Adaptive resistance to aminoglycoside antibiotics in Pseudomonas aeruginosa

Aminoglycoside-resistant variants of Pseudomonas aeruginosa strain PAO1 were readily selected by culturing the organism in medium containing increasing concentrations of gentamicin, tobramycin or amikacin until the strains were growing in a concentration of drug 128-fold greater than the minimal inhibitory concentration for the sensitive parent strain. These resistant strains exhibited characteristics previously associated with the impermeability type of resistance mechanism, i.e., they grew more slowly than the parent strain, the resistance was unstable in the absence of the antibiotic, and adaptation to one of the antibiotics conferred cross-resistance to other aminoglycosides. The adapted strains grew, with minimal morphological alterations, in concentrations of the various aminoglycosides that normally produced cell envelope damage, misshapen and filamentous cell formation, and cell lysis in the sensitive strain. Neither protein H1 nor phospholipid alterations appear to play a significant role in adaptive resistance to aminoglycoside antibiotics in this model system. The acquisition of adaptive resistance to the aminoglycoside antibiotics did not confer resistance to polymyxin B, another cationic antibiotic which is thought to share binding sites within the outer membrane with the aminoglycosides.     

Synergistic effect of fosfomycin and fluoroquinolones against Pseudomonas aeruginosa growing in a biofilm

Ulifloxacin is the active form of the prodrug prulifloxacin and shows a highly potent antipseudomonal activity. In this study, we examined the combined effect of fosfomycin and ulifloxacin against Pseudomonas aeruginosa (P. aeruginosa) growing in a biofilm using a modified Robbins device with artificial urine, and compared it to that of the combination of fosfomycin and ciprofloxacin or levofloxacin. An ATP bioluminescence assay was used to evaluate the antibacterial activity of the agents against sessile cells in a mature biofilm developed on a silicon disk. The total bioactivity of P. aeruginosa growing in a biofilm that had not been fully eradicated by fosfomycin or any of the fluoroquinolones alone at 10 times the MIC decreased after combination treatment with fosfomycin and fluoroquinolones. Morphological changes occurred in a time-dependent fashion; namely, swollen and/or rounding cells emerged within a couple of hours after combination treatment, marking the initial stage in the process leading to the destruction of the biofilms. We could not find any difference among the 3 fluoroquinolones with regard to their synergistic effects when administered with fosfomycin. The combination treatment of fosfomycin and fluoroquinolones with highly potent antipseudomonal activities was effective in eradicating sessile cells of P. aeruginosa in the biofilm and promises to be beneficial against biofilm-associated infectious diseases.     

Silver against Pseudomonas aeruginosa biofilms

Silver has been recognized for its antimicrobial properties for centuries. Most studies on the antibacterial efficacy of silver, with particular emphasis on wound healing, have been performed on planktonic bacteria. Our recent studies, however, strongly suggest that colonization of wounds involves bacteria in both the planktonic and biofilm modes of growth. The action of silver on mature in vitro biofilms of Pseudomonas aeruginosa, a primary pathogen of chronic infected wounds, was investigated. The results show that silver is very effective against mature biofilms of P. aeruginosa, but that the silver concentration is important. A concentration of 5-10 mug/mL silver sulfadiazine eradicated the biofilm whereas a lower concentration (1 mug/mL) had no effect. The bactericidal concentration of silver required to eradicate the bacterial biofilm was 10-100 times higher than that used to eradicate planktonic bacteria. These observations strongly indicate that the concentration of silver in currently available wound dressings is much too low for treatment of chronic biofilm wounds. It is suggested that clinicians and manufacturers of the said wound dressings consider whether they are treating wounds primarily colonized either by biofilm-forming or planktonic bacteria.     

