Contamination of groundwater that is suitable for drinking is of growing concern as the water supply of South Africa is becomingincreasingly limited. This is especially the case in the North West province, with its semi – arid climate and variable rainfall patterns. The aim of the study was to evaluate the microbiological and physico – chemical qualities of groundwater obtained from selected DWA (Department of Water Affairs) monitoring boreholes in the Mooi River and Harts River catchment areas. Physico -chemical parameters included temperature, pH, electrical conductivity (EC), salinity, total dissolved solids (TDS), sulphate and nitrate concentrations. Physical parameters were measured using a calibrated submerge-able multimeter and chemical parameters using specialised kits and a spectrophotometer. Microbiological parameters included heterotrophic plate counts and total and faecal coliform enumeration. Membrane filtration and culture based methods were followed for enumeration of bacteria. During the identification procedures multiplex PCR for E. coli identification and 16S rRNA gene sequencing for identification of heterotrophic plate count bacteria and amoeba resistant bacteria were used. For antibiotic resistance, the Kirby- Bauer (1996) disk diffusion method was used. During the warm and wet season high electrical conductivity and salinity were observed in the Trimpark (65.3 mS/m; 325 ppm), School (125.1 mS/m; 644 ppm), Warrenton (166.9 mS/m; 867 ppm) and Ganspan (83.3 mS/m; 421 ppm) boreholes. Warrenton borehole had a high sulphate level (450 mg/l) as well. High chemical oxygen demand was observed in the Blaauwbank (62 mg/l) and Warrenton (98.5 mg/l) boreholes. In the dry and cold season similar observations were made for the various boreholes. Electrical conductivity and salinity levels remained high for the Trimpark (70.1 mS/m; 427.5 ppm), School (127 mS/m; 645 ppm), Warrenton (173.3 mS/m; 896.5 ppm) and Ganspan (88.1 mS/m; 444.5 ppm) boreholes. Nitrate levels for the Trimpark (14.1 mg/l) and School (137 mg/l), as well as sulphate levels for the Warrenton (325 mg/l) borehole were also high. Total coliforms, faecal streptococci and HPC bacteria were enumerated from water samples from all boreholes, except Blaauwbank where no faecal streptococci were enumerated. Faecal coliforms were enumerated from 5 of the possible 7 boreholes during a warm and wet season (Trimpark – 42 cfu/100ml; School – 2 cfu/100ml; Cemetery – 175 cfu/100ml; Warrenton – 3.84 x 10³ cfu/100ml; Ganspan – 1.9 x 10³ cfu/100ml). Indicator bacteria (FC, TC, HPC) exceeded target water quality ranges (TWQR) for drinking water in each case. During the cold and dry sampling season, faecal coliforms were enumerated mainly from the Trimpark (11 cfu/100ml) borehole. Total coliforms, faecal streptococci and HPC bacteria were enumerated from all the boreholes, except for Blaauwbank that contained no faecal streptococci or total coliforms. Enumerated indicator bacteria levels again exceeded TWQR for domestic use. Total coliform counts for the Pad dam borehole, however, complied with TWQR for domestic use. Identified E. coli were resistant to Erythromycin, Cephalothin and Amoxicillin and susceptible to Ciprofloxacin. Escherichia coli isolated from the Mooi River catchment shared the same antibiotic resistance phenotype. The most abundant HPC bacterial genus identified was Pseudomonas spp. (7 isolates). Opportunistic pathogens isolated included Pseudomonas aeruginosa, Acinetobacter, Aeromonas, Alcaligenes, Flavobacterium, Bacillus cereus and Mycobacterium spp. Varying degrees of antibiotic resistance were observed. Generally, the same pattern between the same genera were observed. All HPC isolates were resistant to Cephalothin and Amoxicillin and a lower degree Erythromycin and Streptomycin. The most abundant amoeba resistant bacteria was identified as Pseudomonas spp. Other isolates included Alcaligenes faecalis and Ochrobactrum sp. and Achromobacter sp. All of these are opportunistic pathogens, except for Achromobacter. Resistance to more antibiotics (Streptomycin, Chloramphenicol, Cephalothin, and Amoxicillin) was observed in ARBs compared to HPC (Cephalothin, Amoxicillin) from bulk water from the same borehole. The water of all the aquifers sampled is of very poor physico - chemical or microbiological quality or both. Water may be used for irrigation or livestock watering only in the case where these boreholes comply with TWQR for said purposes. Results obtained indicate that the groundwater is faecally contaminated. Amongst the bacteria, opportunistic pathogens displaying various degrees of antibiotic resistance were frequently isolated. These results indicate health risks if untreated groundwater is consumed. Therefore groundwater needs to be treated before distribution especially if the water is for human consumption. / Thesis (MSc (Environmental Sciences))--North-West University, Potchefstroom Campus, 2013.

