Drug resistance is unfortunately becoming a prevalent issue in the course of patient treatment, ranging from chemotherapy resistance to antimicrobial resistance. The Centers for Disease Control and Prevention (CDC) estimated in 2016 that at least 23,000 people die every year in the United States from an infection with an antibiotic-resistant organism (Munita, et al, 2016). Carl Friedlander was the first scientist to describe Klebsiella pneumoniae in 1882 as an encapsulated bacillus after isolating the bacterium from the lungs of patients who had died from pneumonia (Ashurst and Dawson, 2022). Klebsiella pneumoniae is the type species for the Klebsiella genus and is the bacterium of interest for this project. It is one of the very few Gram-negative bacilli that can cause primary pneumonia, commonly affecting patients with compromised immune systems, alcohol use disorder, or diabetes mellitus (Ristuccia and Burke, 1984). However, microbes are able to produce a wide range of microbial defense systems including classic antibiotics, metabolic byproducts, and lytic agents. Bacteriocins are some of the most common defense mechanisms produced, which are different from antibiotics in that they have a narrow killing spectrum and are toxic only to bacteria that is closely related to the strain that is producing it. It has been estimated that 99% of all bacteria possibly make a minimum of one bacteriocin (Riley and Wertz, 2002). Because of the rapidly growing number of infections that are caused by antibiotic-resistant bacteria along with the harm that broad-spectrum antibiotics can cause to the human microbiome, these bacteriocins are being studied as potential alternatives to tradition antibiotics. In this study, we will assess and characterize a Klebsiella bacteriocin that may work synergistically with antibiotics so that antibiotic dosage might be reduced. In this study, we have isolated the plasmids from a possible Klebsiella bacteriocin and transformed them into E. coli to characterize the plasmid. This potential bacteriocin demonstrates efficacy towards Citrobacter, Enterobacter, and Klebsiella species and could offer an alternative treatment option for the highly drug resistant Enterobacteriaceae family.

β-lactam antibiotics have been the most widely used drug of choice to combat infectious disease caused by bacteria. Unfortunately, their effectiveness is drastically threatened by bacterial β-lactamases. β-lactamases is responsible for the resistance to most antibiotic drugs. For decades, β-lactam β-lactamases inhibitors have been used to reduce bacterial resistance; however, in this study 1,2,4-oxadiazolidinone derivatives as a non-β-lactam β-lactamases inhibitor against TEM-1 and P99 β-lactamases. The significance of oxadiazolidinone is the prominent five-membered ring scaffold in its structure, which is configurationally stable and present in other biologically active compounds such as linezolid and avibactam. Oxadiazolidinones were synthesized by treating nitrones with isocyanates. The synthesized compounds were characterized using 1H and 13C NMR, GC-MS, and FTIR. Afterward, they were tested using Nitrocefin as substrate to determine their effectiveness against TEM-1 and P99 serine β-lactamase. Compound 2a-2c, and 3 showed inhibition ranging from 12-38%.

