Escherichia coli, Klebsiella pneumoniae y Klebsiella oxytoca durante el período septiembre 2008 - diciembre 2009. Se estudiaron 92 pacientes (40 casos y 52 controles); se definió como caso a todo paciente con registro de un cultivo de enterobacteria positivo a betalactamasas de espectro extendido y como control a todo paciente con registro de un cultivo de enterobacteria no positivo a betalactamasa de espectro extendido. Se calculó la fuerza de asociación del uso previo de antibiótico, presencia de comorbilidad grave subyacente, y exposición a método invasivo con riesgo de producción de betalactamasas de espectro extendido por enterobacterias y por E. coli. Se mostró la sensibilidad y resistencia antibiótica de acuerdo a los resultados del antibiograma. Los resultados se analizaron y graficaron mediante el programa estadístico EPI INFO versión 3.5.1 y hoja de cálculo de Microsoft Excel. RESULTADOS: Se encontró que quienes tuvieron uso previo de antibiótico tuvieron 3,0 veces más riesgo de producción de BLEE comparado con quienes no tuvieron dicha exposición; y quienes usaron ceftriaxona tuvieron 3,4 veces más riesgo de producción de BLEE. La exposición a catéter endovenoso tuvo 3,1 mayor riesgo de producción de BLEE. El uso de sonda nasogástrica tuvo 4,7 más riesgo de producción de BLEE. La afección de tejido blando presentó 5,3 veces más riesgo de producción de BLEE. El uso de sonda urinaria no se halló asociada estadísticamente con producción BLEE por enterobacterias ni por E. coli.

Increasing carbapenem resistance among clinical isolates of E. coli and K. pneumoniae has become a serious public health problem over the last decade. Molecular epidemiology studies have shown that there is a global dissemination of epidemic clones of carbapenem-resistant E. coli and K. pneumoniae. Besides, successful epidemic plasmids were reported to disseminate carbapenemase genes in Enterobacteriaceae. The wide spread of carbapenem-resistant E. coli and K. pneumoniae limits treatment options of the infection, poses severe challenges to clinical professionals and threatens our health. Recently, carbapenem-resistant E. coli and K. pneumoniae are increasingly reported in Hong Kong. In 2012, our group has documented the emergence of carbapenem-resistant clinical isolates in Hong Kong. The findings of the previous study showed that 26.1% of the Enterobacteriaceae isolates were confirmed to produce carbapenemase. Notably, a novel IncX3 plasmid was found to be involved in the dissemination of blaNDM-1 gene. However, the previous findings fail to explicate the carbapenem resistance mechanisms of the remaining non-carbapenemase producing isolates. Further investigation is needed to elucidate the situation. Firstly, we investigated the carbapenem resistance mechanism of carbapenem-resistant E. coli and K. pneumoniae isolates recovered from the Hong Kong West Cluster hospitals from 2010 to 2012. PCRs were used to detect carbapenemase genes (blaNDM, blaKPC, blaIMP, blaVIM and blaOXA-48), blaCTX-M ESBL genes and blaAmpC genes. SDS-PAGE was used to detect porin loss. Among the 92 isolates in this study, only nine (9.8 %) isolates were detected with carbapenemase genes. The blaCTX-M and/or blaAmpC β-lactamase genes plus porin loss were detected in 47 non-carbapenemase-producing isolates (16 E. coli and 31 K. pneumoniae). The resistance determinant profiles of these 16 E. coli included: blaCTX-M + porin loss (n= 10), blaCIT + porin loss (n = 1), blaCTX-M + blaCIT/DHA + porin loss (n = 5). The resistance determinant profiles of the 31 K. pneumoniae included: blaCTX-M + porin loss (n= 4), blaDHA + porin loss (n = 7), blaCTX-M + blaCIT/DHA + porin loss (n = 20). The results showed that apart from acquired carbapenemases, the production of AmpC β-lactamase and/or ESBLs plus porin loss played a main role in the carbapenem resistance mechanism of the carbapenem-resistant E. coli and K. pneumoniae isolates. Secondly, we accessed the clonal relatedness of the isolates. Multi-locus sequence typing results showed that 55 (77.5%) K. pneumoniae isolates fall into the clonal complex 37. Our results suggest that the CC37 K. pneumoniae are associated with the acquisition of DHA-1 β-lactamase, CTXM-1-group β-lactamase and porin alterations which could confer a high-level of resistance to carbapenems resulting in their predominance in this study. Finally, we characterized the plasmids that carry carbapenemase gene by S1-PFGE, Southern blot, plasmid replicon typing and whole plasmid sequencing. A novel IncX3 plasmid was found to carry blaKPC gene. Together with the previously reported blaNDM-1 carrying IncX3 plasmids, it shows that IncX3 plasmids might be new epidemic plasmids involved in the dissemination of carbapenemase genes. These novel IncX3 plasmids are worrisome. Nationwide surveillance and more epidemiological study of IncX3 plasmids are needed. (Word / published_or_final_version / Microbiology / Master / Master of Philosophy