Comparative bactericidal activity of imipenem and other antibiotics against Pseudomonas aeruginosa

The bactericidal activity of imipenem (IM), ticarcillin (TIC), ceftazidime (CEZ), amikacin (AMK) or tobramycin (TOB), ciprofloxacin (CIP), was compared on 6 P. aeruginosa: 1 ticarcillin, susceptible strain (TICs), 5 constitutive beta-lactamases producing strains (PSE, TEM, OXA1, OXA2, cephalosporinase (CEP). The time-kill-curves method was performed. Bacteria were incubated with antibiotics at M.I.C. X2 and at concentrations obtained in vivo with usual therapeutic doses: IM 4-8 mg/l, TIC 64-128, CEZ 4-32, TOB 2-8, AMK 4-16, CIP 1-4. The bactericidal activity of IM was independent of the concentration. A 5 Log10 reduction in viability was observed at 3 h for strains TICs, TEM and PSE, 3 Log10 for strains OXA and CEP. This bactericidal activity was also observed in a non growing system. The bactericidal activity of TIC (strain TICs) and CEZ was slower and weaker: 1-2 Log10 at 6 h, 2-3 Log10 at 24 h. It is not observed in a non growing system. On the other hand, the bactericidal activity of aminoglycosides and ciprofloxacin was rapid: 3-4 Log10 at 3 h, 5 Log10 at 6 h for all strains in growing and non growing systems. IM is the only beta-lactam antibiotic bactericidal on growing and non growing cells of P. aeruginosa like aminoglycosides and new quinolones.     

Synergistic Interactions of Pseudomonas aeruginosa and Staphylococcus aureus in an In Vitro Wound Model

In individuals with polymicrobial infections, microbes often display synergistic interactions that can enhance their colonization, virulence, or persistence. One of the most prevalent types of polymicrobial infection occurs in chronic wounds, where Pseudomonas aeruginosa and Staphylococcus aureus are the two most common causes. Although they are the most commonly associated microbial species in wound infections, very little is known about their interspecies relationship. Evidence suggests that P. aeruginosa–S. aureus coinfections are more virulent than monoculture infection with either species; however, difficulties in growing these two pathogens together in vitro have hampered attempts to uncover the mechanisms involved. Here we describe a simple and clinically relevant in vitro wound model that supported concomitant growth of P. aeruginosa and S. aureus. We observed that the ability of P. aeruginosa and S. aureus to survive antibiotic treatment increased when they were grown together in planktonic cocultures and that antibiotic tolerance was further enhanced when they were grown together in the wound model. We attributed this enhanced tolerance to both the “host-derived” and “bacterium-derived” matrix components. Taken together, our data indicate that P. aeruginosa and S. aureus may benefit each other by coinfecting wounds and that the host-derived matrix may serve as important a role as the bacterium-derived matrix in protecting bacteria from some antibiotics.     

Morpholinium-based ionic liquids show antimicrobial activity against clinical isolates of Pseudomonas aeruginosa

Pseudomonas aeruginosa is a multi-drug resistant (MDR) pathogen. It is classified by WHO as one of the most life-threatening pathogens causing nosocomial infections. Some of its clinical isolates and their subpopulations show high persistence to many antibiotics that are recommended by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Thus, there is a need for non-traditional classes of antibiotics to fight the increasing threat of MDR P. aeruginosa. Ionic liquids (IL) are one such promising class of novel antibiotics. We selected four strains of P. aeruginosa and studied the growth inhibition and other effects of 12 different ILs. We used the well-characterized P. aeruginosa PAO1 (ATCC 15692) as model strain and compared it to three other isolates from chronic lung infection (LES B58), skin burn infection (UCBPP-PA14) and keratitis infection (39016), respectively. The ILs consisted of either 4,4-didecylmorpholinium [Dec₂Mor]⁺ or 4-decyl-4-ethylmorpholinium [DecEtMor]⁺ cations combined with different anions. We found that the ILs with 4,4-didecylmorpholinium [Dec₂Mor]⁺ cations most effectively inhibited bacterial growth as well as reduced strain fitness and virulence factor production. Our results indicate that these ILs could be used to treat P. aeruginosa infections.     