Formål: Formålet med dette studie var at udforske og beskrive hvordan sundhedspersonale opfatter og håndterer risiko for smittespredning, både hos isolationspatienter og patienter, som ikke er isoleret. Desuden var formålet at afdække, om en eventuel særlig opfattelseaf smitterisiko hos isolationspatienter påvirker sundhedspersonalets opfattelse af betydningen af de generelle infektionshygiejniske forholdsregler. Metode:Studiet er et kvalitativt studie, hvor det empiriske materiale blev indsamlet i otte fokusgruppeinterviews, hvor deltagerne var sundhedspersonale.Som analysemetode blev anvendtsystematisk tekstkondensering. Den konceptuelle ramme omfatter antibiotikaresistens i et folkesundhedsperspektiv, en beskrivelseaf rammerne for infektionsforebyggelse i Danmark samt en teoretisk ramme bestående af risikobegrebet, sundhedspædagogik og et perspektiv på samarbejde. Resultater:Studiet viste, at sundhedspersonalet vurderede smitterisikoforskelligt, både ved isolationspatienterog ved ikke-isolerede patienter. De opfattede, at deres hygiejne ved isolations-patienter var bedre, fordi de tænkte sig bedre om og arbejdede mere struktureret. Samarbejde var en vigtig motivationsfaktor for arbejdet på isolationsstuer. Hos ikke-isolerede patienter opfattede sundhedspersonalet det som risikosituationer, når patienter delte stue og toilet. De oplevede selv brist i egen smitteafbrydelse og at patienters og pårørendes adfærd udgjorde en smitterisiko. Sundheds-personalet læste og forholdt sig forskelligt til infektionshygiejniske forholdsregler, hvilket kunne give anledning til forvirring og misforståelser. Det blev betragtet som en udfordring at skulle forholde sig til,at viden og praksis ændrede sig over tid og at ny udvikling skabte nye infektionshygiejniske udfordringer. Konklusion:Sundhedspersonale opfatter smitterisiko forskelligt, både i forhold til smitterisiko ved isolerede og ikke-isolerede patienter og arbejdet med at pleje og behandle isolationspatienter kunne være forbundet med stor angst for at sprede smitte. Forskelle i videns-og erfaringsgrundlag samt individuelle risikovurderinger ses som medvirkende årsager til,at sundhedspersonale opfatter og håndterer smitterisiko forskelligt / Aim:This study aimed to explore and describe how healthcare workers (HCWs) perceive and handle the risk of infection in isolated and non-isolated patients.The study also sought to determinewhetherany specialperceived risk of infection in isolated patients affects how HCWsperceive the importance of general infection control measures. Method:This was a qualitative study. Data was collected from eight HCW focus groups and analyzed using a systematic textcondensation method. The conceptual framework includes antibiotic resistance in a public health perspective, adescription of the context of infection controland prevention in Denmark, a theoretical framework consisting of the concept of risk, health education and a perspective on cooperation. Results: The study showed that HCWsassessed risk differently inisolated and in non-isolated patients. HCWs perceivedthat they prevented infection more effectively in isolated patients, due to greater attentiveness and a more structured approach.Cooperation was an important motivation in isolation rooms. HCWsperceived special risk situations among non-isolated patients who shared rooms and toilets. The HCWs experienced flaws in their own infection control measures andin the behaviour of patients and their relatives. HCWs read and interpreted infection control protocols differently leading to confusion and misunderstandings. It was a challenge keeping up the changing of knowledge and practice over time as well as new development caused new infection control challenges. Conclusion:HCWsperceive the risk of infection differently in isolated and non-isolated patients. Further, HCWs often associatethe work of caring for and treating isolated patients with fear of spreading infection. Differences in knowledge base, experience level and individualrisk assessments contribute to the explanation of differing perceptions and approaches to handle infection control / <p>ISBN 978-91-86739-49-2</p>

