Plasmid-coded ampicillin resistance in Haemophilus ducreyi.

Seven of the 96 ampicillin-resistant isolates of Haemophilus ducreyi reported in the preceding article (Bilgeri et al., Antimicrob. Agents Chemother. 22:686-688, 1982) were investigated and found to harbor plasmids of 3.95, 5.2, 5.8, and 6.4 megadaltons. All except the 5.8-megadalton plasmid have been shown to code for beta-lactamase. The 6.4- and 5.2-megadalton plasmids of three isolates were conjugally transferable to a streptomycin-resistant mutant of H. ducreyi at high frequencies, perhaps due to the presence in these strains of a high-molecular-weight plasmid.     

Characterization of a multiple antibiotic resistance plasmid from Haemophilus ducreyi.

Plasmid pLS88 from a clinical isolate of Haemophilus ducreyi encoded resistance determinants for sulfonamides and streptomycin related to those of RSF1010 and for kanamycin related to Tn903 but lacked the inverted repeats of the transposon. Its host range included Haemophilus influenzae, Actinobacillus pleuropneumoniae, and Escherichia coli; and it was compatible with pDM2 and RSF1010.     

Characterization of non-beta-lactamase-mediated ampicillin resistance in Haemophilus influenzae.

Ampicillin resistance in Haemophilus influenzae is most often due to the plasmid-mediated production of TEM beta-lactamase. We studied four strains with high-level ampicillin resistance (MIC of 32 micrograms/ml with an inoculum of 10(5) CFU on solid media) which did not produce detectable beta-lactamase activity with two different detection methods. Two of the four strains contained extrachromosomal DNA by agarose gel electrophoresis. Conjugation failed to transfer ampicillin resistance; in contrast, transformation yielded ampicillin-resistant transformants in three of the four strains. These transformants did not contain detectable extrachromosomal DNA. In addition, mobilization of the resistance determinant by transformation to, or conjugation with, recombination-deficient strains was unsuccessful. DNA-DNA hybridization experiments revealed no homology of the DNA of these strains with two R plasmids (one coding for ampicillin resistance, the other for chloramphenicol and tetracycline resistance). We conclude that the genetic basis of the non-beta-lactamase ampicillin resistance in these strains appears to be chromosomally mediated. We investigated the mechanism of resistance in these strains. Enzymatic modification of penicillin was not detected by autoradiography of a thin-layer chromatogram of cell sonic extracts of three ampicillin-resistant transformant strains incubated with [14C]penicillin. To assess changes in permeability of the cell envelope, a plasmid coding for beta-lactamase was conjugated into these strains, and the hydrolysis of penicillin by intact cells and cell sonic extracts was compared. Only one of three transformant strains had significantly diminished permeability. Outer membrane proteins of these strains analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis revealed apparent differences in comparison with the isogenic ampicillin-susceptible recipient strain. Autofluorography of a sodium dodecyl sulfate-polyacrylamide gel electrophoresis of Sarkosyl-solubilized crude membrane (the putative inner membranes) from these ampicillin-resistant transformant strains incubated with [3H]penicillin compared with the isogenic ampicillin-susceptible recipient strain revealed reduced binding to PBP 3 and 6, 3 and 4, or 4. In addition, affinity binding studies revealed decreased affinity of PBP 4 for ampicillin of all four transformants tested. We conclude that the major mechanism of resistance in these strains is altered penicillin-binding proteins; however, other mechanisms, including permeability, may also play a role.     

Molecular epidemiology of beta-lactamase-specifying plasmids of Haemophilus ducreyi.

We have studied the genetic basis of beta-lactamase production in eight strains of Haemophilus ducreyi isolated in diverse areas of the world. Beta-lactamase production in all strains was mediated by plasmids having a molecular mass of either 5.7 or 7.0 megadaltons. Plasmids of 5.7 megadaltons were shown to carry the entire sequence of pFA7, the beta-lactamase specifying plasmid found in isolates of Neisseria gonorrhoeae epidemiologically linked to West Africa. Plasmids of 7.0 megadaltons were shown to carry the entire sequence of pFA3, the beta-lactamase specifying plasmid found in Far Eastern isolates of N. gonorrhoeae. Both groups of H. ducreyi plasmids were shown to carry physically complete and functional TnA sequences. Thus we have identified two types of H. ducreyi beta-lactamase plasmid which are identical to the two types of N. gonorrhoeae beta-lactamase plasmid, except that they carry complete TnA sequences.     

