Orientador: Mara Correa Lelles Nogueira / Coorientador: Doroti de Oliveira Garcia / Banca: Ana Cristina Gales / Banca: Afonso Luis Barth / Banca: Aripuanã Sakura Aranha Watanabe / Banca: Margarete Teresa Gottardo de Almeida / Resumo: O aumento nas taxas de infecção por K. pneumoniae produtoras de KPC tornou-se um sério problema de saúde pública mundial. Estas enzimas hidrolizam carbapenêmicos, oxyimino-cefalosporinas, cefamicinas e não são inibidas por inibidores das -lactamases tais como o ácido clavulânico, sulbactam e tazobactam. Além disso, em plasmídeos que carreiam o gene blaKPC, geralmente são encontrados genes de resistência a outros antimicrobianos, como quinolonas e aminoglicosídeos. Deste modo, o objetivo deste estudo foi investigar, de forma comparativa, a presença de genes de resistência aos aminoglicosídeos, quinolonas e - lactâmicos entre K. pneumoniae produtoras de KPC, provenientes de diversos hospitais da cidade de São Paulo e de um hospital terciário localizado em São José do Rio Preto, região noroeste do estado de São Paulo. A similaridade genética e a relação clonal entre as cepas isoladas em cada região também foram determinadas. Foram estudadas cem cepas de K. pneumoniae produtoras de KPC, sendo cinquenta de hospitais da cidade de São Paulo, armazenadas na coleção do Instituto Adolfo Lutz de São Paulo, denominadas SP, e cinquenta do Hospital de Base de São José do Rio Preto, denominadas KP. O gene blaCTX-M foi detectado em 76% das cepas KP e em 58% das cepas SP. Entre as cepas KP, 68,4% apresentaram blaCTX-M-15, 23,7% blaCTX-M-2, 2,6%% blaCTX-M-59, 2,6% blaCTX-M-15 e blaCTX-M-59 simultaneamente e 2,6% não identificado. Entre as cepas SP, 51,7% apresentaram blaCTX-M-2, 37,9% blaCTX-M-15, 2,5% blaCTX-M-15 e blaCTX-M-2 simultaneamente e 5% blaCTX-M-14. Dos sete genes de AMEs investigados, foram detectados cinco, sendo aph(3')-VI, aph(3')-Ia, aac(6')- Ib, aac(3)-Ia e aac(3)IIa, distribuídos entre 95% das cepas, sem diferença entre KP e SP. Dos sete genes de metiltransferases 16S RNAr, apenas o gene rmtB foi detectado, em duas cepas SP. Quanto aos genes determinantes de resistência às quinolonas, 42% das cepas KP... / Abstract: The increase in infection rates by KPC producing K. pneumoniae is a serious global public health problem. These enzymes hydrolyze carbapenems, oxyimino-cephalosporins, cephamycins, and -lactamase inhibitors such as clavulanic acid, sulbactam and tazobactam. In addition, the plasmids carrying blaKPC genes generally harbor other antimicrobial resistance genes. Thus, the aim of this study was to investigate, in a comparative way, the presence of genes conferring resistance to aminoglycosides, quinolones and -lactams between KPC producing K. pneumonia from various hospitals in São Paulo City and from a tertiary hospital located in Sao Jose do Rio Preto, northwest of São Paulo state. The genetic similarity and the clonal relationship among strains were also determined. One hundred isolates were studied: fifty from different hospitals in São Paulo (named SP), and fifty from the "Hospital de Base de São José do Rio Preto" (named KP). The blaCTX-M gene was detected in 76% of the KP strains and in 58% of the SP strains. Among the KP strains, 68.4% had blaCTX-M-15, 23.7% blaCTX-M-2, 2.6% blaCTX-M-59, 2.6% blaCTX-M-15 and blaCTX M-59 simultaneously, and 2.6% were unidentified. Among the SP strains, 51.7% presented blaCTX-M-2, 37.9% blaCTX-M-15, 2.5% blaCTX-M-15 and blaCTX-M-2 simultaneously, and 5% blaCTX-M-14. Regarding the genes for AMEs, among the seven types investigated, five were detected: aph (3') -VI, aph (3 ') - Ia, aac (6') - Ib, aac (3) -Ia and aac (3) IIa were detected among 95% of the strains, and no difference was observed between KP and SP strains. Among the seven genes for 16S rRNA methyltransferases, only the rmtB was detected, in two SP strains. Concerning genes that determine resistance to quinolones, 42% of he KP and 14% of the SP strains showed qnrB. The oqxAB gene was detected in 56% and 2% of the SP and KP strains, respectively. Molecular typing by ERIC-PCR revealed that genetical... / Doutor