As one of the mechanisms of antibiotic resistance, bacteria use several families of membrane-embedded α-helical transporters to remove cytotoxic molecules from the cell. The small multidrug resistance protein family (SMR) is one such group of drug transporters that because of their relative small size [ca. 110 residues with four transmembrane (TM) helices] must form at the minimum dimers to efflux drugs. We have used the SMR homologue Hsmr from Halobacterium salinarum to investigate the oligomerization properties of the protein family at TM helix 4. We produced point mutations along the length of the TM4 helix in the full length Hsmr protein and assayed their dimerization and functional properties via SDS-PAGE and bacterial cell growth assays. We found that Hsmr forms functionally dependent dimers via an evolutionarily conserved 90GLxLIxxGV98 small residue heptad repeat. Upon investigation of the large hydrophobic residues in this motif by substituting each large residue to Ile, Leu, Met, Phe, and Val, we determined that Hsmr efflux function relies on an optimal level of dimerization. While some substitutions led to either decreased or increased dimer and substrate-binding strength, several Ile94 and Val98 mutants were equal to wild type dimerization levels but were nonfunctional, leading to the hypothesis of a mechanistic role at TM4 in addition to the locus of dimerization. The functionally sensitive TM4 dimer represents a potential target for SMR inhibition using a synthetic TM4 peptide mimetic. Using exponential decay measurements from a real-time cellular efflux assay, we observed the efflux decay constant was decreased by up to ~60% after treatment with the TM4 peptide inhibitor compared to control peptide treatments. Our results suggest that this approach could conceivably be used to design hydrophobic peptides for disruption of key TM-TM interactions of membrane proteins, and represent a valuable route to the discovery of new therapeutics.

Despite the large arsenal of antibiotics available on the market, treatment of bacterial infections becomes more challenging in view of the fact that microbes develop resistance against existing drugs. There is an obvious need for novel drugs acting on both old and new targets in bacteria. In this thesis we have employed a whole cell bacterial assay for screening and identification of type III secretion system (T3SS) inhibitors in Yersinia pseudotuberculosis. The T3SS is a common virulence mechanism utilized by several clinically relevant Gram-negative bacteria including Salmonella, Shigella, Pseudomonas aeruginosa, Chlamydiae and Escherichia coli. Several components in the T3SS have proved to be conserved and hence data generated with Y. pseudotuberculosis as model might also be valid for other bacterial species. We have screened a 9,400 commercial compound library for T3S inhibitors in Y. pseudotuberculosis using a yopE reporter gene assay. The initial ~ 30 hits were followed up in a growth inhibition assay resulting in 26 interesting compounds that were examined in more detail. Three of the most interesting compounds, salicylanilides, 2-hydroxybenzylidene-hydrazides and 2-arylsulfonamino-benzanilides, were selected for continued investigations. The inhibitor classes show different profiles regarding the effects on T3SS in Yersinia and their use as research tools and identification of the target proteins using a chemical biology approach will increase our understanding of bacterial virulence. The 2-hydroxybenzylidene-hydrazides have been extensively studied in vitro and show potential as selective T3S inhibitors in several Gram-negative pathogens besides Y. pseudotuberculosis. The data obtained suggest that this inhibitor class targets a conserved protein in the secretion apparatus. In cell-based ex vivo infection models T3SS was inhibited to the advantage of the infected eukaryotic cells. The salicylanilides and 2-arylsulfonamino-benzanilides have been further investigated by statistical molecular design (SMD) followed by synthesis and biological evaluation in the T3SS linked reporter gene assay. Multivariate QSAR models were established despite the challenges with data obtained from assays using viable bacteria. Our results indicate that this SMD QSAR strategy is powerful in development of virulence inhibitors targeting the T3SS.

