Outputs of human-derived chemicals and constituents to the environment, and shifts in these outputs, can result in unintended consequences to human and ecological health. One such shift is the advent of the modern antibiotic era, in which mass production and outputs of antibiotics, which are mostly naturally-derived microbial defense compounds and include a few synthetic antimicrobials, has profound implications for contributing to the spread of antibiotic resistance. Antibiotic resistance arises from mutations and/or sharing of antibiotic resistance genes (ARGs) among bacteria via horizontal gene transfer, with carriage of ARGs by pathogenic bacteria of particular concern to human health. While most attention to stopping the spread of antibiotic resistance has been devoted to the clinic, it is critical to consider the environmental origin, ecology and pathways by which antibiotic resistance spreads in order to develop comprehensive strategies to combat antibiotic resistance. In particular, wastewater treatment plants (WWTPs) represent a potentially key critical control point given that they receive antibiotic resistant bacteria (ARB) and ARGs from the population, which are then routed to activated sludge biological treatment, consisting of high density, highly active microbial populations. The research projects described in this dissertation aimed to explore the occurrence of ARGs in WWTPs, particularly WWTPs in developing countries representing the extremes of what is expected to be encountered in terms of potential to spread antibiotic resistance, and to improve and apply novel technologies for monitoring key markers of antibiotic resistance in WWTPs and affected environments. The pathogen Staphylococcus aureus and a corresponding ARG (methicillin resistance mecA gene) were chosen as model biocontaminants of concern due to their environmental and public health relevance. The results reported in Chapters 3-5 advance the knowledge of bio(nano)sensing techniques and highlight areas of promise and challenge. The results reported in Chapter 2 provided insight into the baseline levels of ARGs expected in a highly impacted WWTP in India, thereby highlighting the magnitude and global scale of the problem of antibiotic resistance as well as the need for innovative solutions. / Ph. D. / Release of human-derived pollutants into the environment can result in unintended consequences to human and environmental health. The rise of antibiotic resistance in disease-causing bacteria serves as a notorious example. Antibiotic resistance arises from mutations and/or sharing of antibiotic resistance genes (ARGs), which are the genetic elements that enable the resistance to occur. While most attention to stopping the spread of antibiotic resistance has been devoted to the clinic, it is critical to consider the environmental factors by which antibiotic resistance spreads in order to develop wellinformed strategies to combat it. In particular, wastewater treatment plants (WWTPs) represent a potentially key critical control point given that they receive antibiotic resistant bacteria (ARB) and ARGs from the population, which are then routed to a highly active biological treatment process. The research projects described in this dissertation aimed to explore the occurrence of ARGs in WWTPs, particularly WWTPs in developing countries representing the extremes of what is expected to be encountered in terms of potential to spread antibiotic resistance, and to improve and apply novel technologies for monitoring key markers of antibiotic resistance in WWTPs and affected environments. The disease-causing bacterium <i>Staphylococcus aureus</i> and a corresponding ARG (methicillin antibiotic resistance mecA gene) were chosen as model biological contaminants of concern due to their environmental and public health relevance. The results reported in Chapters 3-5 advance the knowledge of integrated microbiology and nanotechnology techniques, and also highlight some associated limitations. The results reported in Chapter 2 provide insight into the baseline levels of ARGs expected in a highly impacted WWTP in India, thereby highlighting the magnitude and global scale of the problem of antibiotic resistance as well as the need for innovative solutions.

