Tuberculosis (TB) is the most common opportunistic infection in HIV-infected patients and the emergence of drug-resistant tuberculosis (DR-TB) is a growing problem in resource-limited settings (RLS). TB diagnosis in most RLS still depends on smear microscopy for acid-fast bacilli (AFB) while adequate infrastructure for testing drug sensitivity is unavailable. However, molecular diagnostics that detect Mycobacterium tuberculosis (Mtb) DNA and its genetic markers of drug resistance were recently developed. In this thesis I describe the use of a molecular diagnostic, Genotype MTBDRplus, for characterizing DR-TB and patterns of tuberculosis-like infection in two cities in south-west and north-central Nigeria. I found high rates of DR-TB in Nigerian HIV-infected individuals (9.3% for RIF or INH) with significantly different amounts by location (18.18% in south-west vs. 3.91% in north-central Nigeria, p=0.01). RIF resistance, indicative of MDR-TB, was found in 5.52% treatment-naïve patients, far exceeding the WHO predictions (0-4.3%). Furthermore, RIF resistance was genetically distinct, suggesting location-specific transmission of drug resistance (p=0.04). Genotype MTBDRplus correctly identified the drug-resistant samples compared to sequencing in 96.8% of cases. Mtb was confirmed in 56% of patients and was less likely to be found in patients on ART, while controlling for other relevant demographic characteristics (OR 0.29, P=0.02). Only abnormal respiratory findings on auscultation and the direct sputum smear grade greater than 3/100 were significant predictors of Mtb infection (OR 3.28, P=0.03; OR 6.40, p<0.01 respectively). Concentrated sputum smear was not significantly correlated with Mtb infection, except at the highest grades (>2+). Furthermore, in 49% of samples that were not confirmed for Mtb other actinomycetes were found: atypical Mycobacteria (ATM), Rhodococcus spp., Nocardia spp., Corynebacterium spp. I conclude that concentrated sputum AFB smears may misidentify bacteria as Mtb in a subset of HIV-infected patients. These individuals may have a different, even uncharacterized, actinomycete infection in the respiratory tract. Furthermore, total DR-TB in HIV-infection is high and transmission of DR-TB in HIV-infected patients in Nigeria is higher than estimated by the WHO. Molecular diagnostics are a rapid method for identifying Mtb and monitoring DR-TB, and can guide appropriate treatment decisions for respiratory infections in RLS with a high HIV burden.

Nas últimas décadas, a incidência de infecções hospitalares causadas por bactérias Gramnegativas multidrogarresistentes (MDR) vem crescendo de maneira vertiginosa em todo o mundo, de modo que a Organização Mundial de Saúde (OMS) recentemente reconheceu essas infecções como uma preocupação mundial devido ao seu impacto negativo sobre as taxas de mortalidade intra-hospitalar e dos custos da assistência à saúde, afetando tanto os países desenvolvidos quanto os em desenvolvimento. Atualmente considera-se que a higienização das mãos, o uso racional de antimicrobianos e o isolamento de contato são as principais medidas disponíveis para contenção desse avanço. Porém, elas são apenas parcialmente efetivas e de implementação trabalhosa e onerosa. Assim, considera-se necessário o desenvolvimento de formas mais simples e eficientes paralidar com esse problema. No presente estudo, nos propusemos a avaliar o impacto da administração de um produto simbiótico a pacientes colonizados e/ou infectados por bactérias Gram-negativas MDR sobre as taxas de descolonização desses patógenos no trato digestivo. Trata-se de um ensaio clínico randomizado, duplamente cego, controlado com placebo, envolvendo 101 pacientes hospitalizados com colonização prévia por bactérias Gram-negativas MDR, demonstrada por meio de cultura seletiva de swab retal, cuja intervenção consistiu na administração oral ou enteral diária de 1010 unidades de Lactobacillus bulgaricus e 1010 unidades de Lactobacillus rhamnosus associados a fruto-oligossacarídeos durante (FOS) 7 dias. O desfecho primário do estudo foi a descolonização completa do trato digestivo posterior à intervenção, que, na análise do tipo \"intenção de tratar modificada\" foi de 16,7% (8/48) no grupo experimental e 20,7% (11/53) no grupo controle (p=0,600). Na análise \"per protocol\", a descolonização completa do trato observada foi de 18,9% (7/37) no grupo experimental e 23,3% (7/30) no grupo controle (p=0,659). Em uma análise multivariada por meio de modelo de regressão logística o uso do simbiótico não influenciou significativamente o risco de descolonização completa do trato digestivo (OR= 0,80, IC 95%= 0,28-2,27, p= 0,678). A ocorrência de eventos adversos de natureza leve a moderada foi semelhante entre os grupos: 7,55% no grupo que utilizou placebo e 6,25% no grupo sob intervenção (p= 1,000). Nenhum evento adverso grave potencialmente relacionado às medicações de estudo foi observado. Nas condições estudadas, os dados obtidos pelo estudo nos levam à conclusão de que o simbiótico estudado demonstrou-se inefetivo na descolonização do trato digestivo de pacientes previamente colonizados por bactérias Gram-negativas MDR. / In recent decades the incidence of multidrug resistant (MDR) Gram-negative nosocomial infections has been dramatically raising in the whole world. The World Health Organization (WHO) recently recognized nosocomial infections due to MDR pathogens as a global concern due to its negative impact on patients, health-care workers and health-care institutions, affecting developed countries as well as developing ones. They negatively impact in-hospital mortality and health-care related costs. Hand hygiene promotion, antibiotic stewardship and contact precautions are the main available measures to control such MDR Gram-negative organisms in hospitals. However, they