Stenotrophomonas maltophilia é um bacilo Gram-negativo, não fermentador, considerado um microorganismo pouco virulento, relacionado principalmente a infecções associadas à assistência a saúde. A S. maltophilia apresenta um padrão de resistência intrínseca à maioria das classes de antibióticos. A droga de escolha para o tratamento das infecções por S. maltophilia é a sulfametoxazol/ trimetoprima (SMX/TMP). Entretanto, estudos atuais relatam o aumento da resistência a esse antibiótico, o que limita assim as opções para terapia efetiva. Outras opções de tratamento são o levofloxacino e a tigeciclina, porém, faltam estudos clínicos e in vitro dessas drogas. A proposta deste estudo foi avaliar os possíveis mecanismos de resistência a SMX/TMP e as quinolonas em isolados clínicos de pacientes internados no Instituto Central do Hospital das Clínicas e do Hospital A.C. Camargo. Foram avaliadas 106 amostras de S. maltophilia isoladas de pacientes adultos com infecção relacionada à assistência a saúde, internados no Instituto Central do Hospital das Clínicas da FMUSP e no Hospital de Câncer A.C Camargo durante o período de dezembro de 2008 a dezembro de 2010. A sensibilidade à SMX/TMP foi de 78,3%, para levofloxacino de 82% e 14,2% para cirpofloxacino, para minociclina de 100% e tigeciclina 91,6%. Foi realizado PCR para detecção dos genes sul1, sul2 e dfrA1 para avaliar a resistência à SMX/TMP, os genes int1 e iscr2 para avaliação da presença de elementos genéticos móveis e os genes gyrA, qnr, smeD, smeT e aac(6)-Ib-cr para avaliação da resistência as quinolonas. Quatorze amostras (13,2%) foram positivas para o gene sul1. Desses isolados, nove amostras apresentavam resistência ao SMX/TMP com CIM50 de 8 g/mL e CIM90 de 128 g/mL. Cinco amostras positivas para o gene sul1 foram sensíveis a SMX/TMP com CIM50 de 1 g/mL e CIM90 de 1 g/mL. A sequencia do integron1 da amostra com CIM >125 g/mL mostrou um tamanho aproximado de 4000 pb contendo os genes cassetes aac4 e aadA1 e a região qac/sul1. Uma amostra resistente a SMX/TMP foi positiva para o gene sul2 localizado na transposase-like ISCR 2. Observamos a presença de quatro novos qnr em cepas de S. maltophilia e a presença da enzima aac(6)-ib-cr em 4 amostras. 100% das cepas foram positivas para o gene do sistema de efluxo smeDEF e 12/38 amostras tiveram o gene smeT do sistema de efluxo smeDEF, ,porém não foi observada mutação nesse gene. Na sequencia de aminoácidos da girase A de 15 amostras resistentes a levofloxacino não observamos mutações relacionadas à resistência a quinolonas. As cepas resistentes a SMX/TMP apresentaram um padrão policlonal. Dezoito amostras resistentes ao levofloxacino apresentaram 14 perfis clonais, distribuídos em 10 clusters. S. maltophilia exibe múltiplos mecanismos de resistência, nesse estudo observamos um grande número de cepas com elementos genéticos móveis carregando o gene sul1 e outros genes de resistência. A S. maltophilia pode ser um importante reservatório de transmissão de genes de resistência / Stenotrophomonas maltophilia is a gram-negative, non-fermenter, considered a low virulent organism, mainly related to healthcare associated infections. S. maltophilia shows a pattern of intrinsic resistance to many classes of antibiotics. The drug of choice for the treatment of infections caused by S. maltophilia is SMX/TMP, however, current studies have reported increased resistance to this antibiotic, thus limiting the options for effective therapy. Among the treatment options appear tigecycline and levofloxacin, but clinical trials and studies in vitro to such drugs are lacking. The purpose of this study was to evaluate the possible mechanisms of resistance to SMX/TMP and quinolones in clinical isolates from patients admitted to the Institute\'s Central Clinical Hospital and the Hospital A.C Camargo. We evaluated 106 strains of S. maltophilia isolated from adult patients with healthcare associated infections, at the Instituto Central do Hospital das Clínicas and the Cancer Hospital AC Camargo in the period of December 2008 to December 2010. The sensitivity to SMX/TMP was 78.3%, 82% for levofloxacin, 14,2% for ciprofloxacin, minocycline 100% and for tigecycline 91.6%. PCR was performed for detection of gene sul1, sul2 and dfrA1 to evaluate the resistance to SMX/TMP, genes iscr2 int1 was performed to evaluate the presence of mobile genetic elements and genes gyrA, qnr, smeD , smeT and aac (6 \')-Ib-cr for evaluation of resistance to quinolones. Fourteen samples (13.2%) were positive for the gene sul1. In these isolates, nine samples showed resistance to SMX/TMP with MIC50 of 8 g/ml and MIC90 of 128 g/mL. Five strains were positive for sul1 gene and were susceptible to SMX/TMP with MIC50 of 1 g/ml and MIC90 of 1 g/mL. The sequence of the integron class 1 strain with an MIC> 125 g/mL showed an approximate size of 4000 bp containing the gene cassettes aadA1, aac4 and qac/sul1. A strain resistant to SMX/TMP was positive for the gene sul2 located on ISCR2 a transposase-like. We observed the presence of four new qnr in strains of S. maltophilia and the presence of the enzyme aac (6 \')-ib-cr in 4 samples. 