Susceptibility of Haemophilus ducreyi to ampicillin and sulbactam in vitro.

The MICs of ampicillin, ampicillin plus sulbactam in equal proportions, and a range of ampicillin concentrations with a constant 0.5 micrograms/ml concentration of sulbactam were determined for 66 strains of Haemophilus ducreyi by an agar dilution technique with standardized inocula prepared by ultrasonication. Fifty-five strains were susceptible to ampicillin alone (MIC range, 0.06 to 1 microgram/ml). The MICs for the 11 resistant strains were (micrograms per milliliter): range, 8 to greater than 16; MIC for 50% of the strains tested (MIC50), greater than 16; MIC90, greater than 16; 8 of them produced beta-lactamase. In the presence of an equal concentration of sulbactam, the MICs for ampicillin-resistant strains were lowered to (micrograms per milliliter): range, 0.125 to 2; MIC50, 0.25; MIC90, 1. In the presence of a fixed 0.5-micrograms/ml concentration of sulbactam, the MICs for the resistant strains were (micrograms per milliliter): range, 0.125 to 2; MIC50, 0.125; MIC90, 0.25. Sulbactam-ampicillin appears to be suitable for the treatment of H. ducreyi infections, especially those caused by ampicillin-resistant strains.     

Plasmid-mediated tetracycline resistance in Haemophilus ducreyi.

Clinical isolates of Haemophilus ducreyi were shown to be resistant to tetracycline. Resistance was associated in some strains with a 30-megadalton plasmid capable of transferring resistance in conjugative matings with other strains of H. ducreyi and other species of Haemophilus. Restriction endonuclease digestion patterns suggest a relationship between H. ducreyi plasmids and other tetracycline resistance plasmids in Haemophilus. The presence of plasmid-mediated resistance to the tetracyclines limits the use of these agents for the treatment of chancroid.     

Plasmid-mediated sulfonamide resistance in Haemophilus ducreyi.

Clinical isolates of Haemophilus ducreyi from patients with chancroid were shown to have one or more 4.9- to 7.0-megadalton non-self-transferable plasmids and to have in vitro resistance to sulfonamides. Transformation of Escherichia coli to sulfonamide resistance was associated with the acquisition of a 4.9-megadalton plasmid, which did not confer linked resistance to streptomycin. The guanine-plus-cytosine content of this plasmid was found to be 57%. Filter-blot hybridization and restriction endonuclease digestion studies suggested a relationship of this plasmid to RSF1010. Electron microscope heteroduplex analysis confirmed this relationship. The identification in H. ducreyi of a plasmid closely related to plasmids found in enteric species, rather than transposition of a resistance determinant to an indigenous plasmid, suggests that further dissemination of the enteric plasmid pool to this genus is possible since plasmid transfer between certain Haemophilus species is readily demonstrated.     

Emergence of Haemophilus ducreyi resistance to trimethoprim-sulfamethoxazole in Rwanda.

The in vitro susceptibilities of 112 clinical isolates of Haemophilus ducreyi to six antimicrobial agents were determined. These isolates were obtained in Kigali, Rwanda, during three studies on genital ulcer disease performed in 1986 (18 isolates), 1988 (23 isolates), and 1991 (71 isolates). All H. ducreyi isolates were susceptible to azithromycin, ceftriaxone, ciprofloxacin, and erythromycin; all isolates obtained in 1986 were also susceptible to trimethoprim and to the combination trimethoprim-sulfamethoxazole. In contrast, 39 and 9% of the isolates obtained in 1988 and 59 and 48% of the isolates obtained in 1991 were resistant to trimethoprim (MIC, > or = 4.0 mg/liter) and trimethoprim-sulfamethoxazole (MIC, < or = 4.0/76 mg/liter), respectively. These data indicate that trimethoprim-sulfamethoxazole can no longer be recommended for use in the treatment of chancroid in Rwanda, and possibly elsewhere in Africa.     

Penicillin-binding proteins and ampicillin resistance in Haemophilus influenzae

Ampicillin-resistant, non-beta-lactamase-producing isolates of Haemophilus influenzae contain a variety of penicillin-binding protein (PBP) patterns that differ from the single pattern of eight PBPs characteristic of susceptible strains. During genetic transformation of resistance, only some of the anomalies in PBP pattern were transformed, specifically those relating to the penicillin-binding capacities of PBPs 4 (Mr of 62,000) and 5 (Mr of 59,000) and, in some transformations, PBP 3 (Mr of 71,000). Comparison of the binding of penicillin by PBPs 4 and 5 of three resistant transformants (derived with DNA from different donors) revealed a decrease in the rate of PBP acylation and no appreciable change in the rate of deacylation as compared to the susceptible recipient. Thus, rapid turnover of these PBPs does not play a role. Retransformation studies confirm that altered PBPs 3, 4, and 5 are associated with resistance and suggest that these PBPs are major targets for the beta-lactam antibiotics in H. influenzae.     