O objetivo deste estudo foi caracterizar bactérias multirresistentes (MDR) isoladas de cavalos saudáveis (fezes) e doentes no Brasil e na França. De março de 2012 a dezembro de 2014, amostras clínicas coletadas de cavalos saudáveis e doentes no Brasil foram selecionadas para pesquisa da presença de bactérias MDR. A investigação sobre as amostras franceses foi restria a isolados de Escherichia coli (EC) recuperados a partir de amostras clínicas coletadas entre 2014 e 2015. Nos cavalos brasileiros, a análise de amostras de fezes de animais saudáveis revelou a presença de clones de EC não relacionados pertencentes aos filogrupos A, D ou B2 que carreavam genes como: blaCTX-M-1, blaCMY-2, qnr- e genes add-tipo (amino-transferases); enquanto que nos cavalos doentes foram encontradas EC, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa e Serratia marcescens carreando genes blaCTX-M-15, blaCTX-M-1, rmtD 16S rRNA metilase, qnr-tipo, aac(6´)-Ib-cr e aad-tipo. Nos cavalos doentes franceses de EC MDR foram positivas para CTX-M-1, seguido de M-2- e M-9. Estes resultados destacam a importância de cavalos como um novo reservatório de bactérias MDR. / The aim of this study was to characterize multidrug-resistant (MDR) bacteria isolated from healthy and infected horses in Brazil and France. From March 2012 to December 2014, clinical samples collected from healthy and infected horses, in Brazil, were screened for the presence of MDR bacteria. Investigation on French isolates was restricted to E. coli strains recovered from clinical samples collected between 2014 and 2015. In Brazilian horses, the analysis of fecal samples from healthy animals revealed the presence of clonally unrelated A, D or B2 phylogroups of E. coli strains carrying blaCTX-M-1, blaCMY-2, qnr- and aminoglycoside adenyl transferase (aad)-type genes, whereas in infected horses, E. coli, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa and Serratia marcescens isolates carrying blaCTX-M-15, blaCTX-M-1, rmtD 16S rRNA methylase, qnr-type, aac(6´)-Ib-cr and aad-type genes. In French infected horses, most MDR E. coli isolates were positive for CTX-M-1-, followed by CTX-M-2- and CTX-M-9-type extended-spectrum beta-lactamases. These results highlight the importance of horses as a new reservoir of MDR bacteria.

This study focuses on the question of the epidemiology of resistance to antibiotics in Acinetobacter baumannii, which is nowadays one of the most problematic bacterial patho- gens associated with failing antimicrobial therapy. Its aim was to define population-genetic properties, epidemiology and the nature of multidrug resistance for a sample of the current population of A. baumannii from Czechia. A total of 55 isolates were collected in eight medi- cal facilities in central Bohemia from October 2016 to May 2018. The isolates were assessed for their identity at the species, clonal and strain levels as well as resistance phenotype and genotype; they were classified into five clonal groups, each of which encompassed isolates that were likely to be epidemiologically related. The 55 isolates studied belonged, nearly exclusively, to global clone ECII, with 53 % of them forming a genetically relatively homoge- neous group characterized by extensive resistance to antibiotics (susceptible only to col- istin), the presence of genes encoding ArmA a OXA-23 (resistance to all aminoglycosides and carbapenems) and spread in all locations. The in-depth epidemiological analysis of isolates from the city of Příbram and its vicinity indicated the regional spread of two strains, one of which belonged to the...