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<p> Pasteurella multocida is a respiratory pathogen that is frequently isolated from cattle suffering  from bovine respiratory disease (BRD), the leading cause of mortality and morbidity on modern day cattle farms. Treatment involves the use of antimicrobials which have been shown to fail for  about 30% of BRD cases, leading to the suspicion that etiologic agents, such as P. multocida, may  be resistant. Phenotypic resistance can be confirmed via laboratory antibiotic susceptibility testing  (AST) but this requires several days to complete. Genotypic resistance could be quickly assessed  via nucleic acid assays based on the presence of known antibiotic resistance genes (ARGs). In  human medicine, resistant genes associated with common antibiotics (i.e., ampicillin and penicillin)  in common pathogens (i.e., Salmonella) are very accurate in predicting phenotypic resistance;  however, ARGs associated with antibiotics used to treat BRD, such as enrofloxacin and  tulathromycin, have shown low genotype-phenotype concordance. Hence, this study aims to  improve P. multocida genotype-phenotype concordance by applying a machine learning (ML)  algorithm to identify novel genomic sequences (biomarkers) that have greater accuracy in  predicting resistance to antibiotics commonly used to treat BRD compared to known ARGs.  Cultures of P. multocida were isolated from cattle with clinical signs of BRD. Antibiotic  susceptibility testing was performed and recorded for each isolate. Genomes were sequenced and  assembled, followed by annotating and identifying ARGs using the comprehensive antibiotic  resistance database (CARD). Assembled genomes were then split into 31-base long segments (31- mers), and these segments along with phenotypic antibiotic susceptibility were used as input data  for the ML algorithm. Important genomic biomarkers for four out of the six tested antibiotics were  found to have greater accuracy when predicting resistance phenotype compared to known ARGs.  The biomarker for enrofloxacin had the highest accuracy of 100% whereas the accuracy for the  12 tulathromycin biomarker was 81% but was still greater than the accuracy given by ARGs of 63%.  On the other hand, resistance genes for florfenicol and tetracycline showed greater genotype?phenotype concordance, with accuracies of 95% and 91%, respectively. Annotations to important  rulesets determined by ML were associated with clustered regularly interspaced short palindromic  repeats (CRISPR) sequences, ligases that function to recycle murein into the peptidoglycan (PDG) layer, and transferases that control the synthesis and modulation of the lipopolysaccharide (LPS).  External validation revealed that phenotypic resistance could be accurately predicted for  danofloxacin and enrofloxacin using genomic biomarkers determined by ML, and for florfenicol  using the floR gene. This study demonstrated that genomic biomarkers determined by ML can provide an accurate prediction of antibiotic resistance within Pasteurella multocida isolates.  Assays could be developed to target ML-generated biomarkers and known ARGs to predict resistance in sick animals and to limit treatment failures associated with antibiotic resistance in  cattle suffering from BRD. </p>

The rapid spread of antibiotic resistance is a major global health concern, jeopardizing the successful treatment of bacterial infections. Natural environments are potential hotspots for the emergence and spread of antibiotic resistance genes (ARGs). Among these potential hotspots, aquatic ecosystems are of particular concern, as they receive wastewater containing antibiotic-resistant bacteria and ARGs originating from both human and animal sources. Several key questions remain to be addressed. What is the fate of ARGs in receiving water bodies? What are implications of environmental ARGs for human health? How does wastewater discharge impacts aquatic microbial communities with regard to the overall ecosystem well-being? The objective of this work was to investigate the impact of wastewater, seasonal variations, and the riverine compartment on the prevalence of selected ARGs and the composition of natural microbial communities in a near-pristine river, and to specifically assess the effect of antibiotics on riverine microbial communities. Quantitative real-time PCR was used to monitor the abundance of three indicator ARGs (sul1 and sul2, conferring resistance against sulfonamide antibiotics, and intI1, a marker for anthropogenic pollution) upstream and downstream from a wastewater treatment plant (WWTP). Furthermore, the impact of WWTP effluent on the riverine microbial community was examined through 16S rRNA amplicon sequencing. Wastewater was the main source of all three target genes and significantly altered the microbial community in the river. The surface water compartment served as a dissemination route for ARGs, with increased prevalence even 13 km downstream of the WWTP, particularly during the summer season when the proportion of wastewater in the river was high. Notably, riverbed biofilms served as a local reservoir for ARGs only at the discharge point, with little abundance of target genes further