100% of the strains were positive for the gene of the efflux system smeDEF and 12/38 samples had the gene smeT repressor of smeDEF efflux system, however there was no mutation in this gene. In the amino acid sequence of gyrase A of 15 strains resistant to levofloxacin did not observe mutations related to resistance to quinolones. Strains resistant to SMX/TMP had a polyclonal PFGE pattern. Eighteen strains resistant to levofloxacin showed 14 clonal profiles 14 divided into 10 clusters S. maltophilia displays multiple mechanisms of resistance. In this study, we observed a large number of strains with mobile genetic elements carrying the sul1 gene and other resistance genes. S. maltophilia is may be an important source for transmission of genes of resistance

Pseudomonas aeruginosa et Stenotrophomonas maltophilia, pathogènes opportunistes majeurs, pourraient acquérir leur résistance aux antibiotiques dans l’environnement, sous la pression exercée par les métaux lourds par co-sélection de résistance. Nous avons tout d’abord évalué la distribution et l’abondance de ces espèces dans un large panel de sols d’origine géographique différente (France et Afrique) et évalué l’influence d’activités anthropiques susceptibles d’exposer les sols en éléments métalliques sur cette distribution. Alors que la présence de P. aeruginosa est sporadique et plutôt liée à un apport exogène, S. maltophilia est présente dans tous les sols étudiés, suggérant son endémicité. L’évaluation des résistances des souches isolées de ces sols a également montré des différences entre les deux espèces. Les souches environnementales de P. aeruginosa sont pour la plupart caractérisées par un phénotype sauvage alors que celles de S. maltophilia présentent une grande diversité de phénotypes en fonction des sites, parfois similaires à ceux de souches cliniques. Cette diversité peut être attribuée à l’adaptation aux conditions environnementales très différentes rencontrées mais il est difficile d‘attribuer précisément aux métaux un rôle dans la co-sélection de ces résistances. L’étude menée sur la communauté bactérienne d’un sol contaminé a également permis de mettre en évidence une forte proportion de bactéries résistantes à différents antibiotiques représentée par des espèces qualifiées de pathogènes opportunistes ainsi que la présence du gène blaIMP, permettant la résistance à l’imipénème, utilisé en milieu clinique pour le traitement de clones multi-résistants. / Pseudomonas aeruginosa and Stenotrophomonas maltophilia, two major opportunistic pathogens, could acquire antibiotic resistance in the environment under heavy metal pressure that co-selects both resistances. We first investigated the distribution and abundance of these species in a wide range of soils of different geographical origin (France and Africa) and evaluated the influence of human activities that may expose soils to metallic elements on this distribution. While the presence of P. aeruginosa is rather sporadic and could be linked to exogenous intake, S. maltophilia is present in all studied soils, that suggests its endemicity. Evaluating resistance capacities of strains isolated from these soils also showed differences between the two species. Environmental strains of P. aeruginosa are mostly characterized by a wild type phenotype, whereas those of S. maltophilia present a wide diversity of phenotypes depending on the site, sometimes similar to those of clinical strains. This diversity could be attributed to a deep adaptation to the very different environmental conditions encountered in the original niche but it is difficult to attribute specifically to metals a role in coselection of resistance. The study conducted on the bacterial community present in a contaminated soil has also highlighted a high proportion of bacteria resistant to different antibiotics represented by species qualified as opportunistic pathogens and the presence of the gene blaIMP, enabling resistance to imipenem, used in the hospital to treat infections due to multidrug-resistant clones.