are only partially effective as well as difficult to be implemented and expensive. Therefore, simpler and more effective actions are thought to be helpful and urgent. In the present study, we analyzed the impact of the administration of a symbiotic product on patients harboring Gram-negative multidrug-resistant bacteria upon the subsequent rates of decolonization of these pathogens from the gastro-intestinal tract.This is a double-blinded and placebo controlled randomized clinical trial evaluating the oral/enteral daily administration of 1010 units of Lactobacillus bulgaricusplus 1010 units of Lactobacillus rhamnosus associated with fructo-oligosacharide (FOS), or placebo, for 7 days, to 101 patients previously colonized by MDR Gram-negative bacteria, identified through selective culture of rectal swab. The primary study outcome was the rate of complete decolonization of the MDR microorganism from the gastro-intestinal tract following the intervention. In the \"modified intention to treat\" analysis, decolonization rates observed were 16.7% (8/48) in the experimental group and 20.7% (11/53) in the placebo group (p=0,600). In the \"per protocol\" analysis, decolonization rates were 18.9% (7/37) in the experimental group and 23.3% (7/30) in the placebo group (p=0,659). In a logistic regression model, symbiotic use did not produce any impact on the chance of decolonization (OR=0.80, CI95%=0.28-2.27, p=0.678). Mild to moderate adverse events occured similarly in both the placebo (7.55%) and the experimental group (6.25%), (p=1,000). No severe adverse event potentially related to the medications was detected during the study period. In the present study conditions, the results obtained lead to the conclusion that the studied symbiotic proved to be ineffective to decolonize patients harboring multidrug resistant Gram-negative bacilli.

Nas últimas décadas, a incidência de infecções hospitalares causadas por bactérias Gramnegativas multidrogarresistentes (MDR) vem crescendo de maneira vertiginosa em todo o mundo, de modo que a Organização Mundial de Saúde (OMS) recentemente reconheceu essas infecções como uma preocupação mundial devido ao seu impacto negativo sobre as taxas de mortalidade intra-hospitalar e dos custos da assistência à saúde, afetando tanto os países desenvolvidos quanto os em desenvolvimento. Atualmente considera-se que a higienização das mãos, o uso racional de antimicrobianos e o isolamento de contato são as principais medidas disponíveis para contenção desse avanço. Porém, elas são apenas parcialmente efetivas e de implementação trabalhosa e onerosa. Assim, considera-se necessário o desenvolvimento de formas mais simples e eficientes paralidar com esse problema. No presente estudo, nos propusemos a avaliar o impacto da administração de um produto simbiótico a pacientes colonizados e/ou infectados por bactérias Gram-negativas MDR sobre as taxas de descolonização desses patógenos no trato digestivo. Trata-se de um ensaio clínico randomizado, duplamente cego, controlado com placebo, envolvendo 101 pacientes hospitalizados com colonização prévia por bactérias Gram-negativas MDR, demonstrada por meio de cultura seletiva de swab retal, cuja intervenção consistiu na administração oral ou enteral diária de 1010 unidades de Lactobacillus bulgaricus e 1010 unidades de Lactobacillus rhamnosus associados a fruto-oligossacarídeos durante (FOS) 7 dias. O desfecho primário do estudo foi a descolonização completa do trato digestivo posterior à intervenção, que, na análise do tipo \"intenção de tratar modificada\" foi de 16,7% (8/48) no grupo experimental e 20,7% (11/53) no grupo controle (p=0,600). Na análise \"per protocol\", a descolonização completa do trato observada foi de 18,9% (7/37) no grupo experimental e 23,3% (7/30) no grupo controle (p=0,659). Em uma análise multivariada por meio de modelo de regressão logística o uso do simbiótico não influenciou significativamente o risco de descolonização completa do trato digestivo (OR= 0,80, IC 95%= 0,28-2,27, p= 0,678). A ocorrência de eventos adversos de natureza leve a moderada foi semelhante entre os grupos: 7,55% no grupo que utilizou placebo e 6,25% no grupo sob intervenção (p= 1,000). Nenhum evento adverso grave potencialmente relacionado às medicações de estudo foi observado. Nas condições estudadas, os dados obtidos pelo estudo nos levam à conclusão de que o simbiótico estudado demonstrou-se inefetivo na descolonização do trato digestivo de pacientes previamente colonizados por bactérias Gram-negativas MDR. / In recent decades the incidence of multidrug resistant (MDR) Gram-negative nosocomial infections has been dramatically raising in the whole world. The World Health Organization (WHO) recently recognized nosocomial infections due to MDR pathogens as a global concern due to its negative impact on patients, health-care workers and health-care institutions, affecting developed countries as well as developing ones. They negatively impact in-hospital mortality and health-care related costs. Hand hygiene promotion, antibiotic stewardship and contact precautions are the main available measures to control such MDR Gram-negative organisms in hospitals. However, they are only partially effective as well as difficult to be implemented and expensive. Therefore, simpler and more effective actions are thought to be helpful and urgent. In the present study, we analyzed the impact of the administration of a symbiotic product on patients harboring Gram-negative multidrug-resistant bacteria upon the subsequent rates of decolonization of these pathogens from the gastro-intestinal tract.This is a double-blinded and placebo controlled randomized clinical trial evaluating the oral/enteral daily administration of 1010 units of Lactobacillus bulgaricusplus 1010 units of Lactobacillus rhamnosus associated with