Development of a combination antibiogram for empirical treatments of Pseudomonas aeruginosa at a university-affiliated teaching hospital

IntroductionThe significantly higher mortality rate in the critical illness patients with Pseudomonas aeruginosa (PA) infection is linked to inappropriate selecting of empirical treatment. Traditional local antibiogram provides clinicians the resistant rate of a single antimicrobial agent to the pathogen in the specific setting. The information is valuable to the clinicians in selecting suitable empirical antibiotic therapy. However, traditional local antibiogram can only provide information for single agent empirical antibiotic not combination regimens. The combination antibiogram should be developed to facilitate the selection of appropriate antibiotics to broader the coverage rate of resistant PA.MethodsThe susceptibility to the β-lactam antibiotics (piperacillin/tazobactam (PTZ), ceftazidime, cefepime, imipenem, or meropenem) or to those administered in combination with an aminoglycoside (gentamicin or amikacin) or fluoroquinolone (ciprofloxacin or levofloxacin) was calculated. The chi-square test was used to compare the differences of combination coverage rates between non-ICU and ICU isolates.Results880 PA isolates were isolated during study period. The susceptibility of single agents ranged from 83.1% to 89.7%. The combination regimens containing amikacin provide the highest cover rate (98.9%–99.1%) and those containing levofloxacin provide less coverage rate (92.3%–93.9%). The susceptibility to five β-lactam single agents in ICU isolates significantly lower than non-ICU isolates. The non-ICU isolates exhibited significantly higher susceptibility to the PTZ–gentamicin (p = 0.002) and ceftazidime–gentamicin (p = 0.025) than ICU isolates.ConclusionOur results support the use of aminoglycosides instead of fluoroquinolones as additive agents in empirical combination treatments for patients with critical infections caused by PA.     

铜绿假单胞菌phoQ基因敲除对氨基糖苷类抗生素耐药性的影响

目的 分析氨基糖苷类抗生素敏感或耐药铜绿假单胞菌菌株二元信号系统PhoQ/PhoP编码基因序列并确定该系统与耐约性关系.方法 采用PCR获得铜绿假单胞菌菌株全长phoQ和phoP基因片段,T-A克隆后测序.构建phoQ和phoP基因原核表达系统,Ni-NTA亲和层析法提纯目的 重组表达产物rPhoQ和rPhoP,皮内注射免疫法制备兔抗血清,免疫双扩散法测定抗血清效价.采用Red重组系统敲除氨基糖苷类抗生素耐药铜绿假单胞菌菌株phoQ基因,采用PCR、测序和Western blot对phoQ突变株进行鉴定.采用试管稀释法测定各铜绿假单胞菌野生株和突变株对4种氨基糖苷类抗生素的最低抑菌浓度(MIC).结果 与GenBank中相关序列比较,所克隆的phoP和phoQ基因核苷酸和氨基酸相似性分别为98.7%～99.6%和98.7～100%、98.4%～99.8%和99.1%～100%.采用pET-42a和E. coli BL21DE3系统成功地表达了rPhoQ和rPhoP.rPhoQ和rPhoP兔抗血清免疫双扩效价分别为1:4和1:8抗血清.经PCR、测序和Western blot鉴定,两株phoQ突变株phoQ基因及产物均缺失.上述phoQ突变株对4种氨基糖苷类抗生素的MIC值分别为其野生株的1/512～1/2048.结论 PhoQ/PhoP是序列保守的铜绿假单胞菌二元信号转导系统,该系统介导细菌对氨基精苷类抗生素的耐药性.     

Characterization of a protein from normal human polymorphonuclear leukocytes with bactericidal activity against Pseudomonas aeruginosa.