downstream. The sulfonamide antibiotic sulfamethoxazole (SMX) was persistent in both near-pristine and wastewater-impacted river water when introduced at a concentration of 12.5 µg/L, but had neglectable effects on the microbial community diversity. Interestingly, concentrations as high as 100 µg/L SMX induced a short-term increase in microbial activity in both surface water and biofilm compartment, as revealed by bulk and nanoscale measurements. Altogether, this work underscores the fundamental role of wastewater treatment in combating the environmental dissemination of antibiotic resistance.:Summary 1 Zusammenfassung 5 1 Introduction 9 1.1 Rundown of the global antibiotic resistance crisis 9 1.1.1 History of antibiotics 9 1.1.2 Emergence of antibiotic resistance 9 1.1.3 Integrons as vehicles for antibiotic resistance 10 1.1.4 Risks related to environmental antibiotic resistance 12 1.2 Fate of antibiotic resistance genes in the aquatic environment 14 1.2.1 Genetic indicators for antibiotic resistance 14 1.2.2 River surface water compartment as dissemination route for antibiotic resistance 15 1.2.3 River biofilm compartment as reservoir for antibiotic resistance 17 1.3 Impact of antibiotics on aquatic microbial communities 18 1.4 Fate and effect of sulfamethoxazole in surface waters 20 2 Scope of the thesis 22 3 Main findings and scientific implications 24 3.1 Fate of antibiotic resistance genes after wastewater discharge into a near-pristine river 24 3.1.1 Wastewater is the primary source for aquatic antibiotic resistance 24 3.1.2 Drought increases the antibiotic resistance prevalence in surface waters 25 3.1.3 Riverbed biofilms serve as local reservoirs for antibiotic resistance genes 26 3.2 Anthropogenic pollution is the key driver for microbial community alteration 26 3.3 Sulfamethoxazole increases the microbial activity of aquatic microbial communities 27 4 Conclusions and future perspective 29 5 References 31 6 Publications 43 6.1 Publication 1 43 6.2 Publication 2 56 6.3 Publication 3 69   7 Appendix 94 7.1 Declaration of independent work 94 7.2 List of publications and conference contributions 95 7.2.1 Publications 95 7.2.2 Conference contributions 96 7.3 Contribution of Co-authors 97 7.4 Curriculum vitae 101 7.5 Acknowledgements 104 7.6 Supplementary Material 105 7.6.1 Supplementary Material for Publication 1 105 7.6.2 Supplementary Material for Publication 2 118 7.6.3 Supplementary Material for Publication 3 125

Staphylococcus aureus is a pathogen responsible for a wide variety of life-threatening diseases such as bacteremia, endocarditis, and pneumoniae. S. aureus has been a major concern in recent years due to the rampant spread of antibiotic resistance. The ability of S. aureus to form biofilms aids in the spread of antibiotic resistance as biofilms are a known hotspot for horizontal gene transfer. Biofilms also protect cells from host immune responses and antibiotics, making these infections very difficult to treat. The matrix of S. aureus biofilms can be made of polysaccharides, protein, and DNA. In these studies, we sought to elucidate how biofilm composition correlates with source of isolation in S. aureus strains, the role of biofilm-related genes in biofilm composition, and the potential role of biofilm eDNA in horizontal gene transfer. The composition and strength of biofilms made by a variety of hospital and meat-associated strains of S. aureus was measured using crystal violet (CV) staining and DNase or proteinase K treatment. Biofilm polysaccharide concentration was also measured using the phenol sulfuric-acid assay. We found that biofilms of hospital-associated isolates tend to have more protein and polysaccharides while those of meat isolates contain significantly more DNA. We also investigated the effects that biofilm-related genes have on biofilm formation and composition by analyzing specific transposon mutants of genes suggested by previous studies to play a role in biofilm development. Transposon insertions in agrA, atl, clfA, fnbA, purH, and sarA significantly weakened biofilms as compared to a wild-type control, whereas the acnA insertion mutant produced a significantly stronger biofilm. Biofilms formed from these mutant strains were treated (or mock-treated) with DNase or proteinase K and tested with phenol and sulfuric acid to determine what role these genes play in biofilm composition. We found that the atl and sarA insertion mutants produced biofilms with greater polysaccharide concentrations than the wild-type. Since many of the isolates produced biofilms composed of DNA, we investigated the potential role of this extracellular DNA in horizontal gene transfer. Strains with complementary antibiotic resistances and susceptibilities were paired together and co-cultured together in a biofilm and plated onto double antibiotic plates to select for possible gene transfer. Putative gene transfer was found to be largely biofilm dependent and enhanced with the addition of subinhibitory concentrations of antibiotics added to the biofilm. Potential transformation was also shown to naturally occur in many strains when naked DNA was added to a single strain biofilm and was also aided with the addition of subinhibitory antibiotics.