Staff shortages and lack of space at Prince Mshiyeni Hospital in Umlazi, south of Durban, was blamed for an outbreak of Klebsiella that has claimed the lives of five babies. Contaminated intravenous equipment and poor infection control measures were found to be the source of an outbreak of Klebsiella Pneumoniae, which killed twenty-one babies in another KwaZulu-Natal hospital. "Several flaws were identified" with infection control methods, according to the report that was released and compiled by medical microbiologist Professor Willem Sturm of the Nelson R Mandela School of Medicine in Durban. Initial investigations at the Mahatma Gandhi Memorial Hospital north of Durban, found Klebsiella Pneumoniae on the hands of 10% of staff. Interviews revealed that the nursery was usually overcrowded, under-equipped and under-staffed, which worked against adherence to infection control. Early in the investigation at this hospital, a link was found to the babies' intravenous treatment and after other possibilities were ruled out, medication information for seventeen of the babies showed that they had received regular intravenous injections. The spread was attributed to multiple-use of units of the medication to save costs, inadequate hand washing practices and inappropriate hand wash facilities. Recommendations included sealing off the nursery with strict hygiene controls and abandoning the practice of multiple uses of units of intravenous preparations. "Such preparations should be used only once. Multiple-use for one patient should also not be done" Furthermore, long sleeves on gowns, white coats and uniforms, or personal wear should be forbidden, and rings and watches should not be worn on hands and wrists as these interfere with hand washing. Such recommendations, though pertinent, do not disguise the seriousness of this situation in our hospitals. / A case study submitted in partial fulfillment of the requirements for the degree of Masters in Public Administration.

Die Mehrzahl der jährlich 400.000 bis 600.000 Krankenhausinfektionen in Deutschland wird von Erregern der sog. ESCAPE-Gruppe (Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Acinetobacter baumannii, Pseudomonas aeruginosa und verschiedene Enterobacteriaceae, u.a. Klebsiella pneumoniae) verursacht. Besondere Sorge bereitet dabei die Ausbreitung von K. pneumoniae-Stämmen mit enzymvermittelter Resistenz gegenüber Carbapenem-Antibiotika (K. pneumoniae-Carbapenemase, KPC) und die Zunahme von C. difficile-Infektionen (CDI) durch hypervirulente Epidemiestämme (z.B. Ribotyp 027). Die spezifischen Erfahrungen eines prolongierten Ausbruchsgeschehens durch einen KPC-bildenden K. pneumoniae-Stamm (KPC-KP) am Leipziger Universitätsklinikum machen deutlich, dass bei diesem Erregertyp ein hohes Transmissionspotential bei enormer Tenazität (Umweltresistenz) zu berücksichtigen ist, ein Versagen von Standardhygienemaßnahmen in Betracht zu ziehen ist, und Infektionsketten oftmals unklar bleiben. Die Anwendung von Antibiotika ist bei KPC-KP-Infektionen auf einzelne Substanzen (Colistin, Tigecyclin, Gentamicin) beschränkt und vor allem bei immunsupprimierten Patienten (z.B. Lebertransplantierte) mit einem relevanten Risiko des Therapieversagens behaftet. Die Therapie von CDI wird gerade bei Immunsupprimierten durch eine steigende Zahl an Rezidiven erschwert, die teilweise antibiotisch (Vancomycin, Fidaxomicin) nicht beherrschbar sind, so dass alternative Therapieverfahren wie die fäkale Bakterientherapie („Stuhltransplantation“) zur Anwendung kommen. CDI-Rezidive, aber auch eine dauerhafte intestinale Besiedelung mit multiresistenten Enterobakterien wie KPC-KP, scheinen neben wirtsspezifischen Faktoren der Immunantwort durch eine Dysregulation der physiologischen intestinalen Standortflora mit Störung der Kolonisationsresistenz bedingt zu sein. Der Versuch einer Eradikationsbehandlung von Patienten mit persistierender intestinaler Besiedelung durch KPC-KP mittels oraler Applikation der nicht resorbierbaren Antibiotika Colistin und Gentamicin ist mit einem relevanten Risiko der Entstehung von Sekundärresistenzen behaftet. Die Zulassung neuer, besser wirksamer Antibiotika ist für die nächsten Jahre nicht in Sicht, so dass der Infektionsprävention überragende Bedeutung zukommt. Die Erfahrungen der KPC-Ausbruchsbewältigung am Leipziger Universitätsklinikum zeigen, dass nahezu lückenlose Compliance bei der Händedesinfektion, rigoros praktizierte und kontrollierte Barriere- und Isolationsmaßnahmen, Optimierung des Gebrauchs von Breitspektrum-Antibiotika (sog. „Antibiotic Stewardship“) und systematisches mikrobiologisches Erregerscreening dabei unabdingbar sind. Nachhaltige Verbesserungen hinsichtlich der globalen Ausbreitung von multiresistenten Krankenhausbakterien werden sich nur durch grundlegende Umgestaltungen in Umwelt, Landwirtschaft, Tierzucht und Gesundheitswesen mit sparsamer und möglichst gezielter Anwendung von Antibiotika erzielen lassen. Um Risikopopulationen hospitalisierter Patienten vor potentiell lebensbedrohlichen Erregertransmissionen effektiv schützen zu können, sind erweiterte Surveillance und konsequent umgesetzte krankenhaushygienische Maßnahmen erforderlich.