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-04-16T14:40:02Z No. of bitstreams: 1 FernandaNomiyamaFigueiredoDissertacao2018.pdf: 2178476 bytes, checksum: 23f38c14567d00ff189eaef20f904495 (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-04-16T14:40:47Z (GMT) No. of bitstreams: 1 FernandaNomiyamaFigueiredoDissertacao2018.pdf: 2178476 bytes, checksum: 23f38c14567d00ff189eaef20f904495 (MD5) / Made available in DSpace on 2018-04-16T14:40:47Z (GMT). No. of bitstreams: 1 FernandaNomiyamaFigueiredoDissertacao2018.pdf: 2178476 bytes, checksum: 23f38c14567d00ff189eaef20f904495 (MD5) Previous issue date: 2018-03-06 / Klebsiella pneumoniae is one of the main bacterial agents that may cause infections related to health care assistance. K. pneumoniae frequently carries the resistance gene K. pneumoniae carbapenemase (KPC). Currently, tigecycline can be considered one of the last therapeutic options for KPC, but reports of tigecycline-resistant KPC isolates are on the rise, being indicated as most common mechanism the increased AcrAB-TolC efflux pump system expression. However, molecular tigecycline resistance mechanisms associated to AcrAB-TolC still remains obscure. Thus, the main goal of this study was to verify if tigecycline resistance can be related to the presence of mutations in the regulatory genes of AcrAB-TolC, AcrR and RamR. Therefore, 32 K. pneumoniae isolates were used, identification and antibiogram performed using Vitek 2 systems. The minimum inhibitory concentrations were confirmed using E-test. Primers were designed in order to verify mutations within AcrR and RamR genes. PCR analysis showed that the mutations found within these genes were transversions (94% for AcrR and 90% for RamR) and transitions (6% for AcrR and 10% for RamR). Nevertheless among the mutations, no distinction between tigecycline susceptible and resistant isolates was found. Some of the transversions caused change in the amino acid encoding 6 in AcrR and 15 in RamR. Presence of these types of mutations evaluation can be seen as the first bacterial resistance study step, as it may be caused by oxidative damage for bacterial DNA, frequently caused by antibiotic selective pressure. Tigecycline resistance found in this study`s clinical isolates may be associated to alterations in another genes that can trigger mechanisms associated to this antibiotic. / Klebsiella pneumoniae consiste em um dos principais agentes bacterianos causadores de infec????es relacionadas ?? assist??ncia ?? sa??de (IRAS). K. pneumoniae carrega frequentemente o gene de resist??ncia K. pneumoniae carbapenemase (KPC). Atualmente, a tigeciclina pode ser considerada uma das ??ltimas op????es terap??uticas para KPC, mas os relatos de isolados de KPC resistentes a tigecilina est??o em ascens??o, sendo a hiperexpress??o da bomba de efluxo AcrAB-TolC indicado como mecanismo mais comum. No entanto, os mecanismos moleculares de resist??ncia ?? tigeciclina associada ao AcrAB-TolC permanecem obscuros. Desta forma o objetivo deste trabalho foi verificar se a resist??ncia a tigeciclina pode estar relacionada ?? presen??a de muta????es nos genes ArcR e RamR, reguladores de AcrAB-TolC. Para tanto, 32 isolados de K. pneumoniae foram utilizados, sendo a identifica????o e o antibiograma feitos utilizando o sistema Vitek 2. A confirma????o das concentra????es inibit??rias m??nimas (CIMs) foram realizadas por E-test. Iniciadores foram desenhados para verifica????o de muta????es nos genes (AcrR e RamR). As an??lises por PCR mostraram que as muta????es encontradas nos genes AcrR e RamR foram substitui????es por transvers??o (94% e 90% para AcrR e RamR respectivamente) e transi????o (6% e 10% para AcrR e RamR respectivamente), por??m n??o foi identificada distin????o da presen??a de muta????es entre isolados sens??veis e resistentes a tigeciclina. Algumas tranvers??es ocasionaram mudan??a na codifica????o do amino??cido, sendo 6 em AcrR e 15 em RamR. A avalia????o da presen??a desses tipos de muta????es consiste em um primeiro passo para o estudo da resist??ncia bacteriana, j?? que pode ser causada por dano oxidativo ao DNA bacteriano, frequentemente ocasionado por press??o seletiva dos antibi??ticos. A resist??ncia a tigeciclina encontrada nos isolados cl??nicos do presente estudo, provavelmente pode estar associada a altera????es em outros genes desencadeadores de mecanismos de resist??ncia a tigeciclina.

