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Wang YM, Dong WL, Odah KA, Kong LC, Ma HX. Transcriptome Analysis Reveals AI-2 Relevant Genes of Multi-Drug Resistant Klebsiella pneumoniae in Response to Eugenol at Sub-MIC. Front Microbiol 2019; 10:1159. [PMID: 31191486 PMCID: PMC6547871 DOI: 10.3389/fmicb.2019.01159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
Eugenol, the major active essential oil component of clove, was reported to possess QS (quorum sensing) inhibitory activity. A previous study found that eugenol could bind to quorum sensing receptors of Pseudomonas aeruginosa and down-regulate the expression of Streptococcus mutans virulence genes at sub-MIC (minimum inhibitory concentration) without affecting the bacterial growth. However, the alterations of QS signal molecules at transcription levels was not well understood. To better understand interactions of Klebsiella pneumoniae in response to eugenol and explore molecular regulations, transcriptome sequencing was performed. A total of 5779 differentially expressed genes (DEGs) enriched in a variety of biological processes and pathways were identified. The transcriptional data was validated by qPCR and the results showed that the expression profiles of 4 major genes involved in autoinducers-2 (AI-2) synthesis, including luxS, pfs, and lsrK were consistent with transcriptome analysis except for lsrR, a transcriptional repressor gene of lsr operon, which may repress the expression of following genes responsible for AI-2 signal transmission in vivo. In vitro AI-2 synthesis assay also revealed that eugenol could inhibit AI-2 generation. The results of our study offer insights into the mechanisms of QS inhibitory activity and K. pneumoniae AI-2 alterations after eugenol treatment.
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Affiliation(s)
- Yi-Ming Wang
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Wen-Long Dong
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Kokou Ayefounin Odah
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Ling-Cong Kong
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
| | - Hong-Xia Ma
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, China
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102
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Khalil MAF, Hager R, Abd-El Reheem F, Mahmoud EE, Samir T, Moawad SS, Hefzy EM. A Study of the Virulence Traits of Carbapenem-Resistant Klebsiella pneumoniae Isolates in a Galleria mellonella Model. Microb Drug Resist 2019; 25:1063-1071. [PMID: 31033413 DOI: 10.1089/mdr.2018.0270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The increasing incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) strains is considered as a terrifying public health concern. This study target was to gain a further insight into the virulence traits of CRKP isolates in Egypt. The study was carried out by using 43 clinical K. pneumoniae isolates. Antibiotic susceptibility testing, biofilm formation assay, and molecular characterization of carbapenemase and virulence genes were done for all isolates. In addition, the genotypic relationship between CRKP isolates was identified by using enterobacterial repetitive intergenic consensus-polymerase chain reactions (ERIC-PCRs). A Galleria mellonella survival assay was adopted for in vivo testing of virulence of the CRKP. Carbapenem resistance was exhibited among 58% (25/43) isolates. Minimum inhibitory concentration values of carbapenem-resistant K. pneumoniae (CRKP) ranged from 32 to 128 μg/mL. Biofilm assay has revealed that 21 isolates (49%) had moderate biofilm formation and 11 isolates (25.5%) were strong biofilm producers. BlaNDM-1 was recognized in 20.9% (9/43) of the isolates, while blaOXA-48 was observed in 18.5% (8/43). Type 3 fimbriae (mrkD) and entB were addressed among 72.1% and 62.8% of K. pneumoniae isolates, respectively. The ybtS and iutA genes were detected among 44.2% and 37.2% of the isolates, respectively. ERIC-PCR showed 23 genetic profiles among CRKP isolates. CRKP biofilm producers were virulent according to the G. mellonella model, which indicates the importance of biofilm as a virulence trait among CRKP. This study indicates the emergence of CRKP with increased virulence traits, especially biofilm formation, in Egypt. This alarming report highlights the ongoing need for effective screening procedures and strict infection control measures.
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Affiliation(s)
- Mahmoud A F Khalil
- Department of Microbiology and Immunology, Faculty of Pharmacy, Fayoum University, Fayoum, Egypt
| | - Raghda Hager
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Misr University for Science and Technology, 6th October City, Egypt
| | - Fadwa Abd-El Reheem
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Eman E Mahmoud
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Tamer Samir
- Department of Microbiology and Immunology, Faculty of Pharmacy and Industrial Science, Misr University for Science and Technology, 6th October City, Egypt
| | - Sawsan S Moawad
- Department of Pests and Plant Protection, National Research Center (N.R.C), Giza, Egypt
| | - Enas M Hefzy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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103
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Singh AK, Yadav S, Chauhan BS, Nandy N, Singh R, Neogi K, Roy JK, Srikrishna S, Singh RK, Prakash P. Classification of Clinical Isolates of Klebsiella pneumoniae Based on Their in vitro Biofilm Forming Capabilities and Elucidation of the Biofilm Matrix Chemistry With Special Reference to the Protein Content. Front Microbiol 2019; 10:669. [PMID: 31019496 PMCID: PMC6458294 DOI: 10.3389/fmicb.2019.00669] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 03/18/2019] [Indexed: 12/13/2022] Open
Abstract
Klebsiella pneumoniae is a human pathogen, capable of forming biofilms on abiotic and biotic surfaces. The limitations of the therapeutic options against Klebsiella pneumoniae is actually due to its innate capabilities to form biofilm and harboring determinants of multidrug resistance. We utilized a newer approach for classification of biofilm producing Klebsiella pneumoniae isolates and subsequently we evaluated the chemistry of its slime, more accurately its biofilm. We extracted and determined the amount of polysaccharides and proteins from representative bacterial biofilms. The spatial distribution of sugars and proteins were then investigated in the biofilm matrix using confocal laser scanning microscopy (CLSM). Thereafter, the extracted matrix components were subjected to sophisticated analysis incorporating Fourier transform infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR) spectroscopy, one-dimensional gel-based electrophoresis (SDS-PAGE), high performance liquid chromatography (HPLC), and MALDI MS/MS analysis. Besides, the quantification of its total proteins, total sugars, uronates, total acetyl content was also done. Results suggest sugars are not the only/major constituent of its biofilms. The proteins were harvested and subjected to SDS-PAGE which revealed various common and unique protein bands. The common band was excised and analyzed by HPLC. MALDI MS/MS results of this common protein band indicated the presence of different proteins within the biofilm. The 55 different proteins were identified including both cytosolic and membrane proteins. About 22 proteins were related to protein synthesis and processing while 15 proteins were identified related to virulence. Similarly, proteins related to energy and metabolism were 8 and those related to capsule and cell wall synthesis were 4. These results will improve our understanding of Klebsiella biofilm composition and will further help us design better strategies for controlling its biofilm such as techniques focused on weakening/targeting certain portions of the slime which is the most common building block of the biofilm matrix.
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Affiliation(s)
- Ashish Kumar Singh
- Bacterial Biofilm and Drug Resistance Research Laboratory, Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
- Molecular Immunology Laboratory, Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Shivangi Yadav
- Bacterial Biofilm and Drug Resistance Research Laboratory, Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Brijesh Singh Chauhan
- Cell and Neurobiology Laboratory, Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Nabarun Nandy
- Cytogenetics Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Rajan Singh
- Molecular Immunology Laboratory, Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Kaushik Neogi
- Department of Pharmaceutics, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Jagat Kumar Roy
- Cytogenetics Laboratory, Department of Zoology, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Saripella Srikrishna
- Cell and Neurobiology Laboratory, Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Rakesh Kumar Singh
- Molecular Immunology Laboratory, Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Pradyot Prakash
- Bacterial Biofilm and Drug Resistance Research Laboratory, Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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104
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Dias C, Ribeiro M, Correia-Branco A, Domínguez-Perles R, Martel F, Saavedra MJ, Simões M. Virulence, attachment and invasion of Caco-2 cells by multidrug-resistant bacteria isolated from wild animals. Microb Pathog 2019; 128:230-235. [DOI: 10.1016/j.micpath.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 11/25/2022]
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105
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Dose-Dependent Synergistic Interactions of Colistin with Rifampin, Meropenem, and Tigecycline against Carbapenem-Resistant Klebsiella pneumoniae Biofilms. Antimicrob Agents Chemother 2019; 63:AAC.02357-18. [PMID: 30642942 DOI: 10.1128/aac.02357-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/02/2019] [Indexed: 01/13/2023] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) can cause biofilm-related bloodstream infections associated with significant morbidity and mortality worldwide. We investigated the bactericidal activities of colistin (CST), rifampin (RIF), meropenem (MEM), gentamicin (GEN), and tigecycline (TGC) alone and that of CST in combination with RIF, MEM, GEN, or TGC against CR-Kp mature biofilms. Twenty CR-Kp blood isolates were derived from an equal number of bloodstream infections in adult patients. Biofilm formation was assessed by staining with 0.4% crystal violet and measuring the optical density spectrophotometrically at 545 nm. Biofilm damage was measured as the percent reduction of metabolic activity by an XTT [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt] assay. The MIC50 for biofilms was determined as the minimum concentration that caused ≥50% bacterial damage compared to that for untreated controls. Antibacterial drug interactions were analyzed by the Bliss independence model. Four of the 20 CR-Kp isolates were biofilm producers. Biofilm MIC50s of CST, RIF, MEM, GEN, and TGC for these isolates were 64, 8, >256, 128, and 8 mg/liter, respectively. Synergistic interactions were observed at 32 to 64 mg/liter of CST combined with 0.25 to 4 mg/liter of RIF, at 32 mg/liter of CST combined with 0.007 to 0.25 mg/liter of MEM, and at 16 to 32 mg/liter of CST combined with 16 to 64 mg/liter of TGC. The synergy was highest for CST plus RIF, with a mean ΔE ± standard error (SE) of 49.87% ± 9.22%, compared to 29.52% ± 4.97% for CST plus MEM (P < 0.001) and 32.44% ± 6.49% for CST plus TGC (P < 0.001). Indifferent results were exhibited by CST plus GEN. None of the combinations exhibited antagonism. These drug interaction findings, especially those for CST with RIF, may be of importance in the treatment of biofilm-related CR-Kp infections.
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106
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Martins KB, Ferreira AM, Pereira VC, Pinheiro L, de Oliveira A, da Cunha MDLRDS. In vitro Effects of Antimicrobial Agents on Planktonic and Biofilm Forms of Staphylococcus saprophyticus Isolated From Patients With Urinary Tract Infections. Front Microbiol 2019; 10:40. [PMID: 30745897 PMCID: PMC6360166 DOI: 10.3389/fmicb.2019.00040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/11/2019] [Indexed: 12/30/2022] Open
Abstract
Bacterial biofilms play an important role in urinary tract infections (UTIs), being responsible for persistent infections that lead to recurrences and relapses. Staphylococcus saprophyticus is one of the main etiological agents of UTIs, however, little is known about biofilm production in this species and especially about its response to the antimicrobial agents used to treat UTIs when a biofilm is present. For this reason, the aim of this work was to evaluate the response of S. saprophyticus biofilms to five antimicrobial agents. Staphylococcus saprophyticus was evaluated for antimicrobial susceptibility in its planktonic form by means of minimum inhibitory concentration (MIC) and in biofilms by means of minimum inhibitory concentration in biofilm (MICB) against the following antimicrobial agents by the microdilution technique: vancomycin, oxacillin, trimethoprim/sulfamethoxazole, ciprofloxacin, and norfloxacin. Of the 169 S. saprophyticus studied, 119 produced a biofilm as demonstrated by the polystyrene plate adherence method. Biofilm cells of S. saprophyticus exhibited a considerable increase in MICB when compared to the planktonic forms, with an increase of more than 32 times in the MICB of some drugs. Some isolates switched from the category of susceptible in the planktonic condition to resistant in the biofilm state. Statistical analysis of the results showed a significant increase in MICB (p < 0.0001) for all five drugs tested in the biofilm state compared to the planktonic form. Regarding determination of the minimum bactericidal concentration in biofilm (MBCB), there were isolates for which the minimum bactericidal concentration of all drugs was equal to or higher than the highest concentration tested.