fructo-oligosacharide (FOS), or placebo, for 7 days, to 101 patients previously colonized by MDR Gram-negative bacteria, identified through selective culture of rectal swab. The primary study outcome was the rate of complete decolonization of the MDR microorganism from the gastro-intestinal tract following the intervention. In the \"modified intention to treat\" analysis, decolonization rates observed were 16.7% (8/48) in the experimental group and 20.7% (11/53) in the placebo group (p=0,600). In the \"per protocol\" analysis, decolonization rates were 18.9% (7/37) in the experimental group and 23.3% (7/30) in the placebo group (p=0,659). In a logistic regression model, symbiotic use did not produce any impact on the chance of decolonization (OR=0.80, CI95%=0.28-2.27, p=0.678). Mild to moderate adverse events occured similarly in both the placebo (7.55%) and the experimental group (6.25%), (p=1,000). No severe adverse event potentially related to the medications was detected during the study period. In the present study conditions, the results obtained lead to the conclusion that the studied symbiotic proved to be ineffective to decolonize patients harboring multidrug resistant Gram-negative bacilli.

Orientador: Carlos Magno Castelo Branco Fortaleza / Resumo: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Seasonality of healthcare-associated infections (HCAIs) has been recently reported, especially involving Gram-negative bacilli (GNB). Factors underlying this phenomenon were not elucidated. It is theoretically conceivable it reflects seasonal variations in traditional risk factors for those infections. With this in mind, we conducted a study to analyze the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). The study had a retrospective, case-only desing. It was conducted in the teaching hospital from Botucatu School of Medicine (450 beds). The study enrolled 446 patients with GNB-BSI caused by Escherichia coli, Enterobacter spp., Klebsiella spp., Pseudomonas aeruginosa or Acinetobacter baumannii, diagnosed from July 2012 through June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, as well as weather parameters of the day of diagnosis, were recorded. We analyzed factors associated with occurrence of GNB-BSI in different seasons (with winter as reference category) and caused by different GNB (reference category, E. coli). Univariate and multivariable models of polytomous (multinomial) logistic regressions were used for analysis. In multivariable analysis, GNB-BSI diagnosed in summer were more likely to be caused by Klebsiella spp. (OR, 5.33; 95%CI, 2.04-13.96) or A. baumannii (OR, 2.... (Complete abstract click electronic access below) / Mestre

Soil microbial communities are affected extensively by addition of amendments to their environment. Of particular concern is the addition of poultry litter, which contains a substantial C, energy, and nutrient supply, but also antibiotic resistance genes (ARG), antimicrobials, and a multitude of microbial species. This project seeks to primarily assess if there is a change in bacterial community structure in response to poultry litter amendments to pasture land across geographically independent land across northern Georgia. It may be that changes in the relative abundance of bacterial communities also result in alteration in ARGs, and the community resistance to antibiotics (“resistome”) which in turn increases the potential threat of antibiotic resistance genes. While another part of this study will determine changes in integrons and specific ARGs, this project will focus on changes in bacterial communities and the potential functional changes in the community, which in turn have consequences for ARG levels and its horizontal transfer to various members of the soil community. Addition of waste from livestock is a historical method for increasing nutrients needed in the soil for the cultivation of crops, and in turn causes pronounced shifts in soil microbial communities due to the addition of large amounts of carbon, nutrients, foreign microbes, and other material. This study is unique because it utilizes a novel and relatively large landscape-scale to determine if there are discernable and repeatable patterns of bacterial community structure change in response to amendment regardless of exact soil type or source of chicken litter amendment. In the future, these data can also provide insight into the changes in the relative abundance antibiotic related genes associated with community change. / M.S. / Soil is complicated, both in terms of its physical makeup and the organisms that live inside of it. Predicting changes in soil based on the addition of foreign material such as chemicals or biological waste is not an easy process, and whether or not it is even possible to reliably predict those changes is a matter of some dispute. This study is designed to illustrate that such changes can in fact be reliably and consistently predicted even with regard to the addition of complicated materials to the soil. In this study, specifically, the material in question is chicken litter. A mix of the bedding and waste produced by chickens, litter is commonly handled by composting and is added to soil in farms as a fertilizer rich in organic matter. It is possible to point at specific elements of the soil such as the chemistry and bacteria and see how it is changed with the addition of chicken litter, which allows us to determine the nature and extent of the change that chicken litter has on soil. This study is conducted on a larger scale than similar experiments conducted in the past, making it apparent that these relationships exist on a repeated basis. It is the object of this study to pave the way and make it easier for scientists in the future to determine these relationships in other unique contexts.