Klebsiella pneumoniae (KP) pertence à família Enterobacteriaceae e é frequentemente isolada em infecções nosocomiais, reportada globalmente como uma das mais importantes causas de bacteremias. O seu tratamento usual com β-lactâmicos foi posto a prova na década de 80, com o surgimento de cepas produtoras de β-lactamases de espectro estendido (ESBLs), e posteriormente com as carbapenemases, como sua principal representante Klebsiella pneumoniae carbapenemase (KPC), capazes de hidrolisar todos os β-lactâmicos. Apesar das limitadas opções, em geral as Klebsiella pneumoniae produtoras de KPC (KP-KPC) apresentam susceptibilidade às polimixinas, aminoglicosídeos e tigeciclina, que são comumente aplicadas em regimes terapêuticos combinados, dependente dos perfis de sensibilidade ou resistência a estas drogas, mas dos quais ainda não há informações suficientes para a definição do tratamento mais adequado. A escassez de opções terapêuticas é um dos fatores que contribuem para os altos índices de mortalidade das infecções por K. pneumoniae, de cerca de 40%. Assim, se fazem necessárias avaliações dos perfis fenotípicos de isolados de KP-KPC e a caracterização da disseminação deste mecanismo de resistência, avaliando a presença de perfis clonais relacionados dentro da população. A partir deste cenário, os objetivos deste trabalho foram determinar as concentrações inibitórias mínimas (CIMs) frente à polimixina B (PMB), meropenem (MEM) e tigeciclina (TGC), os perfis de sensibilidade frente a outras drogas comumente utilizadas no tratamento destas infecções, assim como caracterizar molecularmente as amostras resistentes à PMB. Para a determinação das CIMs e dos perfis de susceptibilidade foram utilizadas as técnicas de microdiluição em caldo e disco-difusão, respectivamente, e o perfil molecular foi analisado através de técnica de macrorestrição de DNA seguida por PFGE. Foram incluídas neste estudo 158 amostras isoladas de corrente sanguínea, de quatro hospitais terciários de Porto Alegre. Destas 158 amostras, nenhuma foi sensível a MEM de acordo com o Clinical and Laboratory Standard Institute (CLSI), 118 (74,7%) a PMB utilizando a recomendação do European Committee on Antimicrobial Susceptibility Testing (EUCAST), e 94 (59.5%) à TGC considerando EUCAST ou 137 (86.7%) de acordo com o Food and Drug Administration (FDA). Um total de 48 (30.4%), 28 (17.7%) e 16 (10.1%) isolados foram considerados sensíveis à amicacina (AMK) de acordo com CLSI, EUCAST e USCAST, respectivamente, e 11 (7.0%), 9 (5.7%) e 9 (5.7%) reportados como sensíveis à gentamicina (GEN) de acordo com CLSI, EUCAST e USCAST, respectivamente. Doxiciclina foi o antimicrobiano mais ativo (24, 60.0%) frente aos 40 (25,3%) isolados resistentes a PMB. Destes 40 isolados, 29(72.5%) foram caracterizados molecularmente sendo encontrados 18 clones, dos quais cinco perfis clonais foram identificados em mais de um hospital. Neste estudo, pudemos demonstrar um importante aumento nos níveis de resistência às polimixinas, acompanhado por um desafiador perfil de susceptibilidade frente as outras opções terapêuticas disponíveis, ainda que os índices de sensibilidade destas drogas variem de acordo com os pontos de corte de cada comitê. Quanto à caracterização molecular, a detecção de dezoito clones diferentes e a presença do mesmo perfil em mais de um hospital provavelmente estão associadas à emergência de resistência mediada por mutações, assim como a um processo de disseminação horizontal. / Klebsiella pneumoniae (KP) belongs to the family Enterobacteriaceae and is frequently isolated in nosocomial infections, reported globally as one of the most important causes of bacteremia. Its usual β-lactam treatment was challenged in the 1980s with the emergence of extended-spectrum β-lactamase producing (ESBLs) strains, and later with carbapenemases, as its main representative Klebsiella pneumoniae carbapenemase (KPC), capable of hydrolyze all β-lactam. Despite the limited options, KPC-producing Klebsiella pneumoniae (KPC-KP) are generally susceptible to polymyxins, aminoglycosides and tigecycline, which are commonly applied in combination therapy regimens depending on levels of sensitivity or resistance to these drugs, but of which there is still insufficient information to define the most appropriate treatment. The scarcity of therapeutic options is one of the factors that contribute to the high mortality rates of K. pneumoniae infections, of around 40%. Thus, it is necessary to evaluate the phenotypic profiles of KPC-KP isolates and the characterization of the dissemination of this resistance mechanism, evaluating the presence of related clonal profiles within the population. From this scenario, the objectives of this study were to determine the minimum inhibitory concentrations (MICs) against polymyxin B (PMB), meropenem (MEM) and tigecycline (TGC) by broth microdilution and the susceptibility profiles to aminoglycosides and other drugs by disk-diffusion method, as well as to evaluate