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Affiliation(s)
- Katheryne Benini Martins
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Universidade Estadual Paulista, Botucatu, Brazil
| | - Adriano Martison Ferreira
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Universidade Estadual Paulista, Botucatu, Brazil.,Department of Tropical Diseases, Botucatu School of Medicine University Hospital, UNESP - Universidade Estadual Paulista, Botucatu, Brazil
| | - Valéria Cataneli Pereira
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Universidade Estadual Paulista, Botucatu, Brazil
| | - Luiza Pinheiro
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Universidade Estadual Paulista, Botucatu, Brazil
| | - Adilson de Oliveira
- Department of Microbiology and Immunology, Institute of Biosciences, UNESP - Universidade Estadual Paulista, Botucatu, Brazil
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107
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Dumaru R, Baral R, Shrestha LB. Study of biofilm formation and antibiotic resistance pattern of gram-negative Bacilli among the clinical isolates at BPKIHS, Dharan. BMC Res Notes 2019; 12:38. [PMID: 30658694 PMCID: PMC6339267 DOI: 10.1186/s13104-019-4084-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/14/2019] [Indexed: 01/31/2023] Open
Abstract
Objectives Gram-negative bacilli are the common causative agents for community-acquired, nosocomial and opportunistic infections. The recent upsurge of biofilm, as well as beta-lactamases producing strains, have synergistically led to the extensive dissemination of multi-drug resistant gram-negative bacilli. This study was carried out with an intention to detect the biofilm formation by gram-negative bacilli and determine their antibiogram along with the detection of extended-spectrum beta-lactamases (ESBLs) and metallo-beta-lactamases (MBLs) production. Results Among 314 isolates, Escherichia coli (38%) were the predominant isolates followed by Acinetobacter spp. (20%), Klebsiella spp. (16%), and Pseudomonas spp. (12%). Overall, 197 (62.73%) of isolates were biofilm positive. 84 (26.75%) and 51 (16.24%) were confirmed as ESBL and MBL producers respectively. The association between MBL production and biofilm formation was statistically significant (χ2 = 10.20, P value= 0.002) whereas it was insignificant between ESBL and biofilm production (χ2 = 0.006, P-value= 0.937). Most of the biofilm and MBL producing strains were multi-drug resistant.
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Affiliation(s)
- Rabina Dumaru
- Microbiology & Infectious Diseases, B.P Koirala Institute of Health Sciences, Dharan, 56700, Nepal.
| | - Ratna Baral
- Microbiology & Infectious Diseases, B.P Koirala Institute of Health Sciences, Dharan, 56700, Nepal
| | - Lok Bahadur Shrestha
- Microbiology & Infectious Diseases, B.P Koirala Institute of Health Sciences, Dharan, 56700, Nepal
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108
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Induction of Biofilm Formation in Klebsiella pneumoniae ATCC 13884 by Several Drugs: The Possible Role of Quorum Sensing Modulation. Antibiotics (Basel) 2018; 7:antibiotics7040103. [PMID: 30486494 PMCID: PMC6315841 DOI: 10.3390/antibiotics7040103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/29/2022] Open
Abstract
Bacterial resistance is caused by several biochemical factors, the formation of biofilm being one of the main causes. This process is triggered by Quorum Sensing (QS), through the production of endogenous molecules, although other substances such as natural products can also do this. In this work, we aimed to determine whether some drugs are involved in the induction of biofilm formation in Klebsiella pneumoniae ATCC 13884, and thus, increase bacterial resistance. For this, the effect of 22 drugs on K. pneumoniae ATCC 13884 growth was determined at sub-plasmatic concentrations; the production of autoinducer lactones was established by HPLC and with a biosensor. The induction of biofilm formation was determined through crystal violet assay at 585 nm in a microplate reader and using urethral catheters. According to the in vitro assays, some drugs were found to induce biofilm formation in K. pneumoniae ATCC 13884. The effect of acetaminophen, hydrochlorothiazide, and progesterone stood out. The first drug caused several changes in the biochemistry of K. pneumoniae ATCC 13884 related to QS: high synthesis of N-hexanoyl-homoserine lactone, increasing bacterial populations by 27% and biofilm formation by 49%, and a more gentamicin resistant biofilm. Furthermore, it increased the colonization area of urethral catheters. Hydrochlorothiazide showed the biggest increase in the induction of biofilm formation of 51%, and progesterone displayed the greatest ability to provoke bacterial mass adherence but had no effects on K. pneumoniae ATCC 13884 bacterial population growth.
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109
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Association of Antibiotic Resistance, Cell Adherence, and Biofilm Production with the Endemicity of Nosocomial Klebsiella pneumoniae. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7012958. [PMID: 30345305 PMCID: PMC6174813 DOI: 10.1155/2018/7012958] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/31/2018] [Indexed: 11/17/2022]
Abstract
Klebsiella pneumoniae is a leading cause of multiple nosocomial infections, some of which are associated with high mortality. The increasing prevalence of antibiotic-resistant strains highlights their clinical importance and how complicated managing treatment can be. In this study, we investigated antimicrobial resistance, cell adherence, and biofilm production of nosocomial K. pneumoniae strains isolated from surveillance studies in a Mexican tertiary hospital and evaluated the potential association of these phenotypes with endemicity. The great majority of the clones exhibited adhesion to cultured epithelial cells and were strong biofilm producers. A direct relationship between adhesion phenotypes, biofilm production, and endemicity was not always apparent. Biofilm formation and production of ESBL did not appear to be directly associated. Notably, all the endemic strains were multidrug-resistant. This study emphasizes that while endemic strains possess various virulence-associated properties, antimicrobial resistance appears to be a determining factor of their endemicity.
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110
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The Fructose-Specific Phosphotransferase System of Klebsiella pneumoniae Is Regulated by Global Regulator CRP and Linked to Virulence and Growth. Infect Immun 2018; 86:IAI.00340-18. [PMID: 29844239 DOI: 10.1128/iai.00340-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 12/24/2022] Open
Abstract
Klebsiella pneumoniae is an opportunistic pathogen, and its hypervirulent variants cause serious invasive community-acquired infections. A genomic view of K. pneumoniae NTUH-2044 for the carbohydrate phosphotransferase system (PTS) found a putative fructose PTS, namely, the Frw PTS gene cluster. The deletion mutant and the complemented mutant of frwC (KP1_1992), which encodes the putative fructose-specific enzyme IIC, were constructed, and the phenotypes were characterized. This transmembrane PTS protein is responsible for fructose utilization. frwC deletion can enhance biofilm formation and capsular polysaccharide (CPS) biosynthesis but decreases the growth rate and lethality in mice. frwC expression was repressed in the cyclic AMP receptor protein (CRP) mutant. Electrophoretic mobility shift assay showed that CRP can directly bind to the promoter of frwC These results indicated that frwC expression is controlled by CRP directly and that such regulation contributes to bacterial growth, CPS synthesis, and the virulence of the Δcrp strain. The findings help elucidate fructose metabolism and the CRP regulatory mechanism in K. pneumoniae.
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111
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Anes J, Martins M, Fanning S. Reversing Antimicrobial Resistance in Multidrug-Resistant Klebsiella pneumoniae of Clinical Origin Using 1-(1-Naphthylmethyl)-Piperazine. Microb Drug Resist 2018; 24:1497-1506. [PMID: 30004292 DOI: 10.1089/mdr.2017.0386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Eleven clinical Klebsiella pneumoniae fluoroquinolone-resistant isolates were tested to access the potential of adjuvant therapies to reduce antimicrobial resistance using fixed concentrations of the chemosensitizers chlorpromazine (CPZ), thioridazine (TZ), phenylalanine-arginine-β-naphthylamide (PAβN), and 1-(1-naphthylmethyl)-piperazine-(NMP) with varying concentrations of antimicrobial agents nalidixic acid (NAL), ciprofloxacin (CIP), moxifloxacin (MXF), tetracycline (TET), and chloramphenicol (CHL). Ethidium bromide dye was used together with the chemosensitizers to investigate permeabilization effects. NMP was assessed for its capacity to reduce the mass of biofilm alone and in combination with CIP and MXF. Of the selected chemosensitizers, NMP exhibited the greatest capacity to reverse resistance and inhibit efflux, based on the concentrations tested. Susceptibility to antimicrobial agents including (fluoro)quinolones, TET, and CHL were found to be increased in the presence of NMP, in a concentration-dependent manner. PAβN also demonstrated similar effects when combined with the chemosensitizers tested. In the case of half of the isolates studied, NMP alone reduced preformed biofilm biomass. Combinations of latter along with CIP or MXF were also found to reduce the mass of preformed biofilm, in the case of only some of the bacterial isolates. The capacity of NMP to reduce antimicrobial resistance could be of relevance as a strategy to limit bacterial colonization on abiotic surfaces.
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Affiliation(s)
- João Anes
- 1 School of Public Health, Physiotherapy and Sports Science, UCD Centre for Food Safety, University College Dublin , Dublin, Ireland
| | - Marta Martins
- 1 School of Public Health, Physiotherapy and Sports Science, UCD Centre for Food Safety, University College Dublin , Dublin, Ireland
| | - Séamus Fanning
- 1 School of Public Health, Physiotherapy and Sports Science, UCD Centre for Food Safety, University College Dublin , Dublin, Ireland
- 2 Institute for Global Food Security, Queen's University Belfast , Belfast, United Kingdom
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112
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Ghasemian A, Mobarez AM, Peerayeh SN, Bezmin Abadi AT. The association of surface adhesin genes and the biofilm formation among Klebsiella oxytoca clinical isolates. New Microbes New Infect 2018; 27:36-39. [PMID: 30581573 PMCID: PMC6290254 DOI: 10.1016/j.nmni.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/26/2018] [Accepted: 07/04/2018] [Indexed: 01/11/2023] Open
Abstract
Bacterial adhesins mediate the attachment and biofilm production leading to the persistence of colonized strains. The aim of this study was evaluation of the association of surface adhesin genes with the biofilm formation among Klebsiella oxytoca isolates. Among 50 isolates of K. oxytoca from patients with antibiotic-associated diarrhoea, the susceptibility test, MIC (according to CLSI 2016) and phenotypic biofilm formation (with microtitre tissue-plate assay) were performed. The presence of adhesins was investigated using PCR. Thirty-three (66%) isolates produced moderate-level biofilms, but none of them exhibited strong biofilm formation. The presence of adhesins was as follows: fimA, 60% (n = 30), mrkA, 42% (n = 21), matB, 96% (n = 48) and pilQ, 92% (n = 46). The biofilm formation was related to the presence of fimA (odds ratio (OR) 0.8571, 95% CI 1.733–6.267, p <0.0001), mrkA (OR 0.2462, 95% CI 2.723–4.622, p 0.001), matB (OR 0.4521, 95% CI 1.353–5.332, p 0.008) and pilQ (OR 0.1481, 95% CI 1.691–6.117, p <0.0001). The npsB toxin-encoding gene was detected among 46 (92%) isolates. Resistance to non-β-lactam antibiotics was significantly associated with the presence of adhesin-encoding genes. The presence of adhesins and the capsular encoding gene was significantly associated with biofilm formation among K. oxytoca isolates. The presence of surface adhesin-encoding genes was significantly associated with the biofilm formation and also with resistance to non-β-lactam antibiotics among K. oxytoca clinical isolates. In addition, biofilm production was not significantly associated with β-lactam resistance among the isolates.
