Multiple fimbrial haemagglutinins in Serratia species

Comparison of uropathogens and antibiotic susceptibility patterns in catheterized ambulant middle-aged and elderly Nigerian patients with bladder outlet obstruction

OBJECTIVE

Advanced age is one of the notable risk factors for catheter-associated urinary tract infections (CAUTIs), and differences between middle aged and elderly men with CAUTIs is poorly understood. This study aimed at comparing the pattern of urinary pathogens and antibiotic susceptibility in ambulant catheterized middle-aged and elderly Nigerian men.

MATERIAL AND METHODS

One hundred and fifty-four patients catheterized for >48 hours had provided clean catch mid-stream urine samples for microscopic analysis, culture and sensitivity tests. Eighty-two men aged <65, and 72 men aged ≥65 years matched for age, level of education, occupation and marital status were compared.

RESULTS

Prevalence of CAUTIs among middle-aged men was middle-aged men was higher than the elderly (90.2% and 80.6% respectively) but this was not statistically significant (p=0.086). CAUTIs in middle-aged men with suprapubic catheters were significantly more frequent than those with urethral catheters (p=0.000). The prevalence of CAUTIs in middle-aged men with urethral stricture was different from other causes of bladder outlet obstruction (p=0.004). Men with indwelling catheters longer than 2 weeks had higher CAUTIs (p=0.000). Escherichia coli was the commonest pathogen in both groups while nitrofurantoin was the most sensitive drug.

CONCLUSION

There are differential rates of CAUTIs in both the middle-aged men and the elderly with bladder outlet obstruction in our environment. The knowledge of the common pathogens and the antibiotic susceptibility will prevent irrational antibiotic use. Middle-aged men had higher prevalence of CAUTIs when Proteus spp. was the infectious agent. However, E. coli was the commonest pathogen of CAUTIs in all men. Also, middle- aged men with suprapubic catheters had higher rates of CAUTIs. Nitrofurantoin was the best drug in all men with CAUTIs but elderly men had higher rates of multi-resistance.

Klebsiella pneumoniae and type 3 fimbriae: nosocomial infection, regulation and biofilm formation

The Gram-negative opportunistic pathogen Klebsiella pneumoniae is responsible for causing a spectrum of nosocomial and community-acquired infections. Globally, K. pneumoniae is a frequently encountered hospital-acquired opportunistic pathogen that typically infects patients with indwelling medical devices. Biofilm formation on these devices is important in the pathogenesis of these bacteria, and in K. pneumoniae, type 3 fimbriae have been identified as appendages mediating the formation of biofilms on biotic and abiotic surfaces. The factors influencing the regulation of type 3 fimbrial gene expression are largely unknown but recent investigations have indicated that gene expression is regulated, at least in part, by the intracellular levels of cyclic di-GMP. In this review, we have highlighted the recent studies that have worked to elucidate the mechanism by which type 3 fimbrial expression is controlled and the studies that have established the importance of type 3 fimbriae for biofilm formation and nosocomial infection by K. pneumoniae.

Molecular analysis of type 3 fimbrial genes from Escherichia coli, Klebsiella and Citrobacter species

Background

Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection in the United States and is caused by a range of uropathogens. Biofilm formation by uropathogens that cause CAUTI is often mediated by cell surface structures such as fimbriae. In this study, we characterised the genes encoding type 3 fimbriae from CAUTI strains of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Citrobacter koseri and Citrobacter freundii.

Results

Phylogenetic analysis of the type 3 fimbrial genes (mrkABCD) from 39 strains revealed they clustered into five distinct clades (A-E) ranging from one to twenty-three members. The majority of sequences grouped in clade A, which was represented by the mrk gene cluster from the genome sequenced K. pneumoniae MGH78578. The E. coli and K. pneumoniae mrkABCD gene sequences clustered together in two distinct clades, supporting previous evidence for the occurrence of inter-genera lateral gene transfer. All of the strains examined caused type 3 fimbriae mediated agglutination of tannic acid treated human erythrocytes despite sequence variation in the mrkD-encoding adhesin gene. Type 3 fimbriae deletion mutants were constructed in 13 representative strains and were used to demonstrate a direct role for type 3 fimbriae in biofilm formation.

Conclusions

The expression of functional type 3 fimbriae is common to many Gram-negative pathogens that cause CAUTI and is strongly associated with biofilm growth. Our data provides additional evidence for the spread of type 3 fimbrial genes by lateral gene transfer. Further work is now required to substantiate the clade structure reported here by examining more strains as well as other bacterial genera that make type 3 fimbriae and cause CAUTI.

Oxygen-limiting conditions enrich for fimbriate cells of uropathogenic Proteus mirabilis and Escherichia coli

MR/P fimbriae of uropathogenic Proteus mirabilis undergo invertible element-mediated phase variation whereby an individual bacterium switches between expressing fimbriae (phase ON) and not expressing fimbriae (phase OFF). Under different conditions, the percentage of fimbriate bacteria within a population varies and could be dictated by either selection (growth advantage of one phase) or signaling (preferentially converting one phase to the other in response to external signals). Expression of MR/P fimbriae increases in a cell-density dependent manner in vitro and in vivo. However, rather than the increased cell density itself, this increase in fimbrial expression is due to an enrichment of fimbriate bacteria under oxygen limitation resulting from increased cell density. Our data also indicate that the persistence of MR/P fimbriate bacteria under oxygen-limiting conditions is a result of both selection (of MR/P fimbrial phase variants) and signaling (via modulation of expression of the MrpI recombinase). Furthermore, the mrpJ transcriptional regulator encoded within the mrp operon contributes to phase switching. Type 1 fimbriae of Escherichia coli, which are likewise subject to phase variation via an invertible element, also increase in expression during reduced oxygenation. These findings provide evidence to support a mechanism for persistence of fimbriate bacteria under oxygen limitation, which is relevant to disease progression within the oxygen-restricted urinary tract.