the molecular profile of KPC-KP isolates from four tertiary hospitals in Porto Alegre. A total of 158 samples were included in this study, where none were sensitive to MEM according to the Clinical and Laboratory Standard Institute (CLSI), 118 (74.7%) to PMB using the recommendation of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), and 94 (59.5%) to TGC considering EUCAST or 137 (86.7% %) according to Food and Drug Administration (FDA). A total of 48 (30.4%), 28 (17.7%) and 16 (10.1%) isolates were considered susceptible to amikacin (AMK) according to CLSI, EUCAST and USCAST, respectively, and 11 (7.0%), 9 %) and 9 (5.7%) reported as sensitive to gentamicin (GEN) according to CLSI, EUCAST and USCAST, respectively. Doxycycline was also the most active antimicrobial (24, 60.0%) against 40 (25.3%) PMB resistant isolates. Of these 40 isolates, 29 (72.5%) were clonally related, resulting in 18 clones, where five profiles were identified in more than one hospital. In this study, we could demonstrate an important increase in the levels of resistance to polymyxins, accompanied by a challenging profile of susceptibility to other drugs, although the sensitivity indexes of the latter vary significantly according to the breakpoints of each committee. As for molecular characterization, the detection of eighteen different clones and the presence of the same profile in more than one hospital are probably associated with the emergence of resistance mediated by mutations, as well as a process of horizontal dissemination.

Dentre as principais preocupações relacionadas à cadeia de produção do biodiesel está o excedente de glicerina bruta. Esta corresponde a cerca de 10% da massa total resultante do processo de produção do biodiesel e vem sendo acumulada e armazenada nas usinas, formando grandes estoques de resíduos e deixando diversas empresas diante de um passivo ambiental agravante. Uma forma de diminuir esse problema é utilizá-la para formulação de meios de fermentação para obtenção de produtos de interesse econômico. Exemplos são as produções de dióis como; 1,3-Propanodiol (1,3-PD) e 2,3-Butanodiol (2,3-BD). Estes são monômeros de grande aplicação no mercado, sendo o 1,3-PD usado para fabricação de poliuretanos, compostos cíclicos e novos tipos de poliésteres. O 2,3-BD é utilizado como anticongelante, biocombustível e como um importante aromatizante. Assim, no presente trabalho propõe-se valorizar a glicerina residual da fabricação de biodiesel, visando sua bioconversão em 2,3-BD e 1,3-PD, pela bactéria Klebsiella pneumoniae NRRL B199. Para tanto, a proposta deste trabalho compreendeu quatro etapas conjuntas: 1. Estabelecer um tratamento adequado para a glicerina residual de forma a permitir o crescimento bacteriano e formação dos dióis. 2. Adequar à composição do meio de fermentação, quanto às concentrações de glicerol, com suplementação de glicose, extrato de levedura e elementos traço Fe2+, Zn2+ e Mn2+ no processo fermentativo. 3. Definir a melhor condição de transferência de oxigênio em sistema descontínuo, associada à concentração de substrato, para a melhor formação de produtos. 4. Avaliar o procedimento de separação dos produtos do meio pela técnica de salting-out. Os estudos da etapa 1 e 2 foram realizados em frascos Erlenmeyer de 250 mL com 50 mL de meio. Na etapa 3, o estudo de aeração e agitação foi realizado em fermentador Bioflo III (New Brunswick Sci. Co.) de 1,25 L. Com os resultados obtidos, concluiu-se que o tratamento realizado foi adequado para o emprego da glicerina residual como fonte de carbono para o crescimento da bactéria Klebsiella pneumoniae. Além disso, os trabalhos realizados em frascos revelaram uma produção máxima, em agitação de 200 rpm, de 0,545 g/L.h de 2,3-BD e produção de 0,180 g/L.h de 1,3-PD em agitação de 160 rpm. Sendo que a glicose e o extrato de levedura tiveram efeitos positivos e significativos na produtividade de 2,3-BD e 1,3-PD. Nos ensaios onde foram utilizados maiores transferência de oxigênio observou-se decréscimos na produção de 1,3-PD e uma melhora significativa na produção de 2,3-BD. No estudo de recuperação dos dióis, foi possível recuperar 82% dos dióis utilizando carbonato de potássio 70% na temperatura de 20 ºC e no tempo de reação de 6 horas. / Among the main concerns related to the production of biodiesel is the surplus of crude glycerine. This corresponds to approximately 10% of the total mass of the biodiesel production process and has been accumulated and stored in the biodiesel plants, creating enormous amounts of waste and serious environmental problems. A way to lessen this problem is to use it for the formulation of fermentation medium to obtain products of economic interest. Examples are the production of diols such as, 1,3-propanediol (1,3-PD) and 2,3-butanediol (2,3-BD). These monomers are large market application, and the 1,3-PD used for the manufacture of polyurethanes, cyclic compounds and new types of polyesters. The 2,3-BD is used as antifreeze, biofuel and as an important flavoring. Thus, in present work aims to enrich the residual glycerine from biodiesel production to its bioconversion in 2,3-BD and 1,3-PD by bacterium Klebsiella pneumoniae NRRL B199. Therefore, the purpose of this consisted of four joint steps: 1st. Establish an appropriate treatment for residual glycerine to allow bacterial growth and diols formation. 