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Affiliation(s)
- A Ghasemian
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - A M Mobarez
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - S N Peerayeh
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - A T Bezmin Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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113
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Eskandari-Nasab E, Moghadampour M, Tahmasebi A. Prevalence of blaCTX-M Gene among Extended-Spectrum β-Lactamases Producing Klebsiella pneumoniae Clinical Isolates in Iran: A Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:347-354. [PMID: 30046202 PMCID: PMC6055219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND CTX-M-type extended-spectrum β-lactamases (ESBLs) are the most prevalent ESBLs in bacterial members of Enterobacteriaceae family including Klebsiella pneumoniae. The global spread of CTX-M-producing K. pneumoniae is a major concern in most countries including Iran. The aim of this meta-analysis was to determine the relative frequency (RF) of blaCTX-M gene among ESBLs-producing K. pneumoniae clinical isolates in Iran and to report an overall prevalence. METHODS A comprehensive literature search of studies published up to July 2016 was carried out. The keywords "Enterobacteriaceae", "Klebsiella pneumoniae", "ESBLs", "CTX-M" and "Iran" were searched in PubMed, Scopus, EBSCO, Google Scholar, Scirus, SID and IranMedex in both English and Persian. Selected articles were published between July 2010 and July 2016 and all of them were in English. STATA SE version 11.0 was used for statistical analysis. RESULTS Twenty-four articles/abstracts were included in this analysis. Selected studies were performed in Ahvaz, Arak, Ilam, Kashan, Kerman, Mashhad, Shiraz, Tabriz, Tehran, Zabol, and Zahedan. Our pooled evidence showed that the RF of blaCTX-M gene among ESBLs-producing K. pneumoniae clinical isolates varied from 7.7% in Tabriz to 100% in Mashhad, Tehran, and Zahedan, with an overall RF of 56.7%. CONCLUSION Our meta-analysis revealed that the RF of CTX-M-type ESBLs-producing K. pneumoniae is diverse in different regions of Iran, and the central and eastern regions had higher prevalence rates compared to western regions.
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Affiliation(s)
- Ebrahim Eskandari-Nasab
- Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran,Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehdi Moghadampour
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arezoo Tahmasebi
- Department of Statistical and Actuarial Sciences, University of Western Ontario (UWO), London, ON, Canada
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114
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Peng C, Wang X, Zhang J, Jiang Y, Hou X. Tigecycline application in a 3-month-old infant with multiple drug resistant Klebsiella pneumonia: a case report. Gut Pathog 2018; 10:25. [PMID: 29977345 PMCID: PMC6014034 DOI: 10.1186/s13099-018-0253-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/18/2018] [Indexed: 01/04/2023] Open
Abstract
Background Tigecycline is an ‘immature’ antibiotic for children. We report the youngest surviving patient who received a complete tigecycline treatment, and no significant adverse effects occurred in the patient. Case presentation The 3-month old infant suffered from a catheter-associated bloodstream infection by multiple drug resistant Klebsiella pneumoniae. Tigecycline was considered as a salvage therapy to control the severe sepsis. The therapy consisted of 3 mg/kg as a loading dose and 1.5 mg/kg Q12 h as a maintenance dose for 26 days. Conclusion Current researches are limited in clinical trials directly focused on children. This therapeutic schedule might be safe for patients who are above 3 months old. Electronic supplementary material The online version of this article (10.1186/s13099-018-0253-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheng Peng
- Department of Neonatal Ward, Peking University First Hospital, No. 1, Xi Anmen Street, Xicheng District, Beijing, 100034 China
| | - Xiaofeng Wang
- Department of Neonatal Ward, Peking University First Hospital, No. 1, Xi Anmen Street, Xicheng District, Beijing, 100034 China
| | - Jiangwei Zhang
- Department of Neonatal Ward, Peking University First Hospital, No. 1, Xi Anmen Street, Xicheng District, Beijing, 100034 China
| | - Yi Jiang
- Department of Neonatal Ward, Peking University First Hospital, No. 1, Xi Anmen Street, Xicheng District, Beijing, 100034 China
| | - Xinlin Hou
- Department of Neonatal Ward, Peking University First Hospital, No. 1, Xi Anmen Street, Xicheng District, Beijing, 100034 China
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115
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Ma ZP, Song Y, Cai ZH, Lin ZJ, Lin GH, Wang Y, Zhou J. Anti-quorum Sensing Activities of Selected Coral Symbiotic Bacterial Extracts From the South China Sea. Front Cell Infect Microbiol 2018; 8:144. [PMID: 29868500 PMCID: PMC5951975 DOI: 10.3389/fcimb.2018.00144] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
The worldwide increase in antibiotic-resistant pathogens means that identification of alternative antibacterial drug targets and the subsequent development of new treatment strategies are urgently required. One such new target is the quorum sensing (QS) system. Coral microbial consortia harbor an enormous diversity of microbes, and are thus rich sources for isolating novel bioactive and pharmacologically valuable natural products. However, to date, the versatility of their bioactive compounds has not been broadly explored. In this study, about two hundred bacterial colonies were isolated from a coral species (Pocillopora damicornis) and screened for their ability to inhibit QS using the bioreporter strain Chromobacterium violaceum ATCC 12472. Approximately 15% (30 isolates) exhibited anti-QS activity, against the indicator strain. Among them, a typical Gram-positive bacterium, D11 (Staphylococcus hominis) was identified and its anti-QS activity was investigated. Confocal microscopy observations showed that the bacterial extract inhibited the biofilm formation of clinical isolates of wild-type P. aeruginosa PAO1 in a dose-dependent pattern. Chromatographic separation led to the isolation of a potent QS inhibitor that was identified by high-performance liquid chromatography-mass spectrometry (HPLC-MS) and nuclear magnetic resonance (NMR) spectroscopy as DL-homocysteine thiolactone. Gene expression analyses using RT-PCR showed that strain D11 led to a significant down-regulation of QS regulatory genes (lasI, lasR, rhlI, and rhlR), as well as a virulence-related gene (lasB). From the chemical structure, the target compound (DL-homocysteine thiolactone) is an analog of the acyl-homoserine lactones (AHLs), and we presume that DL-homocysteine thiolactone outcompetes AHL in occupying the receptor and thereby inhibiting QS. Whole-genome sequence analysis of S. hominis D11 revealed the presence of predicted genes involved in the biosynthesis of homocysteine thiolactone. This study indicates that coral microbes are a resource bank for developing QS inhibitors and they will facilitate the discovery of new biotechnologically relevant compounds that could be used instead of traditional antibiotics.
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Affiliation(s)
- Zhi-Ping Ma
- Shenzhen Public Platform for Screening and Application of Marine Microbial Resources, The Graduate School at Shenzhen, Tsinghua University, Beijing, China
| | - Yu Song
- The Department of Earth Science, Tsinghua University, Beijing, China
| | - Zhong-Hua Cai
- Shenzhen Public Platform for Screening and Application of Marine Microbial Resources, The Graduate School at Shenzhen, Tsinghua University, Beijing, China
| | - Zhi-Jun Lin
- The Department of Earth Science, Tsinghua University, Beijing, China
| | - Guang-Hui Lin
- The Department of Earth Science, Tsinghua University, Beijing, China
| | - Yan Wang
- Biology, Shenzhen Polytechnic, Shenzhen, China
| | - Jin Zhou
- Shenzhen Public Platform for Screening and Application of Marine Microbial Resources, The Graduate School at Shenzhen, Tsinghua University, Beijing, China
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116
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Jiang L, Greene MK, Insua JL, Pessoa JS, Small DM, Smyth P, McCann AP, Cogo F, Bengoechea JA, Taggart CC, Scott CJ. Clearance of intracellular Klebsiella pneumoniae infection using gentamicin-loaded nanoparticles. J Control Release 2018; 279:316-325. [PMID: 29704616 DOI: 10.1016/j.jconrel.2018.04.040] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 12/20/2022]
Abstract
Klebsiella pneumoniae is a foremost gram-negative pathogen that can induce life-threatening nosocomial pulmonary infections. Although it can be phagocytosed successfully by lung resident macrophages, this pathogen remains viable within vacuolar compartments, resulting in chronic infection and limiting therapeutic treatment with antibiotics. In this study, we aimed to generate and evaluate a cell-penetrant antibiotic poly(lactide-co-glycolide) (PLGA)-based formulation that could successfully treat intracellular K. pneumoniae infection. Screening of formulation conditions allowed the generation of high drug loaded nanoparticles through a water-in-oil-in-water approach. We demonstrated the therapeutic usefulness of these gentamicin-loaded nanoparticles (GNPs), showing their ability to improve survival and provide extended prophylactic protection towards K. pneumoniae using a Galleria mellonella infection model. We subsequently showed that the GNPs could be phagocytosed by K. pneumoniae infected macrophages, and significantly reduce the viability of the intracellular bacteria without further stimulation of pro-inflammatory or pro-apoptotic effects on the macrophages. Taken together, these results clearly show the potential to use antibiotic loaded NPs to treat intracellular K. pneumoniae infection, reducing bacterial viability without concomitant stimulation of inflammatory or pyroptotic pathways in the treated cells.
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Affiliation(s)
- Lai Jiang
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Michelle K Greene
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Jose Luis Insua
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Joana Sa Pessoa
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Donna M Small
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Peter Smyth
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Aidan P McCann
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Francesco Cogo
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Jose A Bengoechea
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Clifford C Taggart
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK
| | - Christopher J Scott
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL, UK.
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117
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Fighting biofilms with lantibiotics and other groups of bacteriocins. NPJ Biofilms Microbiomes 2018; 4:9. [PMID: 29707229 PMCID: PMC5908865 DOI: 10.1038/s41522-018-0053-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 01/03/2023] Open
Abstract
Biofilms are sessile communities of bacteria typically embedded in an extracellular polymeric matrix. Bacterial cells embedded in biofilms are inherently recalcitrant to antimicrobials, compared to cells existing in a planktonic state, and are notoriously difficult to eradicate once formed. Avenues to tackle biofilms thus far have largely focussed on attempting to disrupt the initial stages of biofilm formation, including adhesion and maturation of the biofilm. Such an approach is advantageous as the concentrations required to inhibit formation of biofilms are generally much lower than removing a fully established biofilm. The crisis of antibiotic resistance in clinical settings worldwide has been further exacerbated by the ability of certain pathogenic bacteria to form biofilms. Perhaps the most notorious biofilm formers described from a clinical viewpoint have been methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Pseudomonas aeruginosa, Gardnerella vaginalis and Streptococcus mutans, the latter of which is found in oral biofilms. Due to the dearth of novel antibiotics in recent decades, compounded by the increasing rate of emergence of resistance amongst pathogens with a propensity for biofilm formation, solutions are urgently required to mitigate these crises. Bacteriocins are a class of antimicrobial peptides, which are ribosomally synthesised and often are more potent than their antibiotic counterparts. Here, we review a selection of studies conducted with bacteriocins with the ultimate objective of inhibiting biofilms. Overall, a deeper understanding of the precise means by which a biofilm forms on a substrate as well as insights into the mechanisms by which bacteriocins inhibit biofilms is warranted.