Syftet med denna magisteruppsats är att gå vidare med resultat från en kandidatuppsats (Westling, 2013) gällande opastöriserade franska mögel- och kittostar genom att undersöka vilka Enterobacteriaceae-arter som ett urval av de analyserade ostarna innehöll. API 20E används som identifieringssystem. Tre Enterobacteriaceae-arter gav acceptabel till utmärkt identifiering av 40 analyserade isolat från de fyra ostarna, nämligen Hafnia alvei, Escherichia coli och Klebsiella pneumoniae. Inga skillnader mellan de identifierade arterna vad gäller inverkan på smak- och doftupplevelser hos opastöriserade franska mögel- och kittostar gick att urskilja med tillgänglig sensorisk data från kandidatuppsatsen (Westling, 2013). Utifrån denna magisteruppsats räcker det inte med att dofta på ostarna för att säkerställa hygienisk kvalitet, ytterligare undersökningar behövs för att kunna identifiera vilka Enterobacteriaceae-arter de innehåller. Däremot skulle en förstudie i form av en sensorisk bedömning av opastöriserade mögel- och kittostar kunna påvisa om ett högt antal Enterobacteriaceae föreligger, vilka vid konsumtion kan vara sjukdomsframkallande.

Syftet med denna magisteruppsats är att gå vidare med resultat från en kandidatuppsats (Westling, 2013) gällande opastöriserade franska mögel- och kittostar genom att undersöka vilka Enterobacteriaceae-arter som ett urval av de analyserade ostarna innehöll. API 20E används som identifieringssystem. Tre Enterobacteriaceae-arter gav acceptabel till utmärkt identifiering av 40 analyserade isolat från de fyra ostarna, nämligen Hafnia alvei, Escherichia coli och Klebsiella pneumoniae. Inga skillnader mellan de identifierade arterna vad gäller inverkan på smak- och doftupplevelser hos opastöriserade franska mögel- och kittostar gick att urskilja med tillgänglig sensorisk data från kandidatuppsatsen (Westling, 2013). Utifrån denna magisteruppsats räcker det inte med att dofta på ostarna för att säkerställa hygienisk kvalitet, ytterligare undersökningar behövs för att kunna identifiera vilka Enterobacteriaceae-arter de innehåller. Däremot skulle en förstudie i form av en sensorisk bedömning av opastöriserade mögel- och kittostar kunna påvisa om ett högt antal Enterobacteriaceae föreligger, vilka vid konsumtion kan vara sjukdomsframkallande.