2nd. To adapt the composition of fermentation medium, as concentrations of residual glycerine, with glucose supplementation, yeast extract and trace elements of Fe2+, Zn2+ e Mn2+ in the fermentation process. 3rd. Define the best condition of oxygen transfer in a batch system, associated with substrate concentration for the best product formation. 4th. To evaluate the separation procedure of products through the of salting-out technique. Studies of step 1 and 2 were conducted in 250 mL Erlenmeyer flasks with 50 mL medium. In step 3, the study aeration and agitation was performed in Bioflo III fermentor (New Brunswick Sci Co.) was 1,25 L. With the results, it was concluded that the treatment was adequate for use of residual glycerine as carbon source for growth of the bacterium Klebsiella pneumoniae. Furthermore, the work carried out on bottles showed a maximum production 2,3-BD of 0.545 g/L.h in agitation of 200 rpm and production 1,3-PD of 0.180 g/Lh in agitation of 160 rpm. With glucose and yeast extract had positive and significant effects on productivity of 2,3-BD and 1,3-PD. For tests were used higher oxygen transfer observed decrease in the production of 1,3-PD and a significant improvement in the production of 2,3-BD. In the study of recovery of diols, it was possible to recover 82% of diols using 70% potassium carbonate at temperature of 20 °C and in reaction time of 6 hours.

L’émergence et la dissémination récentes de clones hypervirulents et multi-résistants de Klebsiella pneumoniae ont renouvelé l'intérêt général envers Klebsiella. Cependant, notre connaissance de la pathogénèse de Klebsiella au niveau moléculaire et cellulaire reste faible. Dans ce travail, nous avons mené deux axes de recherche focalisés sur la pathogénèse de Klebsiella. Le premier projet visait à caractériser un mutant de capsule de K. pneumoniae incapable de produire une toxine colibactine fonctionnelle. La colibactine est un métabolite secondaire génotoxique produit principalement par des souches commensales et extraintestinales pathogènes d’Escherichia coli, mais également par des souches de K. pneumoniae. Elle induit des cassures double brin conduisant à la formation de tumeurs dans des cancers colorectaux et contribue à une virulence accrue de la bactérie. Cependant la structure, les voies de biosynthèse, la sécrétion et le mode d’action de la colibactine restent à définir. Le laboratoire avait préalablement observé qu’un mutant de capsule de K. pneumoniae n’était pas capable de produire une colibactine fonctionnelle, suggérant un rôle de la capsule dans ce processus. Nous avons ensuite démontré qu’en fait la capsule n’est pas impliquée dans la fonction de la colibactine, et que l’incapacité du mutant de la capsule à produire une génotoxicité est due à une mutation avec un fort effet dominant négatif dans la protéine ClbD, une enzyme essentielle de la voie de synthèse de la colibactine. Nous caractérisons actuellement cette mutation pour comprendre comment elle affecte la structure et la fonction de ClbD. Le second projet étudiait le rôle de la capsule dans la pathogénèse de K. rhinoscleromatis. K. rhinoscleromatis est une sous-espèce de K. pneumoniae, responsable du rhinosclérome, une maladie chronique granulomateuse des voies aériennes supérieures spécifiquement humaine, et caractérisée par la formation de macrophages spumeux atypiques appelés cellules de Mikulicz. Or les mécanismes physiopathologiques de cette pathologie sont peu connus. A l’aide d’un modèle murin, nous avons observé qu’un mutant de capsule de K. rhinoscleromatis est atténué in vivo, mais aussi que les cellules de Mikulicz sont recrutées lors d’une infection avec un inoculum élevé du mutant de capsule de K. rhinoscleromatis. Ces données nous indiquent 1) que la capsule est un facteur de virulence de K. rhinoscleromatis qui n’est pas impliqué dans la formation et le recrutement des cellules de Mikulicz, et 2) que des facteurs spécifiques de K. rhinoscleromatis contrôlant la formation de cellules de Mikulicz existent et restent à identifier. Les nouvelles données concernant la pathogénèse de Klebsiella apportées par notre travail représentent une contribution significative dans la connaissance du rhinosclérome et du rôle d’une enzyme impliquée dans la synthèse de la colibactine, tout en ouvrant de nouveaux axes de recherche sur la pathogénèse de K. pneumoniae et K. rhinoscleromatis / The recent emergence and global expansion of hypervirulent and multidrug-resistant clones of K. pneumoniae have increased general interest in Klebsiella. However, knowledge of Klebsiella pathogenesis at