CUNHA, Francisco Afrânio. Detecção de betalactamases de espectro expandindo (ESBL) em cepas de coliformes isolados de hortaliças minimante comercializadas na cidade de Fortaleza -CE. 2007100 f : . Dissertação (mestrado) - Universidade Federal do Ceará, Centro de Ciências Agrárias, Departamento de Tecnologia de Alimentos, Fortaleza-CE, 2007 / Submitted by Nádja Goes (nmoraissoares@gmail.com) on 2016-06-06T13:34:15Z No. of bitstreams: 1 2007_dis_facunha.pdf: 3336053 bytes, checksum: c193599fd7b4044ea639d9c9eaa1b454 (MD5) / Approved for entry into archive by Nádja Goes (nmoraissoares@gmail.com) on 2016-06-06T13:34:28Z (GMT) No. of bitstreams: 1 2007_dis_facunha.pdf: 3336053 bytes, checksum: c193599fd7b4044ea639d9c9eaa1b454 (MD5) / Made available in DSpace on 2016-06-06T13:34:28Z (GMT). No. of bitstreams: 1 2007_dis_facunha.pdf: 3336053 bytes, checksum: c193599fd7b4044ea639d9c9eaa1b454 (MD5) Previous issue date: 2007 / Minimally processed vegetables (MPV) normally consist of fresh raw vegetables, washed, peeled, cut, disinfected, centrifugal dryed packed and kept under refrigeration. Vegetables are potential vehicle of microorganisms that can be associated to the outbreaks of foodborne. Countless are the causes for the presence high microbial load in that product type, among which are: the cultivation techniques, storage, transport and distribution for consumption, the practice of the use of organic fertilizer, the use of polluted water for irrigation, the transport accomplished in open crates and the hygiene conditions in the handling and preparation of meals, mainly when such foods are consumed raw. The objective of this study was to determine the presence of extendedspectrum β-betalactamases (ESBL) in strains of Enterobacteriaceae isolated of MPV marketed in the city of Fortaleza and to verify if the analyzed vegetables assists the Brazilian Food Sanitation Standard, RDC N° 12, 02 of january 2001. 80 samples of MPV were collected marketed in Fortaleza. Were collected vegetables studied: 8 samples beet; 10 lettuce; 8 of cherry-colored tomato; 8 purple cabbage, green cabbage; 10 carrot and green bean; 8 grated carrot; 10 grated carrot, green cabbage and purple cabbage; 10 salads; 8 cilantro, onion and parsley pricked. The analyses were accomplished of april from 2006 to may of 2007. The countings of mesophiles aerobic, varied from 5,60 to 13,35 log UFC / g of MPV. The countings of moulds and yeasts, varied from 5,54 to 9,88 log UFC / g MPV. The counting of total coliforms and fecal coliforms were quite high. The main isolated and identified mold was the Penicillium spp. All of the beet samples, grated carrot, carrot and green bean, grated carrot, purple cabbage and green cabbage, cilantro and parsley pricked met inappropriate for the consumption, because they presented amounts superior of 100 fecal coliforms / g samples. Of the samples of lettuce 50% they presented fecal coliforms counting above legislation. Of the tomatoes cherry analyzed 75% were inside patterns of the Brazilian legislation, for fecal coliforms. Of the samples of purple cabbage, green cabbage 87% were with fecal coliforms counting above. Of the samples of salad 80% were out of the patterns. Salmonellas were not detected in the samples of MPV analyzed. The main isolated Enterobacteriaceae were E. coli, K. pneumoniae and E. aerogenes. All of the strains of K. pneumoniae and E. aerogenes were resistant to the ampicillin. Strains of E. coli, K pneumoniae and E. aerogenes with multidrug resistance were detected. Resistance to ciprofloxacin, ceftazidime and imipenem was not observed. Enterobacteriaceae samples producing of ESBL were not detected. Were not identified strains of E. coli O15:H7 among the strains of E. coli isolated of MPV. The hygienicsanitary conditions of those products can be improved with the application of Good Practices in the whole productive chain. / Hortaliças minimamente processadas (HMP) normalmente consistem de hortaliças frescas, cruas, lavadas, descascadas, cortadas, sanitizadas, centrifugadas, empacotadas e acondicionadas sob refrigeração. Hortaliças são potenciais veículos de microrganismos que podem estar associadas à doenças transmitidas por alimentos. Inúmeras são as causas para a presença de elevada carga microbiana nesse tipo de produto, entre as quais estão: as técnicas de cultivo, armazenamento, transporte e distribuição para consumo, a prática do uso de adubo orgânico, a utilização de água contaminada para rrigação, o