La tuberculose est due à un groupe d’agents infectieux phylogénétiquement proches formant le complexe Mycobacterium tuberculosis, formé de dix espèces. M. tuberculosis est un bacille à croissance lente qui forme des colonies rugueuses. Le complexe M. tuberculosis comporte également des bacilles tuberculeux formant des colonies lisses à croissance rapide, isolées qu’à partir de prélèvements cliniques chez l’homme. Notre revue des articles sur ces souches a montré que les trois premiers isolats ont été obtenus chez des patients en France, à Madagascar et en Polynésie Française par Georges Canetti entre 1968 et 1970. Suite à l'isolement d'une souche lisse à partir d’un ganglion cervical chez un enfant Somali de 2 ans en 1997, ces bacilles tuberculeux ont été nommés "Mycobacterium canettii". Aujourd'hui, moins d'une centaine de ces souches ont été isolées à partir de patients exposés aux pays formant la Corne de l’Afrique, principalement la République de Djibouti, qui présente la plus forte prévalence. Nous avons procédé à l’analyse génotypique de 34 isolats de M. tuberculosis et de 87 isolats de mycobactéries non-tuberculeuses de la Polynésie Française pour voir si des telles souches persistaient.Nous avons pu décrire deux nouvelles lignées de M. tuberculosis et une nouvelle espèce de mycobactérie non-tuberculeuse. Nous avons envisagé une transmission par voie digestive de "M. canettii" et nous avons testé la résistance de "M. canettii" à la chaleur. Nous avons observé la croissance de cette dernière entre 25°C et 45°C. Les données que nous avons obtenues ici pourraient former une base en vue d'élucider les réservoirs et les sources de souches lisses. / Tuberculosis is caused by a group of phylogenetically close infectious agents forming the Mycobacterium tuberculosis complex, consisting of ten species. M. tuberculosis is a slow growing bacterium which form rough colonies. The complex also includes M. tuberculosis tubercle bacilli forming smooth rapidly-growing colonies isolated from clinical specimens in humans. Our review of articles on these strains showed that the first three isolates were obtained from patients in France, Madagascar and French Polynesia by Georges Canetti between 1968 and 1970. Following the isolation of a smooth strain from cervical ganglion of a Somali 2 year-old child in 1997, the tubercle bacilli were named "Mycobacterium canettii". Today, less than a hundred of these strains were isolated from patients exposed to countries forming the Horn of Africa, especially the Republic of Djibouti, which has the highest prevalence. As showed in our revue, one smooth tubercle bacilli was isolated in Frenche Polynesia. To see if such strains persist there, we performed the genotyping of 34 isolates of M. tuberculosis and 87 isolates of non-tuberculous mycobacteria from French Polynesia. We have described two new strains of M. tuberculosis and a new species of mycobacterium tuberculosis not. We considered, on the basis of our data, a transmission through the digestive tract for "M. canettii" and we tested the resistance "Mr. canettii" to heat. We observed the growth of the latter between 25°C and 45°C. The data we got here could form a basis to elucidate the reservoirs and sources of smooth strains.