the molecular and cellular level is still scant. We pursued two lines of research focused on Klebsiella pathogenesis. The first aimed to characterize a K. pneumoniae capsule mutant unable to produce a functional colibactin. Colibactin is a genotoxic secondary metabolite produced mainly by commensals and extraintestinal pathogenic E. coli strains, but also by some K. pneumoniae strains. It induces double-strand DNA breaks leading to tumor formation in colorectal cancer and contributes to increased virulence. However, its structure, biosynthesis, secretion and mode of action have yet to be fully defined. Previous work from our laboratory showed that a K. pneumoniae capsule mutant was unable to produce a functional colibactin, suggesting a role for capsule in this process. We report herein that capsule does not in fact have a role in the colibactin effect and that the inability of the capsule mutant to induce DNA damage is due to a strong dominant negative mutation in ClbD, an essential enzyme of the colibactin biosynthetic pathway. We are currently characterizing this mutation to understand how it deeply affects ClbD structure and function. The second project explored the role of capsule (CPS) in K. rhinoscleromatis pathogenesis. K. rhinoscleromatis is a K. pneumoniae subspecies responsible for rhinoscleroma, a human specific chronic granulomatous disease of the upper airways characterized by the formation of atypical foamy macrophages called Mikulicz cells. However, little is known about the pathophysiological mechanisms underlying this disease. Using our mouse model, we report that a K. rhinoscleromatis CPS mutant is attenuated in vivo but also that Mikulicz cells are observed upon infection with higher doses of K. rhinoscleromatis CPS mutant. Altogether, our data indicate that 1) CPS is a virulence factor of K. rhinoscleromatis, which is not involved in the specific appearance of Mikulicz cells and that 2) the K. rhinoscleromatis specific factors controlling the appearance of Mikulicz cells remain to be identified. The new insights brought to Klebsiella pathogenicity by this work represent a significant contribution to the understanding of rhinoscleroma pathogenesis and of the role of an enzyme implicated in colibactin biosynthesis. This opens new lines of research on K. pneumoniae and K. rhinoscleromatis pathogenesis

Klebsiella pneumoniae is a Gram negative, enteric bacterium that frequently causes disease in immunocompromised individuals. These types of infections are often associated with the presence of indwelling medical devices, which provide a site for the organism to attach and subsequently form a biofilm. A key component in K. pneumoniae biofilm formation in vitro is type 3 fimbriae. The two main components of this project have been to determine if type 3 fimbriae are an in vivo virulence factor using a mouse model of catheter associated urinary tract infection (CAUTI) and to examine the mechanism by which the production of type 3 fimbriae are regulated. Using a mouse model in which a silicone tube is implanted into the bladder of mice, mimicking the effects of catheterization, we have been able to show that type 3 fimbriae are required for colonization and persistence. Using different time points and conditions, we demonstrated that there are conditions when type 3 fimbriae alone are sufficient for colonization and other conditions where both type 1 and type 3 fimbriae have unique roles in colonization and persistence. Additionally, competition experiments showed that neither fimbrial mutant alone, or a double mutant in type 1 and type 3 fimbriae could compete with wildtype K. pneumoniae. In most animals, only wild-type bacteria were recovered by 24 hours post-inoculation. This work reinforced the role of type 1 fimbriae in pathogenesis and showed, for the first time, a role for type 3 fimbriae using an in vivo model. Our early work has indicated that type 3 fimbriae are regulated at least in part by the intracellular levels of the secondary messenger molecule cyclic di-GMP. Downstream from the type 3 fimbrial operon a gene encoding a phosphodiesterase is present; the product of this gene breaks down cyclic di-GMP. In the absence of this gene the levels of type 3 fimbrial expression are increased. Also adjacent to the mrk operon is a two-gene operon containing the determinants we have named mrkH and mrkI. mrkH encodes a PilZ domain containing protein, which we have shown binds cyclic di-GMP. Using a transcriptional fusion we have shown that the mrk gene promoter is activated modestly in the presence of MrkH, but when MrkH and MrkI are both present the activity is increased 100-fold. This has lead to the hypothesis that MrkH and MrkI interact, which we have been able to demonstrate using copurification procedures. This interaction appears to occur in a cyclic di-GMP dependent manner with the resulting protein complex binding to the mrk promoter region and activating the expression of type 3 fimbriae.