Epidemiological studies of large resistance plasmids in Haemophilus

The distribution of large conjugative Haemophilus influenzae plasmids in the nasopharyngeal haemophili of a group of people and in a large collection of 541 H. influenzae type b (Hib) isolates was studied. A newly developed PCR-based assay was used to detect the plasmids. The target sequences were chosen from sequence analysis of part of p1056, a large multiresistance plasmid isolated from a clinical Hib isolate, 1056. Fifty-nine per cent of people were found to carry beta-lactamase-positive (beta-lac(+)), ampicillin-resistant (ampR) haemophili with detectable plasmid sequences. Of these, 83% were in Haemophilus parainfluenzae and 17% were in H. influenzae. In the collection of 541 Hib, antibiotic resistance [beta-lac(+)ampR, beta-lac(+)ampR plus tetracycline resistance (tetR) or tetR] was highly correlated with large plasmids. It was found that 2.3% of the isolates contained large cryptic plasmids (i.e. these isolates were susceptible to antibiotics). The distribution of plasmids between invasive and carried Hib did not differ significantly (25 of 245 and 23 of 276, respectively). Isolates with large plasmids occur at high frequency in the nasopharynx of the normal human population and consist of two populations in Hib, one associated with specific antibiotic resistance traits and the other cryptic. These plasmids do not appear to influence the invasiveness of Hib.     

Antimicrobial Susceptibility of Haemophilus ducreyi

The susceptibility of 19 isolates of Haemophilus ducreyi from a recent chancroid outbreak and four reference strains was determined in vitro to 13 antimicrobial agents. The rabbit intradermal test for virulence was positive for all of the local isolates, but not for the reference strains. The "nonvirulent" reference strains were inhibited by lower minimum inhibitory concentrations (MICs) of most agents tested. For the virulent isolates, the range of MICs (in micrograms per milliliter) of the following were: of vancomycin, 8 to 128; of polymyxin, 32 to 128; of cloxacillin, 32 to 64; of tetracycline, 0.5 to 32; of cephalothin, 4 to 8; of doxycycline, 0.25 to 8; and of kanamycin, 1 to 8. Three strains were resistant to penicillin and ampicillin (MIC >/= 128 mug/ml), and these three strains produced beta-lactamase. The remainder were susceptible to 4 mug/ml. All strains were susceptible to rifampin (MIC 相似文献   

Detection of beta-lactamase-negative ampicillin resistance in Haemophilus influenzae in Belgium

Haemophilus influenzae, a frequent colonizer of the respiratory tract, is the causative agent of several clinically important infections. In cases that require therapeutic intervention, laboratory susceptibility testing can detect beta-lactam antibiotic resistance and guide the best treatment course. In the absence of a beta-lactamase, beta-lactam resistance may be due to an altered form of the PBP3 protein, encoded by the ftsI gene. While these so-called beta-lactamase-negative ampicillin-resistant (BLNAR) strains are of serious clinical interest, identification in the clinical laboratory is not always straightforward. In the current study, the ftsI genes of a set of phenotypic BLNAR H. influenzae isolates taken from samples collected in the UZ Brussel hospital in Belgium were sequenced and re-tested at the National Reference Laboratory (NRC). Non-silent mutations in the ftsI gene were found in 100% of the isolates. Although 30% of the isolates were classified by the NRC as beta-lactamase-negative ampicillin-sensitive (BLNAS) strains based on the EUCAST guidelines on ampicillin minimal inhibitory concentration (MIC), all isolates showed MIC values ≥1?mg/L. These relatively high MIC values indicate a decreased susceptibility to ampicillin, and suggest that sequencing of the ftsI gene should be used as part of an antibiotic susceptibility testing (AST) algorithm in the clinical laboratory. This would allow clinicians to make better informed decisions regarding patient treatment.     