Les bactéries pathogènes opportunistes de l'Homme (bpo) sont retrouvées dans le milieu hospitalier où elles sont responsables d'infections nosocomiales ainsi que dans les milieux naturels terrestres et aquatiques. Elles présentent souvent des résistances intrinsèques aux antibiotiques élevées. En milieu clinique, l'usage intensif d'antibiotiques peut conduire à l'émergence de souches dites « Multi Drug Resistant ». L'anthropisation des milieux naturels peut également influencer la prévalence et les propriétés de résistance des bpo. Mes travaux ont porté sur l'impact de l'épandage d'amendements organiques sur la prévalence de bpo dans les sols, leur diversité génétique et leurs propriétés de résistance aux antibiotiques. Une étude des espèces Stenotrophomonas maltophilia, Pseudomonas aeruginosa et Burkholderia du « cepacia complexe » (Bcc) réalisée sur des sites du Burkina-Faso amendés ou non en déchets urbains bruts a mis en évidence des différences dans les propriétés de résistance des 3 modèles. S. maltophila présente fréquemment des phénotypes MDR contrairement à P. aeruginosa et aux Bcc. Une approche de génomique comparative entre souches de S. maltophilia d'origine environnementale ou clinique et de phénotypes sensibles à MDR a été réalisée afin d'élucider l'origine génétique de l'hétérogénéité des phénotypes de résistance. Une variation dans le contenu en pompes à efflux et la présence de pompes souche spécifique chez des souches environnementales ont été observées. L'étude de l'expression d'une de ces pompes confirme son implication dans la résistance aux antibiotiques et dans l'adaptation à des paramètres environnementaux tels que la température / Opportunistic bacterial pathogens (obp) of Man are found in hospital setting where they are responsible for nosocomial infections as well as in terrestrial and aquatic natural environments. Obp often show high intrinsic antibiotic resistance level. Moreover, the intensive use of antibiotics in clinical settings can lead to the emergence of "Multi Drug Resistant" strains. The anthropisation of the natural environment leads to modifications in bacterial diversity of these environments and can affect the prevalence and the antibiotic resistance properties of obp. My research focused on the impact of organic amendments on the prevalence, genetic diversity and antibiotic resistance properties of obp. A study on the species Stenotrophomonas maltophilia, Pseudomonas aeruginosa and the “Burkholderia cepacia complex" (Bcc) was conducted on sites in Burkina Faso amended or not with raw urban wastes. This study showed differences in antibiotic resistance properties between the 3 models. S. maltophila frequently showed MDR phenotypes unlike P. aeruginosa and Bcc. A comparative genomics study between S. maltophilia strains from environmental or clinical origin showing sensitive or MDR phenotypes was performed to elucidate the genetic origins of heterogeneity in the resistance phenotypes. A variation in the efflux pumps content was observed between strains. The expression of an efflux pump specific to an environmental MDR strain was then evaluated and confirmed its likely involvement in antibiotic resistance and adaptation to environmental parameters such as temperature

Dans le milieu clinique, Stenotrophomonas maltophilia est décrite comme bactérie pathogène opportuniste, responsable d'infections nosocomiales principalement chez des patients immunodéprimés ou présentant des pathologies sévères ou chroniques. L'impressionnant bouclier de résistance aux antibiotiques observé chez les souches cliniques rend les traitements particulièrement complexes pour les patients atteints. Les souches de S. maltophilia représentent une réelle menace pour la santé humaine. De plus, les fortes potentialités d'adaptation des S. maltophilia leur permettent une dispersion dans un éventail très large de biotopes cliniques mais aussi environnementaux. En effet, les S. maltophilia colonisent aussi abondamment les niches écologiques environnementales telles que les sols rhizosphériques. Le niveau des connaissances sur ces souches environnementales est particulièrement limité face à celui disponible du milieu médical. Les propriétés en tant que pathogène opportuniste de ces souches environnementales restent encore peu connues et controversées tant au niveau génétique que phénotypique. Afin de mieux évaluer le potentiel danger sanitaire que représentent les souches environnementales face aux souches cliniques, il a été envisagé lors de ce projet de thèse d'évaluer des caractéristiques phénotypiques d'un groupe de souches de S. maltophilia provenant de contextes différemment en contact avec l'homme et l'environnement. Des souches de S. maltophilia fortement impactées par le contact de l'homme ont été isolées de patients atteints de pathologies variables (mucoviscidose, infections nosocomiales, pathologies sévères). Ce groupe de souches considérées comme les plus à risque pour l'homme, a été comparé à un groupe de souches de S. maltophilia environnementales provenant de contextes ayant pu favoriser des acquisitions/maintiens de résistances aux molécules antimicrobiennes tels que les sols rhizosphériques, les sols pollués aux métaux lourds ou encore les sols soumis aux activités répétées de l'homme. Tout