Purification of a bactericidal protein (BP) from the cytoplasmic granules of normal human polymorphonuclear leukocytes (PMN) with activity against Pseudomonas aeruginosa is described. Bactericidal activity from acid extracts of a mixed granule population was purified 175-fold by a two-step chromatographic procedure. The first step, dye-ligand affinity chromatography with Matrex-Gel Orange A, was followed by cation-exchange chromatography with Bio-Rex 70 resin, and this combination routinely gave a yield near 80%. Only one peak of bactericidal activity against P. aeruginosa type I was found after each chromatographic step. Characterization of BP showed a single band with an apparent molecular weight of 55,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Purified BP was most active against the six strains of P. aeruginosa tested and against Escherichia coli B (a deep rough mutant). Purified BP killed 5 X 10(6) CFU of P. aeruginosa type I per ml at a concentration of 60 to 80 ng/ml. Proteus mirabilis and Staphylococcus aureus were both resistant to the bactericidal activity of BP. BP was shown to be glycosylated by periodic acid staining after gel electrophoresis and to have an isoelectric point near 7.5 by chromatofocusing. The amino acid composition of BP is presented.     

铜绿假单胞菌phoQ基因敲除对氨基糖苷类抗生素耐药性的影响

目的 分析氨基糖苷类抗生素敏感或耐药铜绿假单胞菌菌株二元信号系统PhoQ/PhoP编码基因序列并确定该系统与耐约性关系.方法 采用PCR获得铜绿假单胞菌菌株全长phoQ和phoP基因片段,T-A克隆后测序.构建phoQ和phoP基因原核表达系统,Ni-NTA亲和层析法提纯目的 重组表达产物rPhoQ和rPhoP,皮内注射免疫法制备兔抗血清,免疫双扩散法测定抗血清效价.采用Red重组系统敲除氨基糖苷类抗生素耐药铜绿假单胞菌菌株phoQ基因,采用PCR、测序和Western blot对phoQ突变株进行鉴定.采用试管稀释法测定各铜绿假单胞菌野生株和突变株对4种氨基糖苷类抗生素的最低抑菌浓度(MIC).结果 与GenBank中相关序列比较,所克隆的phoP和phoQ基因核苷酸和氨基酸相似性分别为98.7%～99.6%和98.7～100%、98.4%～99.8%和99.1%～100%.采用pET-42a和E. coli BL21DE3系统成功地表达了rPhoQ和rPhoP.rPhoQ和rPhoP兔抗血清免疫双扩效价分别为1:4和1:8抗血清.经PCR、测序和Western blot鉴定,两株phoQ突变株phoQ基因及产物均缺失.上述phoQ突变株对4种氨基糖苷类抗生素的MIC值分别为其野生株的1/512～1/2048.结论 PhoQ/PhoP是序列保守的铜绿假单胞菌二元信号转导系统,该系统介导细菌对氨基精苷类抗生素的耐药性.     

Phospholipase A activity in Pseudomonas aeruginosa

Our study describes the production, purification and properties of an enzyme from Pseudomonas aeruginosa displaying the properties of phospholipase A. Maximal amounts of enzyme could be detected in the culture supernatant when the bacterium was grown for 3 to 5 days at 37°C in stirred flask cultures containing brain heart infusion. The enzyme was purified by polyethylenimine precipitation and ammonium sulfate precipitation followed by gel filtration. In sodium dodecyl sulfate-polyacrylamide gel electrophoresis, the enzyme preparation exhibited two bands with molecular weights of 13.5 and 60 kD, respectively. Correspondingly, two peaks of the same molecular weight could be demonstrated by high performance size exclusion chromatography. The activity toward the sn-2 ester binding of phospholipids was characterized and found to be highest towards phosphatidylcholine. Enzymatic activity was not influenced by the addition of calcium or EDTA while magnesium and strontium caused a decrease of activity. The lyophilized enzyme was found to be stable when stored at −70°C and most active at pH 8.0.     