Laboratory diagnosis of Haemophilus ducreyi infection

Genital ulcer disease (GUD) is a well documented risk factor for heterosexual transmission of the human immunodeficiency virus (HIV). In Africa, chancroid is the major GUD. The epidemiology for chancroid and Haemophilus ducreyi infection is still poorly understood, mainly because diagnostic tests for chancroid and H. ducreyi infection are not well established. Yet, culture of H. ducreyi remains the method of choice for confirming clinical diagnosis inspite of an unsatisfactory isolation rate. Various non-culture tests for detection of H. ducreyi were developed. As for other diseases, the polymerase chain reaction (PCR) test is proving its usefulness for diagnosing chancroid. However, sample handling should be optimized and criteria allowing the classification of culture negative/PCR positive patients should be established. Several simple and inexpensive diagnostic tests for use in low-resource settings are in progress. Direct microscopy of Gram-stained clinical specimens is an obvious candidate, but variations in sensitivity still limit the usefulness of this test for confirmation of clinical diagnosis. An enzyme immunoassay using a specific polyclonal antiserum, and immunofluorescence microscopy using a specific monoclonal antibody may be useful for the detection of H. ducreyi antigen. As for PCR, criteria should be established to classify patients with discordant test results. Yet, serological tests are useful only for epidemiology. Specific and sensitive antigens were identified, but their usefulness in diagnostic tests remains to be established.     

Molecular characterization of chloramphenicol-resistant Haemophilus parainfluenzae and Haemophilus ducreyi

We examined chloramphenicol-resistant Haemophilus parainfluenzae and Haemophilus ducreyi strains isolated in various parts of the world. The antibiotic resistance determinants were located on conjugative plasmids in H. ducreyi, but were chromosomally located in H. parainfluenzae. Both species produced chloramphenicol acetyltransferases (CATs) that were sensitive to 5,5'-dithiobis(2-nitrobenzoic acid) like the enteric type II and Haemophilus influenzae CAT enzymes, but differed from these enzymes in elution patterns and subunit molecular weight. Southern blot analysis showed the H. parainfluenzae and H. ducreyi CAT genes were molecularly related to the enteric type II class as well as the H. influenzae CAT. Heterogeneity of the physiochemical properties of the CATs was observed; however, the data suggested that all three Haemophilus spp. have a common ancestral source for the CATs.     

Penicillin-binding proteins of Haemophilus ducreyi.

The penicillin-binding protein (PBP) profile of Haemophilus ducreyi was determined by a whole-cell-labeling assay. Only two major PBPs, of molecular weights 90,000 (PBP 1) and 38,500 (PBP 2), were detected in six of eight strains studied. Competition binding experiments and the attendant morphological effects suggested that PBP 1 was either a functional amalgamation or a lack of resolution of two proteins equivalent to PBPs 1 and 3 of Escherichia coli.     

Plasmid-Mediated Ampicillin Resistance in Haemophilus ducreyi

Three of 19 strains of Haemophilus ducreyi, isolated during a recent outbreak of chancroid, were found to produce beta-lactamase and to harbor a 6.0 x 10(6)-dalton plasmid. Escherichia coli transformed with this plasmid acquired beta-lactamase-mediated resistance to ampicillin. The guanine-plus-cytosine content of the plasmid was found to be 41 mol%. Restriction endonuclease digestion studies suggest that a relatively large portion of the Tn1 translocon is carried by this plasmid. Whereas this plasmid could not be transferred to H. influenzae by mating on membrane filters, a strain of H. ducreyi was able to receive and donate a 30 x 10(6)-dalton ampicillin resistance plasmid from H. influenzae. The ability of H. ducreyi to receive and donate conjugative plasmids may result in the appearance of multiply resistant strains.     