Polymyxins are potent antibiotics that bind to the outer membrane of Gram-negative bacteria, entering the cell and disrupting the inner membrane, resulting in cell death. They were traditionally used as antibiotics of last resort, but the recent surge of multidrug resistant pathogens has renewed interest in these antibiotics. The emergence of polymyxin resistance determinants such as the recently discovered plasmid-mediated phosphoethanolamine transferase MCR-1 may put a strain on the future effectiveness of this antibiotic. One method to combat the rise in antibiotic resistant bacteria is through the identification and development of antibiotic adjuvants. These are small molecules that are able to inhibit the resistance mechanism, allowing previously ineffective antibiotics to once again become effective at treating bacterial infections. In this work, a high throughput cell-based screen was conducted using an in-house library of Actinomycete-derived crude cell extracts in order to search for a natural product inhibitor of an E. coli strain expressing mcr-1. In addition, the development of a new enzyme assay was attempted using purified MCR-1 C-terminal catalytic domain and a chromogenic substrate to test enzymatic activity in vitro, in hopes of establishing a simple means of studying inhibition of MCR-1. The structure-function relationship of MCR-1 was also explored by generating amino acid substitutions and studying their effect on the ability of the enzyme to confer resistance to colistin, as well as the generation of MCR-1 transmembrane truncation mutants to determine if it was possible to generate a shorter variant of MCR-1 that retained its enzymatic activity. This work furthers our understanding of the biochemistry and enzymology of MCR-1, and outlines attempts to identify inhibitors of MCR-1 in order to re-sensitize resistant bacteria to polymyxins. / Thesis / Master of Science (MSc) / Polymyxins are potent antibiotics that are threatened by the spread of multi-drug resistant bacteria. Resistance to these antibiotics is relatively rare, although the recent discovery of a mobile polymyxin resistance enzyme, MCR-1, threatens the future use of this antibiotic for treating infections, as it can readily transfer to other bacteria. The goal of this work was to search for a natural product inhibitor of MCR-1 in order to reverse its ability to confer resistance to polymyxins. A color-changing assay was conducted with MCR-1 in hopes of establishing a method to study the inhibition of MCR-1 in vitro. Additionally, amino acid substitutions were generated in MCR-1 to better understand how key amino acids affect enzyme function, as well as transmembrane domain truncations to determine if it was possible to create a shorter functioning variant of MCR-1.

In antibiotic therapy design, conventional wisdom holds that higher antibiotic dosages always leads to the observation of fewer bacterial cells, resulting in a monotonic decay in cell number as a function of increasing antibiotic dose; accordingly, throughout this thesis, we will call this phenomenon a monotone dose-response profile. When we analysed the evolution of antibiotic resistance mediated by the multi-drug efflux pump AcrAB-TolC in Escherichia coli to study if such a monotone dose-response is maintained at all times, our analysis showed that higher dosages can, in fact, lead to higher bacterial loads. This is because selection for drug resistance is mediated by the duplication of the genes, AcrAB-TolC, that encode the aforementioned efflux pump. As explained in detail below, our work highlights the idea that Darwinian selection on additional copies of AcrAB-TolC is a non-linear function of antibiotic dose and that the observed transition from monotone to non-monotone dose-response is a consequence of AcrAB-TolC being strongly selected at very specific dosages. We term this phenomenon an ‘evolutionary hotspot’. Next, we extended the above experimental system to solid media to study how selection on resistance mediated by AcrAB-TolC leads to a ‘spatio-genomic patterning’ effect that we call a ‘bullseye’. Using a bespoke culture device developed as part of this PhD, we show that spatial selection on resistance also depends non-linearly on the distance of the cell from an antibiotic source, and that the non-linearity can be multi-modal as a function of distance, and therefore also of antibiotic dose. This result also contradicts the aforementioned principle that higher antibiotic dosages necessarily lead to fewer bacterial cells. Following on from this, we then studied the ability of microbial competitors for resources to modulate the antibiotic sensitivity of a particular strain of E. coli, namely Tets , using a range of multi-species experiments. We measured the sensitivity to antibiotics of Tets both with, and without, one bacterial or fungal competitor. When that competitor was equally sensitive to the antibiotic, we observed that Tets was less sensitive to it, in part due to an ‘antibiotic sinking’ effect carried out by the competitor strain. However, when the competitor was not sensitive to the antibiotic, Tets was, accordingly, more sensitive than in the absence of competition. In this latter case, the competitor seemed to reduce the growth of Tets by carbon theft as part of a phenomenon known as ‘competitive suppression’. Moreover, this ecological effect is one that synergises with the action of the antibiotic. Finally, we turned to a study of an ecological trade-off motivated by ribosome-binding antibiotics. So, by manipulating the content of ribosomal RNA in the E. coli cell, a large and essential molecule that is bound by antibiotics such as tetracycline or erythromycin, we could subsequently manipulate what is known as a metabolic trade-off between growth rate and growth yield. The latter is the number of cells produced per molecule of carbon found in the extracellular environment of the bacterial population. Using glucose as carbon source we therefore constructed an empirical fitness landscape that shows how the optimum number of ribosomal rRNA operons depends on extracellular glucose concentration. Whilst this study does not relate directly to the presence of an antibiotic, it does show that by altering the number of operons in a manner that is known to affect antibiotic susceptibility, we can also mediate important growth parameters like cell yield, aka efficiency, and growth rate.