transporte realizado em engradados abertos e as condições de higiene no manuseio e preparo de refeições, principalmente quando tais alimentos são consumidos crus. O objetivo desse estudo foi determinar a presença de Enzimas Betalactamases de Espectro Expandido (ESBL) em cepas de Enterobacteriaceae isoladas de HMP comercializadas na cidade de Fortaleza e verificar se as hortaliças analisadas a atendem a RDC N° 12 de 02 de janeiro de 2001, que rege o padrão microbiológico dos alimentos no Brasil. Foram coletadas 80 amostras de HMP comercializadas em Fortaleza. As hortaliças estudadas foram: 8 amostras de acelga; 10 alface; 8 tomate cereja; 8 repolho roxo, repolho verde; 10 cenoura e vagem; 8 cenoura ralada; 10 cenoura ralada, repolho verde e repolho roxo; 10 saladas; 8 coentro, cebola e salsa picados. As análises foram realizadas de abril de 2006 a maio de 2007. As contagens de microrganismos aeróbios mesófilos variaram de 5,60 a 13,35 log UFC/ g de HMP. As contagens de bolores e leveduras variaram de 5,54 a 9,88 log UFC/ g de HMP. A contagem de coliformes totais e coliformes a 45°C foram bastante elevadas. O principal bolor isolado e identificado foi o enicillium spp. Todas as amostras de acelga, cenoura ralada, cenoura e vagem, cenoura ralada, repolho roxo e repolho verde, coentro e salsa picados encontravam-se impróprias para o consumo, pois apresentaram quantidades superiores a 100 coliformesa 45ºC/g de amostra. Das amostras de alface 50% apresentavam contagem decoliformes a 45ºC acima do permitido peça legislação. Dos tomates cereja analisados 75% estavam dentro padrões microbiológicos exigidos pela legislação brasileira, para coliforme a 45ºC. Das amostras de repolho roxo, repolho verde 87% estavam com contagem de coliformes acima do permitido. Das amostras de salada 80% estavam fora dos padrões. Não foram detectadas Salmonellas nas amostras de HMP analisadas. As principais cepas de Enterobacteriaceae isoladas foram E. coli, K. pneumoniae e E. aerogenes. Todas as cepas de K. pneumoniae e E. aerogenes foram resistentes à ampicilina. Foram detectadas cepas de E. coli, K pneumoniae e E aerogenes com multiresistência aos antibióticos testados. Não foi observada resistência a ciprofloxacina, ceftazidima e imipenem. Não foram detectadas amostras de enterobactérias produtoras de ESBL. Não foram identificadas cepas de E. coli O15:H7 entre as cepas de E. coli isoladas de HMP. As condições higiênico-sanitárias desses produtos podem ser melhoradas com a aplicação de Boas Práticas em toda a cadeia produtiva.

This master thesis is focused on the role of horizontal gene transfer in disseminating tetracycline resistance among bacteria in farm soils. In the experimental part, plasmids carrying antibiotic resistance, were exogenously isolated in biparental matings with cattle manure and Escherichia coli K-12 CV601 gfp recipients.

In the first part of my thesis I focus on mapping problems associated with antibiotic therapy and subsequent development of antibiotic resistance. Tracking resistance is based primarily on data collection and evaluation of the results set sensitivity from around the world. Antibiotic resistance is a natural phenomenon that can be observed in the evolution of microbes as one of the mechanisms of adaptation to new conditions in the environment. For this work I have chosen the following research questions. Do the incidence of ESBL strains in the České Budějovice Hospital a.s. increase over time? Are these values comparable to those achieved in another region, namely in Moravian hospitals the University Hospital of Olomouc, Ostrava University Hospital and Regional University Hospital of T. Bata in Zlin? The data collection I made in collaboration with the laboratory technicians and doctors at Hospital?s Bacteriology Laboratory in České Budějovice. Bacteries tested for the detection of ESBL production originated from biological materials, witch came from patients of hospital in České Budějovice. The first objective was to compare the results achieved in the České Budějovice Hospital in the period of 2007 to 2012. If we look at the total number of ESBL strains that have been isolated since 2007, values have upward trend. While in 2007 there were only 64 strains a year later, the number more than doubled. In 2010, the value soared to 281 tribes and in the year 2012, the number was 321 tribes. The incidence of ESBL strains in 2007 increased about five times. In the long term we can say the numbers have