Les bactéries productrices de β-lactamase à spectre élargi (BLSE) ont été rapportées dans plusieurs pays, mais aucune information nest disponible sur les différents types de BLSE produits par les Entérobactéries au Cameroun. On distingue plus de 290 types de β-lactamases divisés en 4 classes (A, B, C, et D) et jusquaujourdhui il nexiste pas des inhibiteurs capables dinhibés toutes les classes de β-lactamase. Un total de 267 souches dEntérobactéries a été isolé entre 1995-1998 (259 souches) et 2002 (8 souches) des produits pathologiques (urines, pus et sang) des patients hospitalisés dans divers services de lHôpital Central de Yaoundé. Létude de la sensibilité in vitro de ces bactéries à 12 antibiotiques (amoxicilline, amoxicilline/acide clavulanique, pipéracilline, imipénème, céfazoline, céfoxitine, céfotaxime, ceftazidime, aztréonam, gentamicine, ofloxacine et triméthoprime/sulfaméthoxazole) par la méthode des disques a permis de noter un certains nombre de faits : limipénème, lofloxacine et la ceftazidime sont les antibiotiques les plus actifs sur les différentes Entérobactéries avec respectivement 100%, 91% et 88% de bactéries sensibles ; les différentes souches présentent un niveau de résistance élevé à lamoxicilline (90%), à la pipéracilline (79%), à la céfazoline (75%) et au triméthoprime/sulfaméthoxazole (74%). En vue de détecter les espèces bactériennes productrices de BLSE, 69 souches résistantes à au moins une céphalosporine de 3ème génération ou au monobactame ont été soumises au test de double synergie. Trente-huit (31 entre 1995-1998 ; 7 en 2002) souches ont montré un test positif. La prévalence des souches productrices de BLSE est de 12% (31/259). Ces souches présentant un phénotype BLSE sont observées chez toutes les espèces dEntérobactéries étudiées avec une prévalence de 18,8% (Klebsiella spp.), de 17,6% (Citrobacter spp.), de 14,3% (E. coli) et de 1,8% (Proteus spp.). Parmi les 38 souches potentiellement productrices de BLSE, 18 (47,4%) ont transféré le gène de résistance des oxyimino-céphalosporines aux souches E. coli HK 225, K12 et DH5α. Seize de ces gènes ont été transférés par conjugaison et deux par transformation. Le transfert de gène de BLSE a été co-transféré avec le gène de résistance à la gentamicine et/ou au triméthoprime/sulfaméthoxazole. Toutes les souches transconjugantes et transformantes ont présenté un phénotype BLSE et ont été toutes sensibles à la céfoxitine et à limipénème. Les extraits enzymatiques bruts obtenus par sonication des souches transconjugantes, transformantes et cliniques ont été capable de réduire les diamètres dinhibition autour des disques de pénicillines, céphalosporines 1ère à la 3ème génération ou monobactame en utilisant une souche dE. coli complètement sensible aux antibiotiques, mais nont pas eu deffet sur ces zones autour des disques dimipénème, de céfoxitine et damoxicilline/acide clavulanique. La détermination des points isoélectriques (pIs) des différentes souches après transfert du gène de résistance par la technique disoélectrofocalisation a montré que les souches transconjugantes et transformantes produisent des β-lactamases dont les pIs varient de 5,4 à 8,8. En effet, 12 souches produisent les BLSE de pI 8,2 ; deux souches en plus de cette BLSE produisent deux autres enzymes de pIs 5,4 et 8,5. Les souches de phénotypes CTX-M produisent soit une enzyme (pI 8,4 ; une souche) soit deux (pIs 7,3, 8,8 ; 2 souches) ou alors 3 types (pIs 5,4 ; 7,3 et 8,8 ; une souche). Les extraits dADN de 19 souches (16 transconjugantes, 2 transformantes et 1 souche clinique) soumis à la technique de PCR, PCR/NheI, en utilisant les amorces spécifiques des gènes blaSHV, blaCTX-M, blaTEM et blaOXA ont montré que les différents extraits contiennent les gènes des b-lactamases du type SHV (sulfhydryl variable), CTX-M (cefotaximase), TEM (Temoniera) et OXA (aoxacillinase). Lanalyse de la séquence des différents produits de PCR a permis de montrer que : 14 souches produisent la BLSE SHV-12, cinq la BLSE CTX-M (CTX-M-1, une souche ; CTX-M-15, 4 souches) ; quatre souches produisent en association avec les BLSE les β-lactamases TEM-1 (SHV-12, 2 souches ; CTX-M-15, 2 souches) OXA-30 (CTX-M-15, 4 souches). Lanalyse des profils de digestion des plasmides portant les gènes blaCTX-M par les enzymes de restriction, dhybridation et des profils génotypiques des souches cliniques productrice de ces enzymes par ERIC-PCR a montré que la dissémination de la BLSE CTX-M peut se faire soit par transfert de plasmide (on retrouve le même plasmide chez deux souches différentes, E. coli YC-14 et K. pneumoniae YC-17) soit par la même souche dun patient à un autre (E. coli YC-5 = E. coli YC-2). Létude de