Normally Occurring Precipitating Antibodies against Pseudomonas aeruginosa

By means of crossed immunoelectrophoresis with intermediate gel the occurrence of precipitating antibodies against Pseudomonas aeruginosa was studied in sera from 151 'normal' persons. A complex Pseudomonas aeruginosa antigen preparation and a corresponding rabbit antiserum were used as a reference system. Fifty-four per cent of the sera contained precipitating antibodies against Pseudomonas aeruginosa , and the prevalence of these antibodies increased with age. The specificity and titre of the precipitins were established in relation to the reference system, and the human Pseudomonas precipitins could in this way be referred to 2 Pseudomonas aeruginosa antigens that have been shown to cross-react with antigens from many other bacterial species. The precipitins were low-titred and could be absorbed with antigens from 7 other bacterial species. The implications of the results are discussed.     

Chromosomal mechanisms of aminoglycoside resistance in Pseudomonas aeruginosa isolates from cystic fibrosis patients

In total, 40 Pseudomonas aeruginosa isolates from cystic fibrosis (CF) patients were included in this study. Twenty of these were collected in 1994 and 1997, from six CF patients, and the rest were collected from different CF patients in 2000 and 2001. The relative expression of mRNA for the efflux pump protein MexY was determined by real-time PCR and correlated with susceptibilities to amikacin and tobramycin. The chromosomal genes mexZ , rplY , galU , PA5471 and nuoG , which were found to have a role in the gradual increase in MICs of aminoglycoside antibiotics in laboratory mutants of P. aeruginosa , were analysed. MexY mRNA overproduction was found in 17/20 isolates collected in 1994 and 1997, and was correlated with decreased susceptibility to aminoglycosides. Alteration of the MexXY–OprM efflux system has been the main mechanism of resistance to aminoglycoside antibiotics in CF P. aeruginosa isolates over the 3-year period. In several isolates, expression of the PA5471 gene product might have some effect on elevated MICs of aminoglycosides. Inactivation of rplY , galU and/or nuoG may explain the gradual increase in MICs of aminoglycosides in laboratory mutants but probably not in the CF environment, as rplY and galU were unaltered in all isolates, and nuoG was not expressed in only one isolate. No 16S rRNA A-site mutations were found in any of the four copies of the gene in 13 investigated isolates.     

FcgammaRIII is protective against Pseudomonas aeruginosa pneumonia

Defenses against bacterial infections involve activation of multiple systems of innate immunity, including complement, Toll-like receptors, and defensins. Reactions to chronic infections bring adaptive immune mechanisms into play as well, with the introduction of modulatory interactions between the two. In humans with chronic lung infections, the severity of inflammation and disease correlate with elevated levels of pathogen-specific immune complexes and complement activation. In mice with genetic deficiency in C5, or targeted deletion of the C5a receptor, Pseudomonas lung infections reveal a role for the C5a anaphylatoxin in disease severity. Deficient animals exhibit significantly reduced survival and clearance of infecting bacteria, simultaneous with greatly increased pulmonary influx of inflammatory cells. Among the actions of C5a on inflammatory cells mediated through the C5a receptor is a shift in the relative expression of Fcgamma receptors to increase FcgammaRIII relative to FcgammaRII. This shift may significantly impact defenses against chronic infection, reflecting the cellular activation profiles of these IgG receptors. We addressed the role of FcgammaRIII in defense against Pseudomonas lung infection, and found that, like C5aR-deficient mice, animals with targeted deletion of FcgammaRIII are more susceptible to mortality upon infection and exhibit reduced clearance of the pathogen. Pseudomonas infection was associated with an increase in the FcgammaRIII/FcgammaRII ratio in wild-type mice, and the data support its role as an additional mechanism of host defense against bacterial infection.     