With regards to the potential severity of increased antibiotic resistance around the world it is puzzling that the global response to this issue has not been more comprehensive. In this thesis I will examine the political frames on ABR formulated by the global network ReAct in an attempt to understand why this is the case. The frames of an issue, that is how it is described politically in different ways, are crucial for agenda-setting. Moreover, framing is an important part of the work of transnational advocacy networks. Since the acknowledgement of an issue in terms of agenda-setting is an important part of a global response, the frames of transnational advocacy networks make up the focus of this thesis. My findings suggests that the existence of multiple frames on ABR to some extent helps us understand the lacking response to ABR. The construction of the frames in terms of causality, and inparticular a general vagueness in terms of responsibility, is however the main finding.

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Environmental pathogens, such as Escherichia coli and Streptococcus uberis, are currently the major cause of mastitis within dairy herds. This leads to severe financial losses, lower production rates and deterioration of the general health of the herd. E. coli mastitis is becoming a major threat to high milk-producing dairy herds. This is because of its increasing resistance to antibiotics, rendering antibiotic treatment regimes against E. coli infections mostly ineffective. The aim of this study was to develop a method to select mastitis causing E. coli isolates for the formulation of effective herd specific vaccines. Two methods, namely a genotyping method (Random Amplification of Polymorphic DNA; RAPD) and an antibiogram based method, were used. A dairy farm milking approximately 1000 Holstein cows in the Darling area, Western Cape Province, was selected for this study. The study was conducted over a period of 48 months and mastitis samples were analysed for mastitis pathogens. Antibiogram testing (disk diffusion method) and an in-house developed RAPD analysis method were used to analyse the E. coli isolates. A total of 921 milk samples were analysed from which 181 E. coli isolates were recovered. The number of all other common mastitis pathogens combined was 99 isolates (Streptococcus uberis 18, Streptococcus dysgalactiae 46, Streptococcus agalactiae 1, Staphylococcus epidermidis 21, Arcanobacterium pyogenes 13). All E. coli isolates, except for one, were resistant to at least three antibiotics. Antibiotic variance profiles were also highly erratic. The RAPD analysis revealed high levels of polymorphisms and clear epidemiological trends were observed over time. No similarities in the variance profiles between the antibiotic variance data and phylogenetic data were observed. Formalin inactivated autogenous vaccines were produced containing E. coli isolated from the herd. The vaccines were formulated using the RAPD or antibiogram data of the E. coli isolates. A total of 5 vaccines were formulated using RAPD data (Rvaccines) and one vaccine was formulated using antibiotic variance data (A-vaccine). The RAPD formulated vaccines were more effective than the antibiotic variance formulated vaccine. After each R-vaccination, the number of E. coli mastitis cases declined within the herd. The A-vaccinations seemed to have had no effect, which lead to a rise in E. coli mastitis cases. RAPD analysis on new emerging isolates was able to detect genetic variation from vaccine strains, which in turn facilitated the formulation of new updated vaccines with higher effectiveness than the previous vaccine. Mastitis data prior to and after the vaccination period revealed significant higher incidences of mastitis in the herd than during the vaccination period. This study demonstrated that sufficient sampling practices coupled with a reliable genotyping method, resulted in the formulation of updatable vaccines which were highly effective in controlling E. coli mastitis within the herd. / Thesis (M Environmental Sciences)--North-West University, Potchefstroom Campus, 2012