lenvironnement génétique de ce gène (blaCTX-M-15) par lanalyse des séquences a montré que CTX-M-15 est codée par deux plasmides multirésistants différents, parmi lesquels un (pYC-5b) porte lélément ISEcp1-blaCTX-M-15 flanqué par un site de réplication constituée de 5 paires de bases et inséré dans le transposon Tn2. Une forme tronquée de cet élément a été identifiée chez lautre plasmide (pYC-14). Les BLSE SHV-12, CTX-M-1 et CTX-M-15 sont décrites pour la première fois au Cameroun. Dans le but de rechercher de nouveaux inhibiteurs des β-lactamases plus actifs, nous avons étudié deux plantes médicinales, Garcinia lucida (Clusiaceae) et Bridelia micrantha (Euphorbiceae) en vue dévaluer leur activité anti- β-lactamase. Les concentrations inhibant 50 % de l'activité de l'enzyme (CI50) des extraits de G. lucida et B. micrantha sont respectivement de 0,01 mg/ml (β-lactamase P99) et de 0,019 mg/ml (β-lactamase OXA-10) indiquant ainsi une bonne inhibition des β-lactamases par les extraits de ces plantes. Le produit 4 issu de la purification par chromatographie haute performance de lextrait de G. lucida est très actif sur la β-lactamase P99 (CI50 = 0,038 mg/ml) alors que les produits 2' et 3' provenant de lextrait de B. micrantha sont actifs sur lenzyme OXA-10 (CI50 de 0,09 mg/ml et 0,11 mg/ml respectivement). La détermination de la structure des composés actifs de ces deux plantes pourrait être une voie importante dans le développement des inhibiteurs des β-lactamases. / Bacteria producing extended-spectrum β-lactamase (ESBL) have been reported in many countries, but there is no information on different type of ESBL-producing enterobacteria in Cameroon. More than 290 β-lactamases have been described and divided into four classes (A, B, C and D) and up to now, there is no good inhibitor which can inhibite all classes of β-lactamases. A total of 267 strains of Enterobacteriaceaae were isolated between 1995-1998 (259 isolates) and 2002 (eight isolates) from pathological products (urines, pus and blood) of patients at the Yaounde Central Hospital. The susceptibility of the isolates to 12 antibiotics (amoxicillin, amoxicillin/clavulanate, piperacillin, imipenem, cefazolin, cefoxitin, cefotaxime, ceftazidime, aztreonam, gentamicin, ofloxacin and trimethoprim/sulfamethoxazole) was determined using the agar diffusion disk method. Imipenem, ofloxacin and ceftazidime were the most active antibiotics against overall enterobacteria with susceptibility rates of 100%, 91% and 88% respectively. High resistance rates were observed to amoxicillin (90%), piperacillin (79%), cefazolin (75%) and trimethoprim/sulfamethoxazole (73%). Enterobacteria isolates (69) resistant to oxyimino-cephalosporin or monobactam were screened for ESBL production by the double disk (DD) synergy test. Thirty-eight (31 from 1995-1998; seven in 2002) were proved positive to the DD synergy test, suggesting the presence of ESBL. The prevalence of ESBL was 12% (31/259) and ESBL-producing strains were Klebsiella spp. (18.8%), Citrobacter spp. (17.6%), Escherichia coli (14.3%) and Proteus spp. (1.8%). Of the 38 ESBL-producing strains, 18 (47.4%) were transferred resistance to oxyimino-cephalosporins to E. coli HK 225, K12 and DH5α. Sixteen of these strains were transferred ESBL gene by conjugation and two by transformation. Resistance to gentamicin and/or trimethoprim/sulfamethoxazole was co-transferred. All transconjugant and transformant strains exhibited ESBL phenotype but remained susceptible to cefoxitin and imipenem. Crude extracts of β-lactamase-producing transconjugants, transformants and clinical strains were able to reduce the diameters of inhibition zones around disks containing penicillins, 1st to 3rd generation cephalosporins or monobactam when tested against a fully susceptible E. coli strains, but had no effect on such zones around cefoxitin-, imipenem- and amoxicillin/clavulanate disks. The determination of isoelectric points (pIs) of the various strains after transfer of resistance determinant showed that transconjugants and transformants strains produced β-lactamases with pIs 5.4 to 8.8. In fact, 12 strains produced β-lactamase with pI 8.2, 2 strains in addition to the above enzyme produced two others enzymes with pIs 5.4 and 8.5. Strains with CTX-M- phenotype produced enzyme (pI 8.4, 1 strain), two (pIs 7.3, 8.8; 2 strains) or three types pIs (5.4, 7.3, 8.8; 1 strain). PCR, PCR/NheI was performed using total or plasmid DNA from 19 strains as templates, and the primers specific to blaSHV, blaCTX-M, blaTEM and blaOXA. Direct sequencing of PCR products revealed that: 14 strains produced SHV-12 ESBL, 5 CTX-M- ESBL (CTX-M-1, one strain; CTX-M-15, 4 strains); four other