Orientador: James Venturini / Resumo: Devido ao crescente isolamento de espécimes de Klebsiella pneumoniae resistentes a praticamente todas as classes de drogas antimicrobianas, a busca por novas drogas que sejam alternativa terapêutica para o tratamento das infecções por eles causadas se torna relevante. Nesse contexto, a complexação de íons metálicos a drogas antimicrobianas é uma das abordagens empregadas, uma vez que é possível gerar novas drogas com atividade superior as drogas já existentes. No presente estudo, foi realizada a síntese de metalofármaco por reação de coordenação entre sulfato de polimixina B e cobre (II). O produto desta reação foi caracterizado e sua atividade antimicrobiana frente a espécimes de K. pneumoniae resistentes aos carbapenêmicos e à polimixina B foi avaliada. Os resultados demonstraram que as concentrações inibitórias mínimas (MIC) do complexo sintetizado foram menores em relação aos MICs de polimixina B para 44,44% dos espécimes avaliados; para 33,33% dos espécimes os MIC’s foram equivalentes, e para 22,23% dos espécimes os MIC’s do complexo foram superiores aos MIC’s da polimixina B. Esses resultados são promissores, uma vez que houve um incremento na atividade bacteriana da polimixina complexada ao metal para quase metade dos espécimes avaliados, mostrando que a síntese de novas drogas antimicrobianas através da complexação de íons metálicos é uma técnica que deve ser mais explorada. Além disso, nossos resultados devem conduzir a novos estudos que visem a melhor compreensão da... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Due to the increasing isolation of Klebsiella pneumoniae specimens resistant to virtually all classes of antimicrobial drugs, the research for new drugs that are alternative therapeutics for the treatment of infections caused by them becomes relevant. In this context, the complexation of metal ions to antimicrobial drugs is one of the approaches used, since it is possible to generate new drugs with higher activity than existing drugs. In the present study, metallodrugs synthesis was performed by a coordination reaction between polymyxin B sulfate and copper (II). The product of this reaction was characterized and its antimicrobial activity against specimens of K. pneumoniae resistant to carbapenems and polymyxin B was evaluated. The results showed that the minimum inhibitory concentrations (MIC) of the synthesized complex were lower than the polymyxin B MICs for 44.44% of the evaluated specimens; for 33.33% of the specimens the MICs were equivalent, and for 22.23% of the specimens the MICs of the complex were superior to the MICs of polymyxin B. These results are encouraging, since there was an increase in the bacterial activity of metal complexed polymyxin for almost half of the evaluated specimens, showing that the synthesis of new antimicrobial drugs through the complexation of metallic ions is a technique that should be further explored. In addition, our results should lead to further studies aiming to a better understanding of the structure, mechanisms of action, toxicit... (Complete abstract click electronic access below) / Mestre

As part of a health survey of New Zealand sea lions (Phocarctos hookeri) on Enderby Island, Auckland Islands (50°30’S, 166°17’E), neonatal mortality was continuously monitored at the Sandy Bay Beach rookery, from 1998/1999 to 2004/2005. The primary causes of death were categorised as trauma (35%), bacterial (24%) and hookworm (13%) infections, starvation (13%) and stillbirth (4%). During the 2001/2002 and 2002/2003 breeding seasons, bacterial epidemics caused by Klebsiella pneumoniae increased mortality by three times the mean in non-epidemic years. Uncinaria spp. from New Zealand sea lion (NZSL) pups was described for the first time using morphometric criteria. It differed from the two species already described in pinnipeds, Uncinaria lucasi and Uncinaria hamiltoni, suggesting the existence of a different morphotype in NZSLs. A study on the epidemiology of hookworm infection showed that all pups up to at least three months of age harboured adult hookworms in their intestines and transmammary transmission was identified as the route of infection of NZSL pups. Uncinariosis as a primary cause of mortality was generally associated with anaemia, haemorrhagic enteritis and frank blood in the lumen. The relationship between hookworm burden and clinical disease could not be clearly established. The 2001/2002 and 2002/2003 bacterial epidemics at Sandy Bay Beach rookery were caused by a clonal strain of Klebsiella pneumoniae as verified by pulse-field gel electrophoresis and antimicrobial testing. Suppurative arthritis was the most common post-mortem diagnosis during the two epidemic seasons. Internal lesions were consistent with septicaemia, which explained the wide range of organs from which the pathogen was grown in pure culture. A serological test investigating the exposure of NZSLs to Klebsiella spp. showed that the large majority of pups up to two months of age did not have any anti-Klebsiella antibodies, even after the epidemics, but that almost all the adults were seropositive. In addition, passive immunoglobulin (Ig) transfer from lactating females to neonates was examined by measuring IgG levels in pups and was very low compared to terrestrial mammals although similar to other pinniped neonates.