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118
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Mion S, Rémy B, Plener L, Chabrière E, Daudé D. [Prevent bacteria from communicating: Divide to cure]. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 76:249-264. [PMID: 29598881 DOI: 10.1016/j.pharma.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 02/07/2023]
Abstract
Quorum Sensing (QS) is a communication system used by numerous bacteria to synchronize their behavior according to the cell density. In this way, bacteria secrete and sense small mediating molecules, called autoinducers (AI), which concentration increases in the environment proportionally to bacterial cell number. QS induces major physiological and phenotypic changes such as virulence induction and biofilm formation. Biofilm represents a physical barrier which shelters bacteria poorly sensitive to antimicrobial treatments and favors the apparition of resistance mechanisms. Disturbing QS is referred to as quorum quenching (QQ). This strategy is used by microorganisms themselves to prevent the development of specific group behaviors. Two strategies are mainly employed: the use of quorum sensing inhibitors (QSI) and of quorum quenching enzymes (QQE) that degrades AI. Many studies have been dedicated to identifying QSI (natural or synthetic) as well as QQE and demonstrating their anti-virulence and anti-biofilm effects on numerous bacterial species. Synergistic effects between QQ and traditional treatments such as antibiotherapy or with reemerging phage therapy have been put forward. The efficiency of numerous QSI and QQE was thereby demonstrated either with in vitro or in vivo animal models leading to the development of medical devices containing QSI and QQE to improve already existing treatments.
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Affiliation(s)
- S Mion
- Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - B Rémy
- Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France; Gene&GreenTK, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - L Plener
- Gene&GreenTK, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - E Chabrière
- Aix-Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - D Daudé
- Gene&GreenTK, 19-21, boulevard Jean-Moulin, 13005 Marseille, France.
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119
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Characterization and Antimicrobial Activity of Alkaloid Extracts from Seeds of Different Genotypes of Lupinus spp. SUSTAINABILITY 2018. [DOI: 10.3390/su10030788] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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120
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Rémy B, Mion S, Plener L, Elias M, Chabrière E, Daudé D. Interference in Bacterial Quorum Sensing: A Biopharmaceutical Perspective. Front Pharmacol 2018; 9:203. [PMID: 29563876 PMCID: PMC5845960 DOI: 10.3389/fphar.2018.00203] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/22/2018] [Indexed: 12/12/2022] Open
Abstract
Numerous bacteria utilize molecular communication systems referred to as quorum sensing (QS) to synchronize the expression of certain genes regulating, among other aspects, the expression of virulence factors and the synthesis of biofilm. To achieve this process, bacteria use signaling molecules, known as autoinducers (AIs), as chemical messengers to share information. Naturally occurring strategies that interfere with bacterial signaling have been extensively studied in recent years, examining their potential to control bacteria. To interfere with QS, bacteria use quorum sensing inhibitors (QSIs) to block the action of AIs and quorum quenching (QQ) enzymes to degrade signaling molecules. Recent studies have shown that these strategies are promising routes to decrease bacterial pathogenicity and decrease biofilms, potentially enhancing bacterial susceptibility to antimicrobial agents including antibiotics and bacteriophages. The efficacy of QSIs and QQ enzymes has been demonstrated in various animal models and are now considered in the development of new medical devices against bacterial infections, including dressings, and catheters for enlarging the therapeutic arsenal against bacteria.
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Affiliation(s)
- Benjamin Rémy
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
- Gene&GreenTK, Marseille, France
| | - Sonia Mion
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
| | | | - Mikael Elias
- Department of Biochemistry, Molecular Biology and Biophysics, Biotechnology Institute, University of Minnesota, St. Paul, MN, United States
| | - Eric Chabrière
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille Université, Marseille, France
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121
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Frequency of virulence factors in high biofilm formation bla KPC-2 producing Klebsiella pneumoniae strains from hospitals. Microb Pathog 2018; 116:168-172. [PMID: 29360567 DOI: 10.1016/j.micpath.2018.01.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 01/03/2023]
Abstract
The aim of this study is to determine the frequency of virulence genes in high biofilm formation blaKPC-2 producing Klebsiella pneumoniae strains collected over a period of two years. A total of 43 non-repetitive high biofilm blaKPC-2 producing isolates were screened from 429 strains. The MIC of carbapenems (imipenem and meropenem) ranged from 4 to 32 μg/ml. The OD595 value of the biofilm ranged from 0.56 to 2.56. The K1, K2, K5, K20, K54, K57 genotypes, MLST and virulence factors, including entB, ybtS, mrkD, fimH, rmpA, allS, iutA, kfu, wcaG, aerobaction, fecIRA, shiF, magA and pagO gene, were determined by PCR. The results showed that, among the 43 isolates, 5 of 43 were K1 type, 25 of 43 were K2 type, 4 strains and 2 strains were K5 and K57 respectively. The MLST results showed that 23/43 strains were ST11, followed by ST433(4/43), ST107(4/43), ST690(4/43), ST304(2/43), ST2058(1/43), ST1(1/43), ST146(1/43), ST914(1/43), ST2636(1/43), ST2637(1/43). As to the virulence factors, all 43 strains carried entB, ybtS and mrkD gene, followed by fimH(38/43), rmpA(14/43), allS(34/43), iutA(27/43), kfu(25/43), wcaG(21/43), aerobaction(16/43), fecIRA(15/43), shiF(10/43), magA(5/43) and pagO(5/43). This study demonstrated that high frequency of virulence factors emerging in high biofim blaKPC-2 producing strains. It also suggested that we should continue to focus on the toxicity variation and it's high time to enhance clinical awareness to the infections causing by Klebsiella pneumoniae.
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122
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Ju X, Li J, Zhu M, Lu Z, Lv F, Zhu X, Bie X. Effect of the luxS gene on biofilm formation and antibiotic resistance by Salmonella serovar Dublin. Food Res Int 2018; 107:385-393. [PMID: 29580499 DOI: 10.1016/j.foodres.2018.02.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 12/26/2022]
Abstract
Biofilms are communities of bacterial cells that serve to protect them from external adverse influences and enhance bacterial resistance to antibiotics and sanitizers. Here, we studied the regulatory effects of glucose and sodium chloride on biofilm formation in Salmonella serovar Dublin (S. Dublin). To analyze expression levels of the quorum sensing gene luxS, we created a luxS knockout mutant. Also, antimicrobial resistance, hydrophobicity and autoinducer-2 (AI-2) activity of both the wild-type (WT) and the mutant strain were investigated. Our results revealed that glucose was not essential for S. Dublin biofilm formation but had an inhibitory effect on biofilm formation when the concentration was over 0.1%. NaCl was found to be indispensable in forming biofilm, and it also exerted an inhibitory effect at high concentrations (>1.0%). Both the WT and the mutant strains displayed significant MIC growth after biofilm formation. An increase of up to 32,768 times in the resistance of S. Dublin in biofilm phonotype against antibiotic (ampicillin) compared to its planktonic phonotype was observed. However, S. Dublin luxS knockout mutant only showed slight differences compared to the WT strain in the antimicrobial tests although it displayed better biofilm-forming capacity than the WT strain. The mutant strain also exhibited higher hydrophobicity than the WT strain, which was a feature related to biofilm formation. The production of the quorum sensing autoinducer-2 (AI-2) was significantly lower in the mutant strain than in the WT strain since the LuxS enzyme, encoded by the luxS gene, plays an essential role in AI-2 synthesis. However, the limited biofilm-forming ability in the WT strain indicated AI-2 was not directly related to S. Dublin biofilm formation. Furthermore, gene expression analysis of the WT and mutant strains revealed upregulation of genes related to biofilm stress response and enhanced resistance in the luxS mutant strain, which may provide evidence for the regulatory role of the luxS gene in biofilm formation.
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Affiliation(s)
- Xiangyu Ju
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China
| | - Junjie Li
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China
| | - Mengjiao Zhu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China
| | - Zhaoxin Lu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China
| | - Fengxia Lv
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China
| | - Xiaoyu Zhu
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China
| | - Xiaomei Bie
- College of Food Science and Technology, Nanjing Agricultural University, Nanjing 210095, People's Republic of China.
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123
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Garza-Ramos U, Barrios-Camacho H, Moreno-Domínguez S, Toribio-Jiménez J, Jardón-Pineda D, Cuevas-Peña J, Sánchez-Pérez A, Duran-Bedolla J, Olguín-Rodriguez J, Román-Román A. Phenotypic and molecular characterization of Klebsiella spp. isolates causing community-acquired infections. New Microbes New Infect 2018; 23:17-27. [PMID: 29692906 PMCID: PMC5913063 DOI: 10.1016/j.nmni.2018.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 12/19/2022] Open
Abstract
Klebsiella spp. isolates from community-acquired infections were characterized. A total of 39 Klebsiella spp. isolates were obtained from outpatients at four rural hospitals in Mexico (2013–2014). The biochemical tests identified all as being K. pneumoniae. The molecular multiplex-PCR test identified 36 (92.4%) K. pneumoniae isolates and one (2.5%) K. variicola isolate, and phylogenetic analysis of the rpoB gene identified two isolates (5.1%) belonging to K. quasipneumoniae subsp. quasipneumoniae and K. quasivariicola. The last one was confirmed by phylogenetic analysis of six-loci concatenated genes. Mostly the isolates were multidrug resistant; however, a minority were extended-spectrum β-lactamase producing (10.2%). The extended-spectrum β-lactamase CTX-M-15 gene was identified in these isolates. Analysis of biofilm production and the hypermucoviscosity phenotype showed a total of 35 (92.3%) and seven (17.9%) of the isolates were positive for these phenotypes respectively. The K2 (4/39, 10.2%), K5 (2/39, 5.1%) and K54 (1/39, 2.5%) serotypes were identified in seven (17.9%) of the isolates, and only 28.5% (2/7) hypermucoviscous isolates were positive for the K2 and K5 serotypes. In general, the sequence type (ST) analysis and phylogenetic analysis of seven multilocus sequence typing loci were heterogeneous; however, ST29 was the most prevalent ST in the analysed isolates, accounting for 19% (4/21) of the total isolates. Two of the four ST29 isolates had the hypermucoviscosity phenotype. The virulence factors for fimbriae were the most prevalent, followed by siderophores. Community-acquired infections are caused by various species from Klebsiella genus, with different profiles of antibiotic resistance and heterogeneous virulence factors.