increasing tendency and the range of each species in the production of ESBL has significantly changed. In 2007, it was K. pneumoniae strains that dominated the statistics, but over time the strains of E. coli came forefront. Values of 2012 suggest that the presence of ESBL strains of K. pneumoniae is again almost equal to the number of E. coli strains. The second objective was to compare the results of the 2012 with study of the Prevalence of ESBL-positive Enterobacteriaceae in large Moravian hospitals. In the general overview of ESBL producers values in Hospital České Budějovice (5.23%) are comparable to those in Ostrava (4.9%) and in Zlín (4.3%). Number of strains in the Hospital in Olomouc (11.8%) is about twice as high as the numbers in České Budějovice. In this comparison the České Budějovice Hospital is one of the hospitals with a lower incidence of ESBL producers. The České Budějovice Hospital is below the national average, which originate from an elaborate system of care for patients with colonization or infection with ESBL strains, and from therapy control system using antibiotic center. These results may serve to the Hospital in České Budějovice for statistical purposes, and also for proposals for improving patient care. In the discussion, I pointed out the danger of the spread of resistant strains of bacteria in the community and also the associated risks that mentioned bacteria mean for patients injured in mass accidents or disasters. In these cases, number of infections including ESBL producers can penetrate through open wounds into the affected body. Unlike conventional sensitive bacteria those strains are resistant to commonly used antibiotics and thereby endanger the lives of people affected by the accident.

Pseudomonas aeruginosa est un pathogène opportuniste à Gram-négatif, responsable d’infections nosocomiales chez des patients immunodéprimés et principale cause de morbidité et de mortalité chez les patients atteints de mucoviscidose. Les traitements utilisés contre P. aeruginosa peuvent être mis en échec en raison des nombreux mécanismes de résistance développés par la bactérie tels que les systèmes d’efflux RND, capables d’exporter les antibiotiques à l’extérieur de la cellule. Parmi ces systèmes, MexEF-OprN est très peu produit dans les souches sauvages mais il est surproduit chez les mutants appelés nfxC et conduit à une résistance aux fluoroquinolones, au chloramphénicol et au triméthoprime. Ces mutants ont également la particularité de résister de façon concomitante aux carbapénèmes et d’être peu virulents. Notons enfin que la pompe MexEF-OprN est codée par un opéron à trois gènes, mexEF-oprN, dont la transcription est activée par MexT, un régulateur appartenant à la famille LysR.Les mutants nfxC étant peu décrits dans le contexte clinique, nous avons évalué leur prévalence et caractérisé les événements génétiques conduisant à la surexpression de mexEF-oprN. A partir d’une collection de 221 souches cliniques isolées au CHRU de Besançon, et sélectionnées en raison de leur sensibilité diminuée à la ciprofloxacine et à l’imipénème, 19.5% surexprimaient mexEF-oprN. Nous avons par la suite caractérisé 22 souches non-redondantes et montré que seulement 13.6% d’entre elles possédaient des mutations inactivatrices dans le gène mexS alors que 40.9% avaient des mutations conduisant à la substitution d’un seul acide-aminé. Il est apparu que ces dernières mutations avaient des effets modérés sur les profils de résistance et de virulence alors que les mutations inactivatrices donnaient des hauts niveaux de résistance mais aucune virulence. Enfin, nous n’avons pas pu identifier de mutations génétiques pouvant expliquer la surexpression de mexEF-oprN des 45.5% de souches restantes, suggérant l’existence des mécanismes de régulation encore inconnus de cet opéron.Nous avons donc étudié des mutants résistants au chloramphénicol, sélectionnés in vitro à partir de la souche de référence PA14. Leur caractérisation nous a permis de découvrir un nouveau type de mutants surproducteurs de MexEF-OprN que nous avons appelé nfxC2. Tous possédaient des mutations gain-de-fonction sur le gène PA14_38040 (nommé cmrA) codant pour un régulateur de la famille AraC, jamais étudié auparavant. Chez les mutants nfxC2, l’expression de cmrA est augmentée, ainsi que celle de l’opéron mexEF-oprN et ceci, d’une façon MexS- et MexT-dépendante. De façon intéressante, ces mutations dans cmrA font apparaître un phénotype résistant sans