d'abord, les signatures métaboliques (croissance, dégradations de substrats) et les capacités de résistance à diverses molécules antibiotiques cliniques ont été évaluées pour la collection de souches de S. maltophilia. Dans un deuxième volet, ont été étudiées les potentialités de virulence de ces souches telles que la mobilité, les sécrétions enzymatiques, la formation de biofilm et la virulence envers des amibes. Enfin, une analyse croisée statistique a mis en lien les différentes signatures obtenues à partir des données métaboliques, de résistance aux antibiotiques et de virulence en confrontant les origines des souches et les influences qu'elles ont subies vis-à-vis de l'homme. D'après le jeu de données du projet, quatre signatures distinctes émergent entre les souches de S. maltophilia structurées par les effets dus la proximité de l'homme et à leur origine. Des souches environnementales potentiellement les plus impactées par les contacts avec l'homme possèdent des caractéristiques similaires aux souches cliniques ; elles sont donc potentiellement aussi dangereuses que les souches cliniques / In the clinical settings, Stenotrophomonas maltophilia is described as an opportunistic bacterial pathogen responsible for nosocomial infections mainly in immunocompromised patients or with severe or chronic diseases. The heavy shield of antibiotic resistances observed in clinical strains lead to particularly complex treatments for patients. S. maltophilia strains represent a real threat to human health. Moreover, the high potential for adaptation of S. maltophilia allow their dispersion in a wide range of clinical habitats but also environmental. Indeed, S. maltophilia strains also colonize widely environmental niches such as the rhizospheric soils. The knowledge about these environmental strains is particularly limited compared to the available medical data. The properties as opportunistic pathogenic of environmental strains remain poorly known and controversial. To better assess the potential health hazard of these environmental S. maltophilia compared to the clinical ones, were assessed in this Ph-D project phenotypic characteristics of a group of S. maltophilia strains from contexts differentially affected by human and environment imprints. S. maltophilia heavily impacted by human contacts have been isolated from patients with varying disease (cystic fibrosis, nosocomial infections, severe pathologies). This group of strains considered as the most at risk to humans, was compared to a group of S. maltophilia from environmental contexts that could promote acquisition/maintaining of resistances to antimicrobial molecules such as rhizospheric soils, heavy metal-contaminated soils or agricultural soils. Firstly, metabolic signatures (growth, substrate degradations) and antibiotic resistance capacities were evaluated among the collection of S. maltophilia strains. In a second part, were studied pathogenic potentialities of these strains such as mobility, enzyme secretions, biofilm formation and virulence to amoebae. Finally, a statistical analysis made connections on the different signatures obtained from the metabolic data, antibiotic resistance and virulence with the origins of the strains and human impacts. According to the datasets of the project, four distinct signatures emerged between S. maltophilia strains structured by the effects of human proximity and origin of the strains. Environmental strains potentially the most impacted by contact with humans showed similar characteristics with the clinical strains; they could potentially be as dangerous as clinical strains

Les espèces bactériennes opportunistes responsables d'infections nosocomiales chez l'Homme se rencontrent dans les environnements terrestres et aquatiques. Elles sont très souvent caractérisées par une résistance naturelle aux antibiotiques leur conférant un phénotype appelé Multi-Drug Resistant (MDR). L'efflux d'antibiotiques via des pompes, est un des mécanismes à l'origine de cette multi-résistance. Alors que le rôle de ces pompes chez des bactéries isolées en milieu clinique est connu, aucune donnée n'est disponible concernant leur rôle chez les bactéries associées avec d'autres organismes eucaryotes du sol tels que les amibes. Pourtant des données de la littérature indiquent que les amibes, jusqu'alors principalement connues pour leur rôle prédateur de bactéries sont susceptibles d'héberger des bactéries " résistantes " aux amibes (ARB). Parmi ces ARB, des pathogènes opportunistes ont été identifiés dont certains sont connus pour être porteurs de pompes à efflux. Les pompes à efflux de ces bactéries pourraient donc intervenir dans l'adaptation aux amibes du sol. Afin de vérifier cette hypothèse, nous avons, dans un premier temps, isolé et identifié la flore amibienne et les ARB de différents sols. Parmi les ARB identifiées, Stenotrophomonas maltophilia, Pseudomonas aeruginosa et Burkholderia cepacia sont caractérisées par des propriétés d'antibiorésistance contrastées et de virulence élevées. Des études d'interaction ont montré que S. maltophilia se multipliait dans des amibes axéniques et que des pompes à efflux Sme étaient surexprimées. Par ailleurs des molécules sécrétées par l'amibe stimulent la croissance bactérienne et des études préliminaires de