Complicated catheter-associated urinary tract infections due to Escherichia coli and Proteus mirabilis

Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options.

Isolation rate of non-hemagglutinating strains of Serratia marcescens from clinical specimens in a general hospital: comparison of serotypes O2 and O14

Given the absence of recent reports on the isolation rate of Serratia marcescens by pili type, clinical isolates from respiratory and urinary tract specimens--prime loci of infection by this organism--were subjected to examination. The 123 S. marcescens strains (serotype O2, 67 strains, serotype O14, 56 strains) used in this study were isolated from inpatients at Showa University Fujigaoka Hospital during the 5 years from April 1997 to March 2002. Higher rates of S. marcescens O2 with mannose-resistant (MR)/K Klebsiella-like pili were detected among the respiratory tract-derived strains. On the other hand, more non-hemagglutinating O14 strains were found among the urinary tract-derived strains. Analysis by study phase revealed a rise in the isolation rate of non-hemagglutinating strains, from 0-17.4% for O2 strains and 34.5%-66.7% for O14 strains, between phase I (April 1997 to March 1999) and phase II (April 1999 to March 2002) of the study. In order to examine the increasing non-hemagglutinating strains in detail, the 28 serotype O14 non-hemagglutinating strains, and 8 strains with only mannose-sensitive (MS) pili were subjected to genotyping by pulsed-field gel electrophoresis (PFGE), revealing the presence of 10 clones with disparate genotypes. The A1 strain isolated at the highest frequency was non-hemagglutinating in all cases and possessed the same genotype, indicating proliferation within the hospital over the 5 years of the study. These results indicate that non-hemagglutinating strains were transmitted among patients within the hospital.

The role of Serratia marcescens in soft contact lens associated ocular infections. A review

Serratia marcescens is a Gram negative rod which for a century and a half was considered a harmless saphrophyte. However, medical technology and the use of antibacterial agents have created ecological niches for this bacterium, which is now a medical problem. The bacterium is encountered in connection with contact lens keratitis, often associated with contaminated contact lens solutions. The concentrations of chlorhexidin and thiomersal required in contact lens solution to suppress the bacterium have been proved toxic to the eye. Modern contact lens solutions with biguanids have rapid killing kinetics, while in solutions with polyquaternium S. marcescens can survive in reduced numbers for up to 72 hours. The adherence of a specific isolate of Serratia to hydrogel lenses increased with decreased water content of the lenses. However, there has been no correlation between hydrophobicity markers or hemagglutinins and adherence to contact lenses or urinary tract epithelium. When handling medical plastic devices, such as contact lenses, strictly enforced hygiene remains the most important method to combat environmental bacteria such as Serratia marcescens.

Prevotella intermedia fimbriae mediate hemagglutination

Our earlier studies demonstrated that clinical strains of Prevotella intermedia, isolated from human periodontal pockets, possess various types of fimbria (surface appendages) as determined ultrastructurally. These bacteria have the ability to agglutinate selected mammalian erythrocytes. Hemagglutinating activity exhibited by these cells may be attributable to these surface structures. Strain 17, which possess fimbriae of 8 nm in diameter and readily agglutinates human, monkey, sheep, rabbit, and mouse erythrocytes was selected to determine whether these fimbriae possessed the hemagglutinating activity. Fimbriae were mechanically sheared, concentrated by ammonium sulfate precipitation, solubilized in 10 mM Tris-HCl buffer containing 0.5% deoxycholate and partly purified by ultracentrifugation in a 10-50% linear sucrose gradient. Isolated fimbriae banded at a density of 1.20-1.15 g/ml, appeared fairly uniform ultrastructurally, and possessed hemagglutinating activity. The hemagglutinating activity of P. intermedia whole cells and isolated fimbriae was reduced by treatment with proteases and eliminated by treatment with heat at 80 degrees C for 10 min. The optimal pH for the hemagglutination was 7.0. In the process of hemagglutination, P. intermedia whole cells and isolated fimbriae bound to rabbit erythrocytes as observed by: (a) decrease in the hemagglutinating activity of bacterial whole cells and isolated fimbriae after incubation with rabbit erythrocytes, (b) increase in hemagglutinating activity of the red cells used for absorption, and (c) the presence of P. intermedia whole cells and fimbriae on red cells after absorption as revealed by immunoelectron microscopy. Both the immune immunoglobulin G of the rabbit polyclonal anti-fimbriae antibody and the immune immunoglobulin G and its Fab fragments of the murine monoclonal anti-fimbriae antibody were effective inhibitors of hemagglutination mediated by isolated fimbriae. Immunogold labeling showed that the monoclonal antibody bound specifically to P. intermedia fimbriae. These results collectively suggest that the hemagglutination exhibited by P. intermedia may be attributable to the fimbriae or the fimbrial-associated components.

The type 3 fimbrial adhesin gene (mrkD) of Klebsiella species is not conserved among all fimbriate strains

The type 3 fimbriae of enteric bacteria mediate agglutination, in vitro, of erythrocytes treated with tannic acid. The gene encoding the polypeptide, MrkD, that mediates this agglutination reaction was placed downstream of an inducible promoter, and the ability of MrkD alone to facilitate hemagglutination was determined. Although Escherichia coli transformants could be shown to produce the MrkD protein, hemagglutination did not occur in the absence of