Klebsiella pneumoniae is a common cause of nosocomial and community-acquired infections, and the increasing incidence and prevalence of antibiotic resistant strains is proving to be particularly problematic to clinicians. K. pneumoniae is capable of employing a multitude of mechanisms by which to confer resistance to most available antibiotics. The carbapenem antibiotics are usually reserved for the treatment of complicated or multidrug resistant (MDR) K. pneumoniae infections. The recent emergence of not only MDR but also pan-drug resistant (PDR) K. pneumoniae strains has signified that it is now more important than ever to understand the mechanisms by which these strains confer resistance so that we may find ways to combat or hinder this progression. This project aimed to investigate the regulation of the transcriptional activator RamA, its ability to confer a MDR phenotype, and the mechanisms employed by K. pneumoniae to confer levels of carbapenem resistance sufficient to result in therapy failure. The analysis of a panel of K. pneumoniae strains, containing both RamA expressers and non-expressers, demonstrated that the overexpression of RamA was sufficient to confer an MDR phenotype. Two compounds, chlorpromazine (CPZ) and tigecycline, were shown to act as inducers of ramA, romA and acrA transcription. CPZ exhibited synergy with the antibiotics chloramphenicol, norfloxacin and tetracycline, all of which are known substrates of the AcrAB efflux pump. The current lack of novel classes of antimicrobials in development indicate a potential for a compound, such as CPZ, to be developed and exploited for clinical use. The ability of both CPZ and tigecycline to cause mutations within ramR however, indicate that both compounds may have the ability to select for efflux mutants as a result of their ability to upregulate ramA, which in turn causes the upregulation of the AcrAB efflux pump. The regulation of RamA by the upstream gene ramR, which encodes a TetR family protein was investigated in K. pneumoniae isolates. Sequencing of the ramR genes revealed that strains exhibiting an MDR phenotype commonly contained mutations within their gene sequences. The complementation of a wildtype ramR into a strain containing a 32 amino acid deletion within its ramR, was shown to increase susceptibility to various antibiotics of different classes, and additionally downregulate the expression of ramA, romA and acrA. CPZ, ciprofloxacin and tigecycline K. pneumoniae mutants were shown to exhibit increased MICs to a broad spectrum of antibiotics with respect to their parent strains, and possess mutations within their ramR genes. Complementation of the wildtype ramR resulted in partial reversion to the parental phenotypes, indicating another mechanism must also be involved in conferring the MDR phenotypes. These studies indicated that RamR plays an important role as a negative regulator of RamA, but also that it is not the sole regulator. The development of reduced susceptibility to the carbapenems was investigated in two clinical strains of K. pneumoniae, K1 and K2, isolated from the urine of a single patient at different stages of antibiotic therapy. The strains were shown to exhibit similar resistance phenotypes with the exception of their susceptibilities to the carbapenems. PCR and phenotypic analyses revealed that neither strain contained any carbapenemases or AmpC enzymes, but both contained OXA-1, SHV-1 TEM-1 and CTX-M-15. Analysis of their OMP profiles indicated that both strains lacked OmpK35, and K2 additionally lacked OmpK36. Mutation studies showed that the phenotype and OMP profile exhibited by K2 could be achieved in K1 via single step mutations using ertapenem, imipenem or meropenem. Susceptibility testing of CTXM- 15 clinical strains showed that strains containing CTX-M-15 showed reduced activity against ertapenem in the presence of clavulanic acid. These studies indicated a potential role for CTX-M-15 in conferring reduced susceptibility to the carbapenems when found in conjunction with altered permeability and active efflux. The mechanisms of antibiotic resistance employed by K. pneumoniae are numerous and complex. This work highlights several of these mechanisms and, more importantly, how they can work in synergy with one another to devastating consequences.