In-vivo impact of the MexXY efflux system on aminoglycoside efficacy in an experimental model of Pseudomonas aeruginosa pneumonia treated with tobramycin

Aminoglycosides are of major importance in treating Pseudomonas aeruginosa pneumonia (PAP). However, their efficacy may be compromised by low-level resistance caused by the inducible MexXY multidrug efflux pump. In the present study, the impact of the MexXY efflux pump was investigated in vivo in an experimental model of PAP in rabbits treated with intravenous tobramycin. Three strains were used to induce PAP in rabbits: PAO1 (wild-type strain; MIC 1 mg/L), mutant 11B (mexX::Tn501; no expression of MexXY; MIC 0.5 mg/L) and mutant MutGR1 (MexZ null; constitutive expression of MexXY; MIC 2 mg/L). Five hours after inoculation, treatment with tobramycin (10 mg/kg) was implemented (peak serum concentration 30 mg/L). The animals were killed humanely 48 h after inoculation, and the residual pulmonary bacterial concentration was determined. Selection of bacteria expressing MexXY was determined by plating lung homogenates on agar plates containing antibiotic. Mean bacterial counts (log(10) CFU/g) for treated vs. untreated rabbits were 6.26 and 8.13 (p < 0.0001), 6.00 and 8.38 (p < 0.001), and 7.25 and 8.79 (p 0.04) for PAO1, 11B and MutGR1, respectively, with an overall mortality rate of 0% vs. 8.9% (p < 0.01). MexXY-overexpressing bacteria were recovered from three (21%) treated rabbits. The C(max)/MIC ratio was the parameter that was best associated with tobramycin efficacy. The bacteria overexpressing MexXY, recovered from lung, occurred with a C(max)/MIC window of 19-26. It was concluded that the experimental PAP model highlights poor tobramycin bacteriological efficacy in vivo, contrasting with survival gain, and that the contribution of the MexXY system to this low level of tobramycin efficacy is modest. Finally, this model appears to be suitable for the investigation of new anti-pseudomonal therapeutic strategies.     

In vitro comparative activity of 4 beta-lactams against Pseudomonas aeruginosa. Role of cefoperazone

The authors compared in vitro activity of cefoperazone, piperacillin, carbenicillin and ceftazidime against 100 clinical isolates of Pseudomonas aeruginosa. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. Minimal bactericidal concentrations were measured using microplates. Eighty-two percent of strains were susceptible or intermediate to cefoperazone, with MICs less than 30 micrograms/ml. The geometric mean of the MICs of cefoperazone was 14.3 micrograms/ml; MIC 50 was 6.9 micrograms/ml. Activity of cefoperazone was comparable to that of carbenicillin, to which eighty-three percent of strains were susceptible, with MICs less than or equal to 128 micrograms/ml. Ceftazidime was also highly active against Pseudomonas, with a mean MIC of 3.29 micrograms/ml. MIC 50 was 1.9 micrograms/ml. Piperacillin was slightly less active, with MICs less than or equal to 32 micrograms/ml for 35% of strains. Cefoperazone exhibited bactericidal activity on 50% of strains at a 28.8 micrograms/ml concentration. These values must be interpreted with caution as they do not allow for the phenomenon of regrowth of Pseudomonas aeruginosa due to the presence of microaggregates of the bacteria in vivo despite bactericidal concentrations of antibiotic.     

The activity of aminoglycoside antibiotics against Trypanosoma brucei

The trypanocidal activity of four aminoglycosides was determined against Trypanosoma brucei in vitro. The drug activity in descending order, was as follows; paromomycin kanamycin>gentamycin > neomycin. Paromomycin bad the highest activity and the concentration that inhibited 50% of trypanosome growth (IC50) was 11.4microM. The effect of paromomycin on the causative agents of the East African form of sleeping sickness - T.b. rhodesiense KETRI 265, 2285, 2545, 2562 and EATRO 110,112, 1152 was subsequently assessed. Variations sensitivities between the trypanosome populations were observed and IC50 values ranging from 13.01 to 43.06 microM recorded. However, when paromomycin was administered intraperitoneally (i.p) at 500 mg/kg, it was not effective in curing mice infected with T. b. rhodesienseKETRI 2545 the most drug-sensitive isolate in vitro. Lack of in vivo activity may be because the trypanosome is an extracellular parasite. The pharmacokinetics of paromomycin in the mouse model need to be determined.