The global increase in antibiotic resistance levels in bacteria is a growing concern to our society and highlights the need for alternative strategies to combat bacterial infections. Bacterial viruses (phages) are the natural predators of bacteria and are as diverse as their hosts, but our understanding of them is limited. The current levels of knowledge regarding the role that phage play in the control of bacterial populations are poor, despite the use of phage therapy as a clinical therapy in Eastern Europe. The aim of this doctoral thesis is to increase knowledge of the diversity and characteristics of bacterial viruses and to assess their potential as therapeutic agents towards multi-resistant bacteria. Paper I is the product of de novo sequencing of newly isolated phages that infect and kill multi-resistant Klebsiella pneumoniae. Based on similarities in gene arrangement, lysis cassette type and conserved RNA polymerase, the creation of a new phage genus within Autographivirinae is proposed. Paper II describes the genomic and proteomic analysis of a phage of the rare C3 morphotype, a Podoviridae phage with an elongated head that uses multi-resistant Escherichia coli as its host. Paper III describes the study of a pre-made phage cocktail against 125 clinical K. pneumoniae isolates. The phage cocktail inhibited the growth of 99 (79 %) of the bacterial isolates tested. This study also demonstrates the need for common methodologies in the scientific community to determine how to assess phages that infect multiple serotypes to avoid false positive results. Paper IV studies the effects of phage predation on bacterial virulence: phages were first allowed to prey on a clinical K. pneumoniae isolate, followed by the isolation of phage-resistant bacteria. The phage resistant bacteria were then assessed for their growth rate, biofilm production in vitro. The virulence of the phage resistant bacteria was then assessed in Galleria mellonella. In the single phage treatments, two out of four phages showed an increased virulence in the in G. mellonella, which was also linked to an increased growth rate of the phage resistant bacteria. In multi-phage treatments however, three out of five phage cocktails decreased the bacterial virulence in G. mellonella compared to an untreated control. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.</p>

The prevalence of Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBLs) and carbapenemases is increasing worldwide. Therapeutic options for infections with these bacteria are limited not only by the production of ESBLs and carbapenemases, which confer resistance to cephalosporins and carbapenems, but also by frequent co-resistance to other antibiotics. The overall aim of this thesis was to obtain a better understanding of multidrug-resistant E. coli and K. pneumoniae in relation to epidemiology, selection and susceptibility to antibiotic therapy. In a prospective study ESBL-producing E. coli was found to spread easily through international travel. Twenty-four of 100 Swedes travelling outside Northern Europe acquired ESBL-producing E. coli in the intestinal flora. The risk was highest for travelers visiting India and those suffering from gastroenteritis during travel. To minimize selection of ESBL-producing K. pneumoniae during a hospital outbreak with these bacteria, an educational antibiotic intervention was performed at Uppsala University Hospital in 2006. The primary aim of the intervention was to reduce the consumption of parenteral cephalosporins. An immediate and radical reduction of cephalosporins was demonstrated with interrupted time series analysis. The outbreak declined during 2007 and no increased resistance to replacement antibiotics was detected. The impact of ESBL production on the antibacterial activity of ertapenem was studied in time-kill experiments. It was shown that porin-deficient subpopulations with reduced susceptibility to ertapenem frequently emerged in ESBL-producing E. coli during exposure to ertapenem at concentrations simulating human pharmacokinetics. Further, the antibacterial effects of antibiotic combinations against four strains of K. pneumoniae producing carbapenemases of the metallo-beta-lactamase type were studied in time-kill experiments. Double and triple combinations of aztreonam, fosfomycin, meropenem, rifampin and colistin at clinically relevant static concentrations were effective despite that the bacteria were frequently resistant to the individual drugs. These results indicate that there is a largely unexplored potential of antibiotic combination therapy for multidrug-resistant K. pneumoniae.