strains shared non-ESBL TEM-1 (2 producing-SHV-12 strains and 2 producing-CTX-M-strains) and OXA-30 (4 producing CTX-M-15 strains). Analysis of restriction patterns of plasmid carrying blaCTX-M gene, hybridization, and genotyping patterns of CTX-M-clinical strains by ERIC-PCR showed that dissemination of blaCTX-M gene could be done by plasmid transfer (same plasmid in different strains, E. coli YC-14 and K. pneumoniae YC-17) or by strains from patient to patient (same strain, E. coli YC-2=E. coli YC-5). Sequence analysis of genetic environment of blaCTX-M-15 revealed that CTXM-15 was encoded by two different multiresistant plasmids, of which one (pYC-5b) carried an ISEcp1-blaCTX-m-15 element flanked by five bp target site duplication and inserted within a Tn2-derived sequence. A truncated form of this element in the second plasmid (pYC-14) was identified. ESBLs SHV-12, CTX-M-1, CTX-M-15 are described for the first time in Cameroon. In our effort to find new active β-lactamase inhibitors, we investigated two medicinal plants, Garcinia lucida (Clusiaceae) and Bridelia micrantha (Euphorbiaceae) for anti- β-lactamase activity. The extracts from G. lucida and B. micrantha exhibited good inhibition of β-lactamase P99 (IC50, 0.01 mg/ml) and OXA-10 (IC50, 0.02 mg/ml) respectively. Purified products from these plants by high performance liquid chromatography showed that, product 4 from G. lucida is very active on β-lactamase P99 (IC50, 0.03 mg/ml) whereas products 2 and 3 from B. micrantha are active on OXA-10 (IC50, 0.09 mg/ml; 0.11 mg/ml respectively). The structural elucidation of the active constituents of these plants will provide useful leads in the development of β-lactamase inhibitors.

L'augmentation et la dissémination de la résistance aux antibiotiques chez les bactéries à gram-negatif, particulièrement les Entérobactéries, les bactéries du genre Pseudomonas et Acinetobacter, représentent un problème majeur de santé publique au niveau mondial. Les infections nosocomiales causées par les bactéries multi-résistantes (BMR) ont conduit non seulement à une augmentation de la mortalité, de la morbidité, et du coût de traitement, mais aussi continuent de mettre en danger la vie des patients surtout immunodéprimés en milieu hospitalier. Bien entendu, l'utilisation abusive et non contrôlée des antibiotiques a grandement contribué à la large diffusion des déterminants de la résistance; cependant, des études récentes ont démontré que ces déterminants de la résistance pouvaient émerger à partir de sources anciennes et/ou environnementales. Ainsi, face à cette préoccupation mondiale, plusieurs études ont été rapportées avec des recommandations importantes de conduire des études épidémiologiques, moléculaires, et génomiques afin de contrôler la diffusion et l'augmentation de la résistance aux antibiotiques. De plus, durant ces 10 dernières années, nous avons assisté à l'emergence et au développement de nouvelles technologies de séquençage à haut débit coïncidant avec une augmentation exponentielle du nombre de genomes bactériens séquencés. / The increase and spread of multidrug-resistant (MDR) gram-negative bacteria especially Enterobacteriaceae, Pseudomonas, and Acinetobacter (E.P.A) species have become a major concern worldwide. The hospital-acquired infections caused by MDR bacteria have led not only to an increase in mortality, morbidity, and cost of treatment, but also continue to endanger the life of patients, especially those immunocompromised. Although the frequent misuse of antibiotic drug has greatly contributed to worldwide dissemination and resistance to antibiotics; recent studies have shown that these resistance determinants could emerge from ancient or environmental sources. Front of this worldwide concern, several studies have been reported with significant recommendations to conduct molecular epidemiology, and genomic studies, in order to control the increase and the dissemination of the antibiotic resistance. Moreover, during these last 10 years, we are witnessing the emergence and development of new technologies of high throughput sequencing and coinciding with an exponential increase of number of bacterial genomes sequenced today. Therefore, it is in this context that the project of this thesis was conducted with three essential objectives: (i) the genome sequencing of clinical MDR bacteria, the analysis and the identification of the mechanisms and the genetic determinants of antimicrobial resistance (ii) the achievement of molecular epidemiology studies from clinical MDR bacteria responsible of outbreak (iii) the development and implementation of molecular tools for monitoring and diagnosis of potential MDR bacteria.