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Affiliation(s)
- U Garza-Ramos
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana y Genómica de Bacterias, Cuernavaca, Morelos, Mexico
| | - H Barrios-Camacho
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana y Genómica de Bacterias, Cuernavaca, Morelos, Mexico
| | - S Moreno-Domínguez
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana y Genómica de Bacterias, Cuernavaca, Morelos, Mexico
| | - J Toribio-Jiménez
- Laboratorio de Biotecnología y Genética Microbiana, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
| | - D Jardón-Pineda
- Laboratorio de Biotecnología y Genética Microbiana, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
| | - J Cuevas-Peña
- Laboratorio de Biotecnología y Genética Microbiana, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
| | - A Sánchez-Pérez
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana y Genómica de Bacterias, Cuernavaca, Morelos, Mexico
| | - J Duran-Bedolla
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana y Genómica de Bacterias, Cuernavaca, Morelos, Mexico
| | - J Olguín-Rodriguez
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación Sobre Enfermedades Infecciosas (CISEI), Laboratorio de Resistencia Bacteriana y Genómica de Bacterias, Cuernavaca, Morelos, Mexico
| | - A Román-Román
- Laboratorio de Biotecnología y Genética Microbiana, Unidad Académica de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
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Li Y, Zhang L, Zhou Y, Zhang Z, Zhang X. Survival of bactericidal antibiotic treatment by tolerant persister cells of Klebsiella pneumoniae. J Med Microbiol 2018; 67:273-281. [PMID: 29458540 DOI: 10.1099/jmm.0.000680] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Persister cells, a subpopulation of tolerant cells within the bacterial culture, are commonly thought to be responsible for antibiotic therapy failure and infection recurrence. Klebsiella pneumoniae is a notorious human pathogen for its increasing resistance to antibiotics and wide involvement in severe infections. In this study, we aimed to investigate the persister subpopulation of K. pneumoniae. METHODOLOGY The presence of persisters in K. pneumoniae was determined by treatment with high concentrations of antibiotics, used alone or in combination. The effect of low level of antibiotics on persister formation was investigated by pre-exposure of cells to antibiotics with low concentrations followed by higher doses. The dependence of persister levels on growth phase was determined by measuring the survival ability of cells along the growth stages upon exposure to a high concentration of antibiotic. Analysis on persister type was carried out by persister elimination assays.Results/Key findings. We show that K. pneumoniae produces high levels of tolerant persister cells to survive treatment by a variety of high concentrations of bactericidal antibiotics and persister formation is prevalent among K. pneumoniae clinical strains. Besides, we find that persister cells can be induced by low concentrations of antibiotics. Finally, we provide evidence that persister formation is growth phase-dependent and Type II persisters dominate the persister subpopulation during the entire exponential phase of K. pneumoniae. CONCLUSION Our study describes the formation of tolerant persister cells that allow survival of treatment by high concentrations of antibiotics in K. pneumoniae.
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Affiliation(s)
- Ying Li
- Department of Immunology, College of Preclinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Luhua Zhang
- Department of Pathogenic Biology, College of Preclinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Yingshun Zhou
- Department of Pathogenic Biology, College of Preclinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Zhikun Zhang
- Department of Pathogenic Biology, College of Preclinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Xinzhuo Zhang
- Department of Pathogenic Biology, College of Preclinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, PR China
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125
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Mataraci Kara E, Ozbek Celik B. Investigation of the effects of various antibiotics againstKlebsiella pneumoniaebiofilms onin vitrocatheter model. J Chemother 2017; 30:82-88. [DOI: 10.1080/1120009x.2017.1390633] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Emel Mataraci Kara
- Department of Pharmaceutical Microbiology Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | - Berna Ozbek Celik
- Department of Pharmaceutical Microbiology Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
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126
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Agarwal M, Shiau S, Larson EL. Repeat gram-negative hospital-acquired infections and antibiotic susceptibility: A systematic review. J Infect Public Health 2017; 11:455-462. [PMID: 29066020 PMCID: PMC5910289 DOI: 10.1016/j.jiph.2017.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/25/2017] [Accepted: 09/30/2017] [Indexed: 12/31/2022] Open
Abstract
Repeat HAIs among frequently hospitalized patients may be contributing to the high rates of antibiotic resistance seen in gram-negative bacteria (GNB) in hospital settings. This systematic review examines the state of the literature assessing the association between repeat GNB HAIs and changes in antibiotic susceptibility patterns. A systematic search of English language published literature was conducted to identify studies in peer-reviewed journals from 2000 to 2015. Studies must have assessed drug resistance in repeat GNB infections longitudinally at the patient level. Two researchers independently reviewed search results for papers meeting inclusion criteria and extracted data. Risk of bias was assessed using a modified quality assessment tool based on the Checklist for Measuring Study Quality and the Quality Assessment Checklist for Cases Series. From 3385 articles identified in the search, seven met inclusion criteria. Five reported lower antibiotic susceptibility in repeated infections, one found a change but did not specify in which direction, and one reported no change. All studies were of low to average quality. Despite the dearth of studies examining repeat GNB infections, evidence suggests that repeat infections result in lower antibiotic susceptibility among hospitalized patients. Larger scale studies with strong methodology are warranted.
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Affiliation(s)
- Mansi Agarwal
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168th St, New York, NY 10032, United States; School of Nursing, Columbia University, 617 W 168th St, New York, NY 10032, United States.
| | - Stephanie Shiau
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168th St, New York, NY 10032, United States
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 168th St, New York, NY 10032, United States; School of Nursing, Columbia University, 617 W 168th St, New York, NY 10032, United States
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127
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Liu Y, Liu PP, Wang LH, Wei DD, Wan LG, Zhang W. Capsular Polysaccharide Types and Virulence-Related Traits of Epidemic KPC-Producing Klebsiella pneumoniae Isolates in a Chinese University Hospital. Microb Drug Resist 2017; 23:901-907. [PMID: 28437231 DOI: 10.1089/mdr.2016.0222] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Yang Liu
- Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, People's Republic of China
| | - Pan-pan Liu
- Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, People's Republic of China
| | - Lian-hui Wang
- Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, People's Republic of China
| | - Dan-dan Wei
- Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, People's Republic of China
| | - La-Gen Wan
- Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, People's Republic of China
| | - Wei Zhang
- Department of Respiratory, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, People's Republic of China
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128
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Ostria-Hernandez ML, Juárez-de la Rosa KC, Arzate-Barbosa P, Lara-Hernández A, Sakai F, Ibarra JA, Castro-Escarpulli G, Vidal JE. Nosocomial, Multidrug-Resistant Klebsiella pneumoniae Strains Isolated from Mexico City Produce Robust Biofilms on Abiotic Surfaces but Not on Human Lung Cells. Microb Drug Resist 2017; 24:422-433. [PMID: 28915364 DOI: 10.1089/mdr.2017.0073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae (Kpn) strains are a leading cause of hospital-acquired infections, including ventilator-associated pneumonia. Resistance to antibiotics, biofilm formation, and the production of certain fimbriae play an important role in the pathogenesis. AIM We investigated the genetic relatedness, antibiotic resistance, virulence potential, and ability to form biofilms of Kpn strains isolated from hospital-acquired infections (n = 76). Strains were isolated at three major hospitals serving the largest metropolitan urban area in Mexico City, Mexico. RESULTS Enterobacterial repetitive intergenic consensus (ERIC)-PCR demonstrated that clonal groups predominate in each hospital. Selected strains chosen from clonal groups (n = 47) were multidrug resistant (MDR, 83%), although the majority (∼70%) were susceptible to carbapenems. All strains produced robust biofilms on abiotic surfaces, and ∼90% harbored adhesin genes fimH, mrkA, and ecpA. The ultrastructure of biofilms was further studied by high-resolution confocal microscopy. The average height of Kpn biofilms on abiotic surfaces was ∼40 μm. We then assessed formation of biofilms on human lung cells, as a surrogate of lung infection. While Kpn strains formed robust biofilms on abiotic surfaces, studies on lung cells revealed attachment to human cells but scarce formation of biofilms. Gene expression studies revealed a differential temporal expression of an adhesin (ecpA) and a capsule (galF) gene when biofilms were formed on different substrates. CONCLUSIONS Kpn strains isolated from nosocomial infections in Mexico City are MDR, although the majority are still susceptible to carbapenems and form more robust biofilms on polystyrene in comparison to those formed on human cells.
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Affiliation(s)
- Martha Lorena Ostria-Hernandez
- 1 Laboratorio de Bacteriología Médica, Departamento de Microbiología Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional , Ciudad de México, México
| | - Karla Cecilia Juárez-de la Rosa
- 1 Laboratorio de Bacteriología Médica, Departamento de Microbiología Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional , Ciudad de México, México
| | - Patricia Arzate-Barbosa
- 2 Laboratorio de Bacteriología, Departamento de Análisis Clínicos, Instituto Nacional de Pediatría , Ciudad de México, México
| | - Antonino Lara-Hernández
- 2 Laboratorio de Bacteriología, Departamento de Análisis Clínicos, Instituto Nacional de Pediatría , Ciudad de México, México
| | - Fuminori Sakai
- 3 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - J Antonio Ibarra
- 4 Laboratorio de Genética Microbiana, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional , Ciudad de México, México
| | - Graciela Castro-Escarpulli
- 1 Laboratorio de Bacteriología Médica, Departamento de Microbiología Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional , Ciudad de México, México
| | - Jorge E Vidal
- 3 Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia
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129
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Vuotto C, Longo F, Pascolini C, Donelli G, Balice M, Libori M, Tiracchia V, Salvia A, Varaldo P. Biofilm formation and antibiotic resistance inKlebsiella pneumoniaeurinary strains. J Appl Microbiol 2017; 123:1003-1018. [DOI: 10.1111/jam.13533] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/15/2017] [Accepted: 07/06/2017] [Indexed: 01/09/2023]
Affiliation(s)
- C. Vuotto
- Microbial Biofilm Laboratory; Fondazione Santa Lucia; Rome Italy
| | - F. Longo
- Microbial Biofilm Laboratory; Fondazione Santa Lucia; Rome Italy
| | - C. Pascolini
- Microbial Biofilm Laboratory; Fondazione Santa Lucia; Rome Italy
| | - G. Donelli
- Microbial Biofilm Laboratory; Fondazione Santa Lucia; Rome Italy
| | - M.P. Balice
- Microbiological Laboratory; Fondazione Santa Lucia; Rome Italy
| | - M.F. Libori
- Microbiological Laboratory; Fondazione Santa Lucia; Rome Italy
| | - V. Tiracchia
- Microbiological Laboratory; Fondazione Santa Lucia; Rome Italy
| | - A. Salvia
- Medical Services; Fondazione Santa Lucia; Rome Italy
| | - P.E. Varaldo
- Department of Biomedical Sciences and Public Health; Section of Microbiology; Marche Polytechnic University Medical School; Torrette di Ancona Italy
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130
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Lalitha C, Raman T, Rathore SS, Ramar M, Munusamy A, Ramakrishnan J. ASK2 Bioactive Compound Inhibits MDR Klebsiella pneumoniae by Antibiofilm Activity, Modulating Macrophage Cytokines and Opsonophagocytosis. Front Cell Infect Microbiol 2017; 7:346. [PMID: 28824881 PMCID: PMC5543099 DOI: 10.3389/fcimb.2017.00346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/20/2017] [Indexed: 01/17/2023] Open
Abstract
The emergence and spread of pathogens harboring extended spectrum beta-lactamase (ESBL) like carbapenem resistant Gram negative bacteria are the major emerging threat to public health. Of particular concern Klebsiella pneumoniae carbapenamase- producing strains have been recorded worldwide. Catheter associated urinary tract infections (CAUTI) caused by K. pneumoniae are significantly associated with morbidity and mortality. Hence the present work was aimed to develop a strategy for addressing these issues through an innovative approach of antibiofilm and immunomodulation. These two independent activities were analyzed in a Streptomyces derived ASK2 bioactive compound. While analysing the effect of sub-minimum inhibitory concentrations (sub-MICs), 0.5x of Minimum Inhibitory Concentration (MIC) was found to be more effective in preventing biofilm formation on coverslip and silicone catheter. The minimum biofilm eradication concentration (MBEC) was found to be 15-fold higher MIC with eradication of 75% of 3 day old biofilm. Apart from its antibiofilm potential, ASK2 also acts as an opsonin and enhances phagocytic response of macrophages against multidrug resistant K. pneumoniae. In addition, ASK2 resulted in elevated levels of nitric oxide generation by the macrophages and has a stimulating effect on IL-12, IFN-γ, and TNF-α proinflammatory cytokines. The opsonic role of ASK2 and its potential in modulating proinflammatory cytokines secreted by macrophages implies the importance of ASK2 in modulating cellular immune response of macrophages against MDR K. pneumoniae. The present study proposes ASK2 as a promising candidate for treating MDR K. pneumoniae infections with its dual properties of antibiofilm and immunomodulatory activities.