Haemophilus ducreyi Is Susceptible to Protegrin

Protegrins, potent antimicrobial peptides found in porcine leukocytes, have activity against the sexually transmitted pathogens Neisseria gonorrhoeae, Chlamydia trachomatis, and human immunodeficiency virus type 1. We tested synthetic protegrin 1 (PG-1) for activity against nine isolates of Haemophilus ducreyi, the etiologic agent of chancroid. The test organisms included CIP 542 (the type strain), 35000HP (a human-passaged variant of 35000), 35000HP-RSM2 (an isogenic d-glycero-d-manno-heptosyltransferase mutant of 35000HP), and six clinical isolates. The isolates were epidemiologically unrelated, represented three HindIII ribotypes, and had varying antimicrobial resistance patterns. In bactericidal assays, five isolates were rapidly killed by synthetic PG-1. In radial diffusion assays, all nine isolates were exquisitely sensitive to PG-1. These data highlight the potential of protegrins for development as topical agents to prevent many sexually transmitted diseases, including chancroid.Haemophilus ducreyi causes chancroid, a genital ulcer disease common in developing countries (10, 20). In a process called epidemiologic synergy, H. ducreyi and the human immunodeficiency virus (HIV) facilitate the transmission of each other (1, 16, 18, 21). The impact of chancroid and other sexually transmitted diseases (STDs) on heterosexually acquired HIV infection has increased interest in the development of topical microbicides that are active against all the major STD pathogens.Protegrins are cysteine-rich antimicrobial peptides derived from porcine leukocytes (7, 24). Protegrins contain 16 to 18 amino acid residues and a β-sheet structure that is stabilized by two intramolecular cysteine disulfide bonds. The maintenance of the β-sheet structure by the disulfide bonds is required for the retention of antimicrobial activity in solutions containing salt concentrations similar to those found in extracellular fluid (4). Protegrins inactivate Neisseria gonorrhoeae, Chlamydia trachomatis, HIV type 1 (HIV-1) (11, 17, 22), and herpes simplex virus type 2 (unpublished data). Protegrins kill gram-negative bacteria by binding to lipids and permeabilizing the outer and inner membranes. In studies performed with derivatives of protegrins, a 12-mer containing one disulfide bond retains almost all activity against N. gonorrhoeae (12). However, optimal activity against C. trachomatis requires both disulfide bonds (23).The activity of protegrins against N. gonorrhoeae, C. trachomatis, herpes simplex virus type 2, and HIV-1 makes them excellent candidates for use as topical agents against STDs. Here we tested the ability of synthetic protegrin 1 (PG-1) to kill several H. ducreyi isolates, including the type strain, an isolate recovered from an experimentally infected human subject and its isogenic lipooligosaccharide (LOS) mutant, and six recent clinical isolates.(This work was presented at the International Congress of Sexually Transmitted Disease in Seville, Spain, October 1997.)     

Evolution of antibiotic resistance plasmids in Neisseria gonorrhoeae and Haemophilus species

The emergence of beta-lactamase producing strains of Haemophilus influenzae and Neisseria gonorrhoeae has required fundamental changes in the antimicrobial therapy of disease caused by these organisms. Ampicillin resistance in both organisms is caused by plasmid mediated production of TEM beta-lactamase. This enzyme is specified by a sequence of mol. wt 3.2 X 10(6) which is capable of inserting itself at multiple sites in DNA replicons without the requirement for significant base sequence homology between donor and recipient replicon. Further, it does so without requirement for conventional recombination enzymes. Analysis of beta-lactamase specifying plasmids of H. influenzae show that they generally have a molecular mass in the order of 30 X 10(6) and contain the complete TnA sequence. They are conjugative but are incapable of mobilizing smaller beta-lactamase plasmids. Previous studies have presented evidence suggesting that these plasmids may have evolved by insertion of the TnA sequence (perhaps introduced from enteric bacteria) into a phenotypically cryptic plasmid of mol. wt 27 X 10(6) resident in rare strains of H. influenzae. In this study, we review data showing a high degree of homology between the small (3--7 X 10(6) mol. wt), nonconjugative beta-lactamase specifying plasmids of N. gonorrhoeae, H. parainfluenzae and H. ducreyl and present new evidence that cryptic plasmids highly homologous to the beta-lactamase plasmids are present in many strains of H. parainfluenzae. This suggests that the small beta-lactamase specifying plasmids of H. parainfluenzae, H. ducreyi and N. gonorrhoeae may have arisen by insertion of TnA into phenotypically cryptic plasmids present in H. parainfluenzae.     

Drug resistance plasmids of Actinobacillus (Haemophilus) pleuropneumoniae serotype 2 strains isolated from swine

Drug resistance plasmids were detected in two drug resistant strains of Actinobacillus (Haemophilus) pleuropneumoniae serotype 2 isolated in Japan. One strain, Hpn25, was resistant to ampicillin, kanamycin, streptomycin and sulfonamides, and harbored two plasmids with a molecular size of 3.7 and 4.1 kilobases (kb). The other strain, Hpn18, which was resistant to streptomycin, tetracycline, and chloramphenicol, harbored three plasmids with a molecular size of 2.2, 12, and 35 kb. The resistance of Hpn 25 to streptomycin and sulfonamides is mediated by a 4.1 kb plasmid and that of Hpn 18 to streptomycin and chloramphenicol by one or more of the 2.2, 12, and 35 kb plasmids.