profilage métabolique ont montré la présence de différents métabolites secondaires produits par l'amibe au cours de l'interaction avec S. maltophilia pouvant jouer un rôle dans l'expression des pompes à efflux / The opportunistic bacterial species, responsible for nosocomial infections in humans, occurs in terrestrial and aquatic environments. They are often characterized by natural resistance to antibiotics giving them a phenotype called Multi-Drug Resistant (MDR). The efflux of antibiotics via pumps, is one of the mechanisms behind this multi-resistance. While the role of these pumps in bacteria isolated from hospital is known, no data are available regarding their role in bacteria associated with other soil eukaryotic organisms such as amoebae. Nevertheless, data from the literature indicate that amoebae, mainly known to be predators of bacteria, are likely to harbour "amoeba resistant bacteria” (ARB). Among these ARB, opportunistic pathogens have been identified, some of which are known to be carriers of efflux pumps. The efflux pumps of these bacteria could thus interfere in the adaptation to soil amoebae. In order to verify this hypothesis, we first isolated and identified the amoebal population and the ARB of different soils. Among the identified ARB, Stenotrophomonas maltophilia, Pseudomonas aeruginosa and Burkholderia cepacia are characterized by high contrast antibiotic resistance and high virulence. Interaction studies showed that S. maltophilia could multiplied in axenic amoebae and Sme efflux pumps were overexpressed. Furthermore, molecules secreted by the amoeba stimulate bacterial growth and preliminary studies of metabolic profile have shown that production of various secondary metabolites by the amoeba during the interaction with S. maltophilia could play a role in the efflux pumps expression

Thesis (Ph. D.)--Miami University, Dept. of Chemistry and Biochemistry, 2008. / Title from second page of PDF document. Includes bibliographical references.

Indiana University-Purdue University Indianapolis (IUPUI) / Cystic fibrosis (CF) is a fatal, incurable genetic disease that affects over 30,000 people in the United States alone. People with this disease have a homozygous mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) which causes defects in chloride transport and leads to build up of mucus in the lungs and disruption of function in various organs. CF patients often suffer from chronic bacterial infections within the lungs, wherein the bacteria persist as a biofilm, leading to poor prognosis. Two of these pathogens, Stenotrophomonas maltophilia and Pseudomonas aeruginosa, are often found in the lungs of patients with CF and are an increasing medical concerns due to their intrinsic antimicrobial resistance. Both species can readily form biofilms on biotic and abiotic surfaces such as intravascular devices, glass, plastic, and host tissue. Biofilm formation starts with bacterial attachment to a surface and/or adjacent cells, initiating the acute infection stage. Chronic, long-term infection involves subsequent or concurrent altered genetic regulation, including a downregulation of virulence factors, resulting in the bacteria committing to a sessile lifestyle, markedly different from the planktonic one. Many of these genetic switches from an acute to chronic lifestyle are due to pressures from the host immune system and lead to permanently mutated strains, most likely an adaptive strategy to evade host immune responses. Biofilms are extremely problematic in a clinical setting because they lead to nosocomial infections and persist inside the host causing long-term chronic infections due to their heightened tolerance to almost all antibiotics. Understanding the genetic networks governing biofilm initiation and maintenance would greatly reduce consequences for CF and other biofilm-related infections and could lead to the development of treatments and cures for affected patients. This study showed that in S. maltophilia, isogenic deletion of phosphoglycerate mutase (gpmA) and two chaperone-usher pilin subunits, S. maltophilia fimbrae-1 (smf-1) and cblA, lead to defects in attachment on abiotic surfaces and cystic fibrosis derived bronchial epithelial cells (CFBE). Furthermore, Δsmf-1 and ΔcblA showed defects in long-term biofilm formation, mimicking that of a chronic infection lifestyle, on abiotic surfaces and CFBE as well as stimulating less of an immune response through TNF-α production. This study also showed that in P. aeruginosa, the Type III secretion system (T3SS), an important virulence factor activated during the acute stage of infection, is downregulated when polB, a stress-induced alternate DNA polymerase, is overexpressed. This downregulation is due to post-transcriptional inhibition of the master regulatory protein, ExsA. Taken together, this project highlights important genes involved in the acute and chronic infection lifestyle and biofilm formation in S. maltophilia and genetic switches during the acute infection lifestyle in P. aeruginosa.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18888号 / 医博第3999号 / 新制||医||1009(附属図書館) / 31839 / 京都大学大学院医学研究科医学専攻 / (主査)教授 中川 一路, 教授 木原 正博, 教授 西渕 光昭 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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