toutefois altérer la virulence de la souche. Une analyse transcriptomique a montré que CmrA pouvait activer l’expression de 11 gènes parmi lesquels PA14_38020 apparaît comme étant nécessaire pour l’activation indirecte de mexEF-oprN. Ce gène code pour une quinol monooxygenase partageant des domaines conservés avec YgiN, une enzyme d’Escherichia coli qui participe à la réponse contre les électrophiles. D’ailleurs, l’exposition de la souche PA14 à des concentrations sub-inhibitrices d’électrophiles toxiques (glyoxal, méthylglyoxal et cinnamaldéhyde) active suffisamment la pompe MexEF-OprN pour générer un phénotype de résistance et ce, de façon CmrA-dépendante. Enfin, cette même exposition aux électrophiles active également deux autres pompes RND, à savoir MexAB-OprM et MexXY/OprM. Les voies de régulation conduisant à l’activation de ces deux opérons d’efflux seront étudiées prochainement au laboratoire. / Pseudomonas aeruginosa is a Gram negative opportunistic pathogen, responsible for several nosocomial infections in immunocompromised patients, and the main cause of mortality and morbidity of patients suffering from cystic fibrosis. Treatment of P. aeruginosa infections turns to be difficult due to its natural resistance to antibiotics, increased in part by the overproduction of RND efflux pumps capable to export antibiotics out of the cell. Amongst these systems, MexEF-OprN exports several antibiotics such as fluoroquinolones, chloramphenicol and trimethoprim. This efflux pump is quiescent in wild-type strains but it is highly produced in nfxC mutants, making them resistant to MexEF-OprN substrates. In addition, these mutants are characterized by their concomitant resistance to carbapenems and their low-virulence profile. MexEF-OprN is encoded by a three-gene operon, mexEF-oprN, whose transcription is activated by MexT, a member of the LysR family of transcriptional regulators. In the clinical context, nfxC mutants being poorly described, we evaluated their prevalence and characterized the genetic events responsible for mexEF-oprN overexpression. A collection of 221 clinical isolates from the University Hospital of Besançon exhibiting a reduced susceptibility to ciprofloxacin and imipenem was screened. We found that 19.5% of these strains overexpressed mexEF-oprN and further characterization of the 22 non-redundant mutants showed that only 13.6% of these mutants harbored a disrupted mexS gene. Moreover, 40.9% of nfxC clinical strains harbored missense mutations in mexS conducing to the substitution of a single amino-acid residue in the encoding protein. Interestingly, these mutations were associated to moderate effects on resistance and virulence factor production while disruptive mutations produced highly resistant but completely non-virulent strains. For the 45.5% of remaining strains, we failed to identify genetic mutations, which could explain mexEF-oprN overexpression; this indirectly suggested that there might be additional regulatory loci controlling the expression of this operon.We thus studied chloramphenicol resistant mutants selected in vitro derived from reference strain PA14 and found a new class of MexEF-OprN overproducers, which we called nfxC2, harboring gain-of-function mutations in a so-far uncharacterized gene, PA14_38040 (hereafter called cmrA) coding for an AraC transcriptional regulator. In nfxC2 mutants, the mutated CmrA increases its proper gene expression and upregulates the expression of mexEF-oprN through MexS and MexT, resulting in a multi-drug resistant phenotype without altering virulence factor production. Transcriptomic experiments showed that CmrA positively regulates the expression of 11 genes, including PA14_38020, which is required for the MexS/MexT-dependent activation of mexEF-oprN. Gene PA14_38020 is predicted to code a quinol monooxygenase sharing conserved domains with YgiN of Escherichia coli, which was reported to be involved in the response of the bacterium to electrophiles. Interestingly, exposure of strain PA14 to sub-inhibitory concentrations of toxic electrophiles (glyoxal, methylglyoxal or cinnamaldehyde) strongly activates the CmrA-pathway and upregulates mexEF-oprN sufficiently to provoke the resistance to the pump substrates. Finally, we found that the same exposure to electrophiles is capable to activate two other RND pumps, MexAB-OprM and MexXY/OprM. The regulatory pathways conducing to activation of these two efflux operons will be elucidated at the laboratory.