Blood stream infections are challenging infections to rapidly diagnose. The current clinical diagnostic methods for blood stream infections require culturing the blood sample prior to identifying the bacteria and any resistance the bacteria may contain. Removing the culturing step from the bacterial identification process of a blood stream infection provides a significant reduction in the processing time. However, eliminating the culturing step shifts the difficulty from processing time to concentration, since clinical concentration levels can be as low as 10 CFU/mL in blood. This dissertation developed and evaluated many aspects of the process required to identify bacteria from a blood stream infection without culturing the bacteria. Two new methods of separating the bacteria from the blood cells were developed: inducing clotting using a centrifugal-sedimentation on a hollow disk, and filtering whole blood. Inducing clotting achieved 69\% bacterial recovery from 7 mLs of whole blood in 117 s. Filtering whole blood achieved 100\% bacterial removal from 5 mLs of whole blood in $\approx 90$ s, but the bacteria were difficult to remove from the filter. Bacterial removal from the filter after blood filtration was also investigated. At a very low bacterial concentration of 200 CFU/mL, a blood lysis solution of 3\% Tween 80 followed by a 3\% Pluronic F108 backflush solution achieved 60\% removal of the bacteria from the filter. In addition to developing two new methods, a previously developed technique using centrifugal-sedimentation on a hollow disk underwent a stability analysis in order to decrease the occurrence of mixing. This analysis yielded the development of the analytical solution to the Navier-Stokes equations for a two-fluid flow with a moving wall boundary and a free surface. The analysis also experimentally identified a stability boundary that was found to be in good agreement with the Kelvin-Helmholtz instability model. After exploring the methods to recover bacteria from blood, experiments were performed to identify a bacterial lysing solution that could lyse \textit{E. coli}, \textit{E. cloacae} and \textit{K. pneumoniae} bacteria. The best bacterial lysing solution consisted of incubating the bacteria with 1 mg/mL lysozyme for 10 min followed by the addition of 6 M GHCl and 1\% SDS. This solution obtained a 46\% DNA recovery. The DNA were then fragmented by ultrasound to reduce the segment length for DNA labelling. In addition to lysing and fragmenting the DNA, a microfluidic device was prototyped and tested for incorporating the lysing, capturing, releasing, and fragmenting of the DNA all on a single device. Whole experiments were performed which extracted the bacteria from the blood, removed and collected the DNA from the bacteria, and fragmented the DNA. The best overall recovery from an experiment performing the whole process was 26.8\%. The 26.8\% recovery was achieved with a 68\% recovery of the bacteria from spinning and a 54.1\% removal of bacteria from off of the filter and a 72.9\% recovery of the DNA from the bacteria.

The study explored the prevalence of biofilm formers and its association with multidrug resistance in Klebsiella Pneumonia, a gram-negative bacterium that has high propensity to form antibiotic resistant strains and forms biofilms. Biofilms are complex microbial community with attributes that vary from planktonic cells. Antibiotic resistance is a property that has shown evidence to be higher in biofilms as compared to planktonic cells. Multi-drug resistance, a higher form of antibiotic resistance, is defined as resistance to at least one agent in three or more antibiotic categories. A single-armed and a two-armed meta-analysis was done to assess prevalence of biofilm formers and to find association between biofilm formation capacity and multi drug resistance. The one-armed meta-analysis revealed 74% (95% CI: 64%-83%) prevalence of biofilm formers among clinical isolates of Klebsiella Pneumonia. The prevalence rate is comparable with that of prevalence rate attained by other bacterium by similar meta-analysis studies. This high prevalence of biofilm formers warrants for a paradigm shift in treatment strategies for treatment of infections. The two-armed meta-analysis showed that there was identical risk of multi drug resistance among the biofilm formers and non-biofilm formers. The result challenges the intrinsic capacity of planktonic cells to resist against antibiotics to achieve multi drug resistance. Further research to update the biofilm formation profiles and to understand the resistance mechanism in commonly occurring bacterial infections in of utmost importance.