L'augmentation et la dissémination de la résistance aux antibiotiques chez les bacilles à Gram-négatif, particulièrement les Entérobactéries, les bactéries du genre Pseudomonas et Acinetobacter, représentent un problème majeur de santé publique. Les infections nosocomiales causées par les bactéries multi-résistantes ont conduit non seulement à une augmentation de la mortalité, de la morbidité et du coût de traitement, mais aussi continuent à mettre en danger la vie des patients surtout immunodéprimés. L'utilisation abusive et non contrôlée des antibiotiques a grandement contribué à la large diffusion de la résistance aux antibiotiques. Cependant, des études récentes ont démontré que cette résistance pouvait émerger à partir de sources anciennes et/ou environnementales. Ainsi, face à cette préoccupation mondiale et suite à de nombreuses recommandations, plusieurs études épidémiologiques et moléculaires ont été rapportées afin de contrôler et surveiller la diffusion et la dissémination de la résistance aux antibiotiques. Il est cependant prioritaire de développer des nouveaux outils de surveillance de la résistance aux antibiotiques. C'est dans cette optique que ce projet de thèse s'articule avec comme objectifs :- Le développement et la mise en place de nouveaux outils et logiciels de surveillance et de diagnostic des bactéries multi-résistantes, - La réalisation des études d'épidémiologie moléculaire sur les isolats cliniques de bactéries multi-résistantes responsables d'épidémies. / The increase and spread of multidrug-resistant (MDR) gram-negative bacteria especially Enterobacteriaceae, Pseudomonas, and Acinetobacter (E.P.A) species have become a major concern worldwide. The hospital-acquired infections caused by MDR bacteria have led not only to an increase in mortality, morbidity, and cost of treatment, but also continue to endanger the life of patients, especially those immunocompromised. Although, the frequent misuse of antibiotic drug has greatly contributed to worldwide dissemination of antibiotics resistance. Recent studies have shown that these resistance determinants could emerge from ancient or environmental sources. Front of this worldwide concern, and various recommendations, several epidemiological and molecular studies have been reported in order to control the spread and the dissemination of the antibiotic resistance. However, it is a priority to develop new tools for monitoring antibiotic resistance. Therefore, it is in this context that the project of this thesis was conducted with two essential objectives: -The development and implementation of news tools and software for monitoring and diagnosis of potential MDR bacteria. -The achievement of molecular epidemiology studies from clinical MDR bacteria responsible of outbreak.

L’augmentation et la dissémination de la résistance aux β-lactamines chez les bacilles à Gram négatif, particulièrement les Entérobactéries, les bactéries du genre Pseudomonas et Acinetobacter, représentent un problème majeur de santé publique. Les infections nosocomiales causées par ces bactéries multi-résistantes (BMR) ont conduit à une augmentation de la mortalité, de la morbidité et du coût de traitement. L’utilisation abusive et non contrôlée de ces antibiotiques a grandement contribué à la large diffusion de cette résistance. Ainsi, face à cette préoccupation mondiale et suite à de nombreuses recommandations, plusieurs études épidémiologiques et moléculaires ont été rapportées afin de contrôler et de surveiller la diffusion et la dissémination des BMR. Contrairement à de nombreuses régions dans le monde, il existe peu d’informations concernant la caractérisation moléculaire des gènes de résistance aux β-lactamines des bacilles à Gram négatif isolés en Tunisie et surtout en Libye. C’est dans cette optique que ce projet de Thèse de Doctorat s’articule avec comme objectifs: (i) mettre en évidence la prévalence des bacilles à Gram négatifs multi-résistants isolés aux niveaux des hôpitaux tunisiens et libyens (ii) identifier le support génétique de la résistance aux β-lactamines de ces souches cliniques (iii) étudier la diversité clonale des souches multi-résistantes par typage moléculaire. / The increase and spread of β-lactam resistance in gram negative bacteria especially Enterobacteriaceae, Pseudomonas and Acinetobacter (E.P.A) species have become a major concern worldwide. The hospital-acquired infections caused by MDR bacteria have led to an increase in mortality, morbidity and cost of treatment. The frequent misuse of antibiotic drug has greatly contributed to worldwide dissemination of antibiotics resistance. Front of this worldwide concern, and various recommendations, several epidemiological and molecular studies have been reported in order to control the spread and the dissemination of these MDR. Unlike many parts of the world, there is little information concerning the molecular characterization of the β-lactam resistance genes of Gram-negative bacilli isolated in Tunisia and especially in Libya. Therefore, it is in this context that the project of this thesis was conducted with essential objectives: (i) highlight the prevalence of multi-resistant Gram negative bacilli isolated in Tunisian and Libyan hospitals (ii) identify the genetic support of resistance to β-lactams of these clinical strains (iii) study the clonal diversity of the multi-resistant strains by molecular typing (iii) study the molecular epidemiology of these BMRs in these countries in order to control the decision-making process of the treatment and the rapid identification of epidemics by implementing appropriate control measures for the spread of infections and especially developing new tools and software for the diagnosis and monitoring of potential MDR bacteria in Mediterranean countries.