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Affiliation(s)
- Cheepurupalli Lalitha
- Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | - Thiagarajan Raman
- Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | - Sudarshan S Rathore
- Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
| | | | | | - Jayapradha Ramakrishnan
- Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityThanjavur, India
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131
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Henig O, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC, Watkins RR, Marshall S, Rudin SD, Domitrovic TN, Hujer AM, Hujer KM, Doi Y, Evans S, Fowler VG, Bonomo RA, van Duin D, Kaye KS. A Prospective Observational Study of the Epidemiology, Management, and Outcomes of Skin and Soft Tissue Infections Due to Carbapenem-Resistant Enterobacteriaceae. Open Forum Infect Dis 2017; 4:ofx157. [PMID: 29026866 PMCID: PMC5629814 DOI: 10.1093/ofid/ofx157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/26/2017] [Indexed: 01/21/2023] Open
Abstract
Background This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE). Methods Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR. Results One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1–5). Forty-eight percent of patients were admitted from long-term care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates (blaKPC-3 [47%], blaKPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18–0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04–0.93). Conclusions Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.
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Affiliation(s)
- Oryan Henig
- Department of Medicine, University of Michigan, Ann Arbor; Departments of
| | | | | | - Federico Perez
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert A Salata
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Richard R Watkins
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown.,Division of Infectious Diseases, Akron General Medical Center, Ohio; Departments of
| | - Steve Marshall
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio
| | - Susan D Rudin
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.,Medicine
| | - T Nicholas Domitrovic
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.,Medicine
| | - Andrea M Hujer
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.,Medicine
| | - Kristine M Hujer
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.,Medicine
| | - Yohei Doi
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania
| | - Scott Evans
- Department of Biostatistics and the Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | - Vance G Fowler
- Division of Infectious Diseases and.,Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Robert A Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio.,Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Medicine.,Pharmacology.,Molecular Biology and Microbiology.,Biochemistry, and.,Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill
| | - Keith S Kaye
- Department of Medicine, University of Michigan, Ann Arbor; Departments of
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132
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Sub-inhibitory concentrations of gentamicin triggers the expression of aac(6')Ie-aph(2″)Ia, chaperons and biofilm related genes in Lactobacillus plantarum MCC 3011. Res Microbiol 2017; 168:722-731. [PMID: 28684253 DOI: 10.1016/j.resmic.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/10/2017] [Accepted: 06/18/2017] [Indexed: 12/23/2022]
Abstract
The study aimed to analyze the effects of sub-inhibitory concentrations of gentamicin on the expressions of high level aminoglycoside resistant (HLAR) bifunctional aac(6')Ie-aph(2″)Ia, biofilm and chaperone genes in Lactobacillus plantarum. The analysis of the biofilm formation in five isolates obtained from chicken sausages indicated their role in exhibiting phenotypic resistance based on the varied MIC values despite carrying the bifunctional gene. The biofilm formation significantly increased when L. plantarum MCC 3011 was grown in sub-inhibitory concentrations of gentamicin (4 μg/ml), kanamycin (8 μg/ml) and streptomycin (2 μg/ml). Thirty day gentamicin selection increased minimum inhibitory concentration (MIC) values from 4 to 64 and 2 to 256 fold for gentamicin and kanamycin, respectively when compared to the parental cultures. Expression studies revealed that constant exposure to gentamicin had induced chaperon [groEL] and the bifunctional gene, aac(6')Ie-aph(2″)Ia upto nine fold. Induction of groEL, groES and lamC genes in gentamicin (4 μg/ml) preincubated MCC 3011 indicated their significant role in aminoglycoside mediated response. Our study indicates that constant exposure to sub inhibitory concentrations of gentamicin allows L. plantarum to adapt against higher doses of aminoglycosides. This highlights the risks and food safety issues associated with the use of aminoglycosides in livestock and consumption of farm oriented fermented food products.
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133
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Association between Virulence Factors and Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae Compared to Nonproducing Isolates. Interdiscip Perspect Infect Dis 2017; 2017:7279830. [PMID: 28684959 PMCID: PMC5480045 DOI: 10.1155/2017/7279830] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 12/30/2022] Open
Abstract
Klebsiella pneumoniae is considered an important opportunistic multidrug-resistant pathogen. Extended spectrum β-lactamases (ESBLs) and expression of a multitude of virulence factors may work in a harmony resulting in treatment failure. This study was undertaken to compare the virulence characteristics and genetic relatedness between ESBL and non-ESBL producing K. pneumoniae. Methods. Antibiotic sensitivity test of all isolates was determined by disc diffusion assay. Phenotypic and genotypic detection of ESBL were done. Various virulence factors and some virulence factor-associated genes were screened. Random amplified polymorphic DNA (RAPD) was employed to investigate the genetic fingerprints of ESBL from non-ESBL producing K. pneumoniae. Results. 50% of isolates were ESBL producers. A significant association was observed between ESBL production and biofilm (strong and moderate), serum resistance, and iss gene. Moreover, significant association between non-ESBL producers and hypermucoviscosity was identified. Dendogram analysis of RAPD profile classified K. pneumoniae isolates into four clusters (a, b, c, and d). Seventy-six percent of ESBL producers belonged to cluster a. In conclusion, this study suggests a correlation between ESBL production and some virulence factors. Therefore, success of treatment depends mainly on increased clinicians awareness and enhanced testing by laboratories to reduce the spread of these isolates.
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134
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Shafreen RB, Seema S, Ahamed AP, Thajuddin N, Ali Alharbi S. Inhibitory Effect of Biosynthesized Silver Nanoparticles from Extract of Nitzschia palea Against Curli-Mediated Biofilm of Escherichia coli. Appl Biochem Biotechnol 2017; 183:1351-1361. [DOI: 10.1007/s12010-017-2503-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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135
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Biofilm is a Major Virulence Determinant in Bacterial Colonization of Chronic Skin Ulcers Independently from the Multidrug Resistant Phenotype. Int J Mol Sci 2017; 18:ijms18051077. [PMID: 28513576 PMCID: PMC5454986 DOI: 10.3390/ijms18051077] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 01/28/2023] Open
Abstract
Bacterial biofilm is a major factor in delayed wound healing and high levels of biofilm production have been repeatedly described in multidrug resistant organisms (MDROs). Nevertheless, a quantitative correlation between biofilm production and the profile of antimicrobial drug resistance in delayed wound healing remains to be determined. Microbial identification, antibiotic susceptibility and biofilm production were assessed in 135 clinical isolates from 87 patients. Gram-negative bacteria were the most represented microorganisms (60.8%) with MDROs accounting for 31.8% of the total isolates. Assessment of biofilm production revealed that 80% of the strains were able to form biofilm. A comparable level of biofilm production was found with both MDRO and not-MDRO with no significant differences between groups. All the methicillin-resistant Staphylococcus aureus (MRSA) and 80% of Pseudomonas aeruginosa MDR strains were found as moderate/high biofilm producers. Conversely, less than 17% of Klebsiella pneumoniae extended-spectrum beta-lactamase (ESBL), Escherichia coli-ESBL and Acinetobacter baumannii were moderate/high biofilm producers. Notably, those strains classified as non-biofilm producers, were always associated with biofilm producer bacteria in polymicrobial colonization. This study shows that biofilm producers were present in all chronic skin ulcers, suggesting that biofilm represents a key virulence determinant in promoting bacterial persistence and chronicity of ulcerative lesions independently from the MDRO phenotype.
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136
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Genetic Determinants of Antibiotic Resistance in Hospital and Community Isolates of Klebsiella pneumoniae and Escherichia coli. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.45678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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137
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Cheepurupalli L, Raman T, Rathore SS, Ramakrishnan J. Bioactive Molecule from Streptomyces sp. Mitigates MDR Klebsiella pneumoniae in Zebrafish Infection Model. Front Microbiol 2017; 8:614. [PMID: 28446900 PMCID: PMC5388697 DOI: 10.3389/fmicb.2017.00614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 03/27/2017] [Indexed: 02/02/2023] Open
Abstract
The emergence and spread of multi-drug resistant (MDR) especially carbapenem-resistant Klebsiella pneumoniae is a major emerging threat to public health, leading to excess in mortality rate as high as 50-86%. MDR K. pneumoniae manifests all broad mechanisms of drug resistance, hence development of new drugs to treat MDR K. pneumoniae infection has become a more relevant question in the scientific community. In the present study a potential Streptomyces sp. ASK2 was isolated from rhizosphere soil of medicinal plant. The multistep HPLC purification identified the active principle exhibiting antagonistic activity against MDR K. pneumoniae. The purified compound was found to be an aromatic compound with aliphatic side chain molecule having a molecular weight of 444.43 Da. FT-IR showed the presence of OH and C=O as functional groups. The bioactive compound was further evaluated for drug induced toxicity and efficacy in adult zebrafish infection model. As this is the first study on K. pneumoniae - zebrafish model, the infectious doses to manifest sub-clinical and clinical infection were optimized. Furthermore, the virulence of K. pneumoniae in planktonic and biofilm state was studied in zebrafish. The MTT assay of ex vivo culture of zebrafish liver reveals non-toxic nature of the proposed ASK2 compound at an effective dose. Moreover, significant increase in survival rate of infected zebrafish suggests that ASK2 compound from a new strain of Streptomyces sp. was potent in mitigating MDR K. pneumoniae infection.
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Affiliation(s)
- Lalitha Cheepurupalli
- Actinomycetes Bioprospecting Lab, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
| | - Thiagarajan Raman
- Laboratory for Inflammation Research, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
| | - Sudarshan S. Rathore
- Actinomycetes Bioprospecting Lab, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
| | - Jayapradha Ramakrishnan
- Actinomycetes Bioprospecting Lab, Centre for Research in Infectious Diseases, School of Chemical and Biotechnology, SASTRA UniversityTirumalaisamudram, India
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138
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Bandeira M, Borges V, Gomes JP, Duarte A, Jordao L. Insights on Klebsiella pneumoniae Biofilms Assembled on Different Surfaces Using Phenotypic and Genotypic Approaches. Microorganisms 2017; 5:microorganisms5020016. [PMID: 28368366 PMCID: PMC5488087 DOI: 10.3390/microorganisms5020016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/06/2017] [Accepted: 03/29/2017] [Indexed: 12/26/2022] Open
Abstract
Klebsiella pneumoniae is a prominent etiological agent of healthcare associated infections (HAIs). In this context, multidrug-resistant and biofilm-producing bacteria are of special public health concern due to the difficulties associated with treatment of human infections and eradication from hospital environments. Here, in order to study the impact of medical devices-associated materials on the biofilm dynamics, we performed biofilm phenotypic analyses through a classic and a new scanning electron microscopy (SEM) technique for three multidrug-resistant K. pneumoniae isolates growing on polystyrene and silicone. We also applied whole-genome sequencing (WGS) to search for genetic clues underlying biofilm phenotypic differences. We found major differences in the extracellular polymeric substances (EPS) content among the three strains, which were further corroborated by in-depth EPS composition analysis. WGS analysis revealed a high nucleotide similarity within the core-genome, but relevant differences in the accessory genome that may account for the detected biofilm phenotypic dissimilarities, such as genes already associated with biofilm formation in other pathogenic bacteria (e.g., genes coding haemogglutinins and haemolysins). These data reinforce that the research efforts to defeat bacterial biofilms should take into account that their dynamics may be contingent on the medical devices-associated materials.
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Affiliation(s)
- Maria Bandeira
- Instituto Nacional de Saúde Dr Ricardo Jorge, Departamento de Saúde Ambiental, Unidade de Investigação e Desenvolvimento-Lisboa, Avenida Padre Cruz, 1649-016 Lisboa, Portugal.
- Universidade de Lisboa, Instituto Superior Técnico, Departamento de Engenharia Química, Avenida Rovisco Pais, 1049-001 Lisboa, Portugal.
| | - Vítor Borges
- Instituto Nacional de Saúde Dr Ricardo Jorge, Departamento de Doenças Infeciosas, Núcleo de Bioinformática, Avenida Padre Cruz, 1649-016 Lisboa, Portugal.
| | - João P Gomes
- Instituto Nacional de Saúde Dr Ricardo Jorge, Departamento de Doenças Infeciosas, Núcleo de Bioinformática, Avenida Padre Cruz, 1649-016 Lisboa, Portugal.
| | - Aida Duarte
- Universidade de Lisboa, Faculdade de Farmácia, Av Prof Gama Pinto, 1649-003 Lisboa, Portugal.
| | - Luisa Jordao
- Instituto Nacional de Saúde Dr Ricardo Jorge, Departamento de Saúde Ambiental, Unidade de Investigação e Desenvolvimento-Lisboa, Avenida Padre Cruz, 1649-016 Lisboa, Portugal.
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139
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Chouhan V. Qivas Therapy for Treatment of Implant Associated MDR Bacterial Infection. J Orthop Case Rep 2017; 6:69-71. [PMID: 28154812 PMCID: PMC5040578 DOI: 10.13107/jocr.2250-0685.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Orthopedic implant-associated infections are difficult to treat, both physically and psychologically, for the patient and the surgeon as well. Organisms capable of forming biofilms tend to be more virulent and have ability of causing chronic infections. Chronic implant associated infections are very difficult to treat, requires a lot of time, money and other resources. Chronic infections produce a lot of morbidity and sometimes mortality to the patient. Case report: A 40-year-old male treated for bilateral acetabular fracture sustained after fall from height due to an episode of seizure. After acetabular surgery, he developed surgical site infection unresponsive to wound wash and intravenous antibiotics. After two weeks, we started treatment with Qurion solution and Vacuum assisted suction (QiVAS) to which patient responded very well and his infection was cured. We are not aware of any study or case report using QiVAS therapy for treatment of infection associated with orthopaedic implant. Conclusion: Orthopaedic implant related infection can be difficult to treat especially if caused by multidrug resistant organisms capable of forming biofilm. QiVAS therapy is a new method which can be used in such difficult situations to treat infection without removal of implant within short period of time thus reducing morbidity for patients.
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Affiliation(s)
- Varun Chouhan
- Department of Orthopaedics, Consultant Orthopaedic Surgeon, Bombay Hospital, Indore. India
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140
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Enhanced Performance and Mode of Action of a Novel Antibiofilm Hydrofiber® Wound Dressing. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7616471. [PMID: 27990437 PMCID: PMC5136405 DOI: 10.1155/2016/7616471] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/09/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
Biofilm development in wounds is now acknowledged to be a precursor to infection and a cause of delayed healing. A next-generation antibiofilm carboxymethylcellulose silver-containing wound dressing (NGAD) has been developed to disrupt and kill biofilm microorganisms. This in vitro study aimed to compare its effectiveness against various existing wound dressings and examine its mode of action. A number of biofilm models of increasing complexity were used to culture biofilms of wound-relevant pathogens, before exposure to test dressings. Confocal microscopy, staining, and imaging of biofilm constituents, total viable counting, and elemental analysis were conducted to assess dressing antibiofilm performance. Live/dead staining and viable counting of biofilms demonstrated that the NGAD was more effective at killing biofilm bacteria than two other standard silver dressings. Staining of biofilm polysaccharides showed that the NGAD was also more effective at reducing this protective biofilm component than standard silver dressings, and image analyses confirmed the superior biofilm killing and removal performance of the NGAD. The biofilm-disruptive and silver-enhancing modes of action of the NGAD were supported by significant differences (p < 0.05) in biofilm elemental markers and silver donation. This in vitro study improves our understanding of how antibiofilm dressing technology can be effective against the challenge of biofilm.
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141
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Gupta S, Laskar N, Kadouri DE. Evaluating the Effect of Oxygen Concentrations on Antibiotic Sensitivity, Growth, and Biofilm Formation of Human Pathogens. Microbiol Insights 2016; 9:37-46. [PMID: 27891050 PMCID: PMC5113855 DOI: 10.4137/mbi.s40767] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/02/2016] [Accepted: 10/06/2016] [Indexed: 01/20/2023] Open
Abstract
Standard antimicrobial susceptibility tests are performed in vitro under normal room oxygen conditions to predict the in vivo effectiveness of antimicrobial therapy. The aim of this study was to conduct a comprehensive analysis of the effect of different oxygen levels on the antibiotic susceptibility of two strains of Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. It was found that anoxic conditions caused reduced sensitivity of bacteria to aminoglycoside antibiotics in four of six bacteria used in the study. In addition, oxygen limitation decreased the susceptibility of P. aeruginosa strains and K. pneumoniae strains to piperacillin/tazobactam and azithromycin, respectively. In contrast, five of six bacteria became more susceptible to tetracycline antibiotics under oxygen-limiting conditions. Our data highlight the importance of considering the potential in vivo oxygen levels within the infection site when setting susceptibility breakpoints for evaluating the therapeutic potential of a drug and its effect on antibiotic sensitivity of the pathogen.
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Affiliation(s)
- Shilpi Gupta
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Nozrin Laskar
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Daniel E Kadouri
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, NJ, USA
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142
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Chung PY. The emerging problems of Klebsiella pneumoniae infections: carbapenem resistance and biofilm formation. FEMS Microbiol Lett 2016; 363:fnw219. [PMID: 27664057 DOI: 10.1093/femsle/fnw219] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 12/14/2022] Open
Abstract
Klebsiella pneumoniae is an opportunistic pathogen that commonly causes nosocomial infections in the urinary tract, respiratory tract, lung, wound sites and blood in individuals with debilitating diseases. Klebsiella pneumoniae is still a cause of severe pneumonia in alcoholics in Africa and Asia, and the predominant primary pathogen of primary liver abscess in Taiwan and Southeast Asia, particularly in Asian and Hispanic patients, and individuals with diabetes mellitus. In the United States and Europe, K. pneumoniae infections are most frequently associated with nosocomial infections. The emergence of antibiotic-resistant strains of K. pneumoniae worldwide has become a cause of concern where extended-spectrum β-lactamases (ESBLs) and carbapenemase-producing strains have been isolated with increasing frequency. The pathogen's ability to form biofilms on inserted devices such as urinary catheter has been proposed as one of the important mechanisms in nosocomially acquired and persistent infections, adding to the increased resistance to currently used antibiotics. In this review, infections caused by K. pneumoniae, antibiotic resistance and formation of biofilm will be discussed.
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Affiliation(s)
- Pooi Yin Chung
- Department of Pathology, School of Medicine, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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143
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Lin CT, Lin TH, Wu CC, Wan L, Huang CF, Peng HL. CRP-Cyclic AMP Regulates the Expression of Type 3 Fimbriae via Cyclic di-GMP in Klebsiella pneumoniae. PLoS One 2016; 11:e0162884. [PMID: 27631471 PMCID: PMC5025149 DOI: 10.1371/journal.pone.0162884] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/30/2016] [Indexed: 12/18/2022] Open
Abstract
Klebsiella pneumoniae is the predominant pathogen isolated from liver abscesses of diabetic patients in Asian countries. However, the effects of elevated blood glucose levels on the virulence of this pathogen remain largely unknown. Type 3 fimbriae, encoded by the mrkABCDF genes, are important virulence factors in K. pneumoniae pathogenesis. In this study, the effects of exogenous glucose and the intracellular cyclic AMP (cAMP) signaling pathway on type 3 fimbriae expression regulation were investigated. The production of MrkA, the major subunit of type 3 fimbriae, was increased in glucose-rich medium, whereas cAMP supplementation reversed the effect. MrkA production was markedly increased by cyaA or crp deletion, but slightly decreased by cpdA deletion. In addition, the mRNA levels of mrkABCDF genes and the activity of PmrkA were increased in Δcrp strain, as well as the mRNA levels of mrkHIJ genes that encode cyclic di-GMP (c-di-GMP)-related regulatory proteins that influence type 3 fimbriae expression. Moreover, the activities of PmrkHI and PmrkJ were decreased in ΔlacZΔcrp strain. These results indicate that CRP-cAMP down-regulates mrkABCDF and mrkHIJ at the transcriptional level. Further deletion of mrkH or mrkI in Δcrp strain diminished the production of MrkA, indicating that MrkH and MrkI are required for the CRP regulation of type 3 fimbriae expression. Furthermore, the high activity of PmrkHI in the ΔlacZΔcrp strain was diminished in ΔlacZΔcrpΔmrkHI, but increased in the ΔlacZΔcrpΔmrkJ strain. Deletion of crp increased the intracellular c-di-GMP concentration and reduced the phosphodiesterase activity. Moreover, we found that the mRNA levels of multiple genes related to c-di-GMP metabolism were altered in Δcrp strain. These indicate that CRP regulates type 3 fimbriae expression indirectly via the c-di-GMP signaling pathway. In conclusion, we found evidence of a coordinated regulation of type 3 fimbriae expression by the CRP-cAMP and c-di-GMP signaling pathways in K. pneumoniae.
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Affiliation(s)
- Ching-Ting Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
- * E-mail: (CTL); (HLP)
| | - Tien-Huang Lin
- Division of Urology, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan, Republic of China
- Tzu Chi University School of Post-Baccalaureate Chinese Medicine, Hualien, Taiwan, Republic of China
| | - Chien-Chen Wu
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Lei Wan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Chun-Fa Huang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Hwei-Ling Peng
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, Republic of China
- * E-mail: (CTL); (HLP)
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144
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Benincasa M, Lagatolla C, Dolzani L, Milan A, Pacor S, Liut G, Tossi A, Cescutti P, Rizzo R. Biofilms from Klebsiella pneumoniae: Matrix Polysaccharide Structure and Interactions with Antimicrobial Peptides. Microorganisms 2016; 4:microorganisms4030026. [PMID: 27681920 PMCID: PMC5039586 DOI: 10.3390/microorganisms4030026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/20/2016] [Accepted: 08/02/2016] [Indexed: 01/15/2023] Open
Abstract
Biofilm matrices of two Klebsiella pneumoniae clinical isolates, KpTs101 and KpTs113, were investigated for their polysaccharide composition and protective effects against antimicrobial peptides. Both strains were good biofilm producers, with KpTs113 forming flocs with very low adhesive properties to supports. Matrix exopolysaccharides were isolated and their monosaccharide composition and glycosidic linkage types were defined. KpTs101 polysaccharide is neutral and composed only of galactose, in both pyranose and furanose ring configurations. Conversely, KpTs113 polysaccharide is anionic due to glucuronic acid units, and also contains glucose and mannose residues. The susceptibility of the two strains to two bovine cathelicidin antimicrobial peptides, BMAP-27 and Bac7(1–35), was assessed using both planktonic cultures and biofilms. Biofilm matrices exerted a relevant protection against both antimicrobials, which act with quite different mechanisms. Similar protection was also detected when antimicrobial peptides were tested against planktonic bacteria in the presence of the polysaccharides extracted from KpTs101 and KpTs113 biofilms, suggesting sequestering adduct formation with antimicrobials. Circular dichroism experiments on BMAP-27 in the presence of increasing amounts of either polysaccharide confirmed their ability to interact with the peptide and induce an α-helical conformation.
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Affiliation(s)
- Monica Benincasa
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Cristina Lagatolla
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Lucilla Dolzani
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Annalisa Milan
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Sabrina Pacor
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Gianfranco Liut
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Alessandro Tossi
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Paola Cescutti
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
| | - Roberto Rizzo
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Trieste I-34127, Italy.
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145
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Detection and Characterization of a Novel Lytic Bacteriophage (vB-KpneM-Isf48) Against Klebsiella pneumoniae Isolates from Infected Wounds Carrying Antibiotic-Resistance Genes (TEM, SHV, and CTX-M). IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.34475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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146
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Aelenei P, Miron A, Trifan A, Bujor A, Gille E, Aprotosoaie AC. Essential Oils and Their Components as Modulators of Antibiotic Activity against Gram-Negative Bacteria. MEDICINES 2016; 3:medicines3030019. [PMID: 28930130 PMCID: PMC5456245 DOI: 10.3390/medicines3030019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 07/17/2016] [Accepted: 07/18/2016] [Indexed: 12/21/2022]
Abstract
Gram-negative bacteria cause infections that are difficult to treat due to the emergence of multidrug resistance. This review summarizes the current status of the studies investigating the capacity of essential oils and their components to modulate antibiotic activity against Gram-negative bacteria. Synergistic interactions are particularly discussed with reference to possible mechanisms by which essential oil constituents interact with antibiotics. Special emphasis is given to essential oils and volatile compounds that inhibit efflux pumps, thus reversing drug resistance in Gram-negative bacteria. In addition, indifference and antagonism between essential oils/volatile compounds and conventional antibiotics have also been reported. Overall, this literature review reveals that essential oils and their purified components enhance the efficacy of antibiotics against Gram-negative bacteria, being promising candidates for the development of new effective formulations against Gram-negative bacteria.
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Affiliation(s)
- Petruta Aelenei
- Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy Grigore T. Popa-Iasi, Universitatii 16, Iasi 700115, Romania.
- Regulatory Affairs Department, Fiterman Pharma LLC, Pacurari Road 127, Iasi 700544, Romania.
| | - Anca Miron
- Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy Grigore T. Popa-Iasi, Universitatii 16, Iasi 700115, Romania.
| | - Adriana Trifan
- Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy Grigore T. Popa-Iasi, Universitatii 16, Iasi 700115, Romania.
| | - Alexandra Bujor
- Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy Grigore T. Popa-Iasi, Universitatii 16, Iasi 700115, Romania.
| | - Elvira Gille
- Stejarul Biological Research Centre/National Institute of Research and Development for Biological Sciences, Alexandru cel Bun 6, Piatra Neamt 610004, Romania.
| | - Ana Clara Aprotosoaie
- Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy Grigore T. Popa-Iasi, Universitatii 16, Iasi 700115, Romania.
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147
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Origüen J, Fernández-Ruiz M, López-Medrano F, Ruiz-Merlo T, González E, Morales JM, Fiorante S, San-Juan R, Villa J, Orellana MÁ, Andrés A, Aguado JM. Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options. Transpl Infect Dis 2016; 18:575-84. [PMID: 27373698 DOI: 10.1111/tid.12547] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/04/2016] [Accepted: 02/09/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antibiotic resistance is an emerging phenomenon in kidney transplantation (KT). METHODS We compared species distribution and antimicrobial susceptibility patterns in 1052 isolates from urine cultures obtained in 2 different cohorts of kidney transplant recipients in a single center (Cohort A: 189 patients undergoing KT between January 2002 and December 2004 [336 isolates]; Cohort B: 115 patients undergoing KT between January 2011 and December 2013 [716 isolates]). RESULTS Asymptomatic bacteriuria accounted for most of the isolates (86.9% in Cohort A and 92.3% in Cohort B). Klebsiella pneumoniae (9.5% vs. 15.6%), Pseudomonas aeruginosa (1.8% vs. 7.9%), and Enterobacter cloacae (0.6% vs. 3.1%) were significantly more common in Cohort B. The isolation of K. pneumoniae in Cohort B was associated with the occurrence of acute pyelonephritis (9.8% of all K. pneumoniae isolates vs. 2.8% of the remaining uropathogens; P = 0.001). Non-susceptibility rates among Enterobacteriaceae in Cohort B were higher for every class of antibiotics (P ≤ 0.003) with the exception of fosfomycin. Compared to Cohort A, significant increases were seen in isolates from Cohort B for multidrug-resistant (MDR) (43.9% vs. 67.8%, respectively; P = 0.001), extended-spectrum beta-lactamase (ESBL)-producing (6.6% vs. 26.1%; P = 0.001), and carbapenemase-producing Enterobacteriaceae strains (0.0% vs. 5.0%; P = 0.001). Such differences were mostly attributable to K. pneumoniae (as 54.5% and 13.4% of isolates in Cohort B were ESBL-producing and carbapenemase-producing, respectively). MDR isolates were responsible for 69.1% of episodes of symptomatic urinary tract infection in Cohort B. CONCLUSION The increase in resistance rates among Enterobacteriaceae uropathogens is significant and may have an effect on KT programs.
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Affiliation(s)
- J Origüen
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - T Ruiz-Merlo
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - E González
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - S Fiorante
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - R San-Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - J Villa
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Á Orellana
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - A Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), School of Medicine, Universidad Complutense, Madrid, Spain
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148
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Cescutti P, De Benedetto G, Rizzo R. Structural determination of the polysaccharide isolated from biofilms produced by a clinical strain of Klebsiella pneumoniae. Carbohydr Res 2016; 430:29-35. [PMID: 27182661 DOI: 10.1016/j.carres.2016.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 11/17/2022]
Abstract
Klebsiella pneumoniae are Gram negative opportunistic pathogens producing capsular (K) polysaccharides. Seventy-seven different K antigens have been described and they are the basis for K serotyping. Capsular polysaccharides are important virulence factors and have a relevant role for the structure of biofilm communities. Nevertheless, little information is available on the polysaccharides produced in biofilm matrices by Klebsiella spp. In the present study, a clinical isolate of Klebsiella pneumoniae was grown both on cellulose membranes deposited on agar plates, where it formed an adherent biofilm, and in liquid medium, where it formed floating biofilms (flocs). Extraction and purification of the polysaccharide fraction showed that only one main carbohydrate polymer was present in both adherent biofilms and flocs. Composition and linkage analysis, Smith degradation followed by ESI-MS, 1D and 2D NMR spectroscopy revealed that the polysaccharide belong to the type K24 and has the following structure.
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Affiliation(s)
- Paola Cescutti
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Bdg. C11, Trieste 34127, Italy.
| | - Gianluigi De Benedetto
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Bdg. C11, Trieste 34127, Italy
| | - Roberto Rizzo
- Department of Life Sciences, University of Trieste, Via L. Giorgieri 1, Bdg. C11, Trieste 34127, Italy
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149
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Padhi A, Naik SK, Sengupta S, Ganguli G, Sonawane A. Expression of Mycobacterium tuberculosis NLPC/p60 family protein Rv0024 induce biofilm formation and resistance against cell wall acting anti-tuberculosis drugs in Mycobacterium smegmatis. Microbes Infect 2016; 18:224-36. [DOI: 10.1016/j.micinf.2015.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/25/2015] [Accepted: 11/28/2015] [Indexed: 10/22/2022]
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150
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de Campos PA, Royer S, Batistão DWDF, Araújo BF, Queiroz LL, de Brito CS, Gontijo-Filho PP, Ribas RM. Multidrug Resistance Related to Biofilm Formation in Acinetobacter baumannii and Klebsiella pneumoniae Clinical Strains from Different Pulsotypes. Curr Microbiol 2016; 72:617-27. [PMID: 26846651 DOI: 10.1007/s00284-016-0996-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
Abstract
The emergence of Acinetobacter baumannii and Klebsiella pneumoniae strains in the hospital environment has been associated with the presence of multiple genetic elements, virulence factors and the ability to form biofilms. This study evaluated the biofilm formation ability of clinical and environmental A. baumannii and K. pneumoniae strains, isolated from various sources and presenting different molecular characteristics, resistance profiles and pulsed-field gel electrophoresis patterns. Fifty-three isolates were recovered from 2009 to 2014 in a Brazilian university hospital. Investigation of biofilm formation was performed for 10 strains of each species assessed by an initial adhesion assay, biofilm cell concentration and biofilm biomass, evaluated by quantitative assays in replicates, in three independent experiments. All strains of A. baumannii were able to attach to polystyrene plates, although two strains adhered to a lesser degree than the control. K. pneumoniae strains showed opposite behaviour, where only three strains adhered significantly when compared to the control. Quantitative evaluation revealed that in five A. baumannii and four K. pneumoniae isolates the biomass production could be characterised as moderate. None of the isolates were strong biofilm producers. Our results demonstrate: (1) biofilm formation is a heterogeneous property amongst A. baumannii and K. pneumoniae clinical strains and it was not associated with certain clonal types; (2) no relationship between multidrug resistance and biofilm production was observed; (3) more virulent K. pneumoniae strains tended to present higher production of biofilm.
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Affiliation(s)
- Paola Amaral de Campos
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
| | - Sabrina Royer
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil.
| | - Deivid William da Fonseca Batistão
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
| | - Bruna Fuga Araújo
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
| | - Lícia Ludendorff Queiroz
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
| | - Cristiane Silveira de Brito
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
| | - Paulo P Gontijo-Filho
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
| | - Rosineide Marques Ribas
- Laboratory of Molecular Microbiology, Biomedical Science Institute, Federal University of Uberlândia, Av. Pará, 1720, Umuarama, Uberlândia, MG, 38400-902, Brazil
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