Les carbapénèmes constituent le traitement de dernier recours des infections associées à des germes multirésistants producteurs de -lactamases à spectre étendu. Les entérobactéries ont cependant développé des mécanismes de résistance à l’encontre de cette classe d’antibiotiques, notamment par la production de carbapénèmases. La carbapénèmase OXA-48 a rapidement disséminé en Europe et dans le pays du pourtour méditerranéen depuis 2010. Les objectifs de ce travail ont englobé, dans une première partie, la caractérisation de trois variants de la carbapénèmase OXA-48, possédant chacun des particularités phénotypiques ou génétiques. Nous nous sommes ensuite intéressés à l’épidémiologie de la carbapénèmase OXA-48 afin de comprendre ses mécanismes de dissémination puis à la variabilité de son environnement génétique. Le dernier objectif était de déterminer les facteurs génétiques à l’origine de la dissémination de la carbapénèmase OXA-48. Nous avons ainsi montré que les carbapénèmases de type OXA-48 bénéficient de tous les éléments moléculaires pour assurer leur succès : mobilisation par un transposon actif pour certains variants, transfert efficace de plasmides et dissémination clonale de souches. / Carbapenems are often the last therapeutic option for treating infections involving multiresistant ESBL-producing bacteria. Nevertheless, enterobacteria have developped resistance mechanisms toward this class of antibiotics, including carbapenemases production. Carbapenemase OXA-48 has rapidly spread throughout Europe and various countries of Mediterranean area since 2010. The aim of this work was first to characterize three variants of the carbapenemase OXA-48, each possessing phenotypic or genetic characteristics. We focused on the epidemiology of carbapenemase OXA-48 in order to understand the mechanisms of its dissemination and on the variability of its genetic environment. The last objective was to determine the genetic factors responsible for the spread of carbapenemase OXA-48. We have shown that the OXA-48-type carbapenemases possess all the molecular elements to ensure its success: mobilization by an active transposon for some variants, efficient transfer of plasmids and clonal spread of strains.

The emergence of β-lactamase-mediated antibiotic resistance is one of the biggest threats in modern times. Combined with the discovery void of new forms of antibiotics, this sets the course toward a future where the efficacy of present-day health care will be jeopardized. To hinder the spread of β-lactamase-mediated antibiotic resistance, the development of the drug class β-lactamase inhibitors has been prioritized. The foremost candidate for development of this drug class, that has wide-spectrum inhibition of β-lactamases, is the clinically available avibactam of the diazabicyclooctane-scaffold (i.e., DBO-scaffold). However, the clinical applications of this inhibitor have been limited against one of the more rapidly spreading β-lactamases; OXA-48. In order to bolster the drug development of β-lactamase inhibitors of the DBO-scaffold, with good inhibitory activity toward OXA-48, DBO-ligands with different structure elements were analyzed for stability of the Michaelis Complex in the OXA-48 binding site using molecular dynamic simulations. The results indicate that elongation of the chain to the anionic group of the ligand combined with the addition of a methyl group to the DBO-ring was stabilizing for the productive position between the backbone hydrogens of Y211 and S70. The binding affinity was also estimated using the Linear Interaction Energy method, and an offset parameter of γ ≈ -19 kcal/mol was found and could represent the entropic differences of a flexible ligand-protein system. The results of this study may also indicate that the ligand stability of the Michaelis Complex is of minor consequence to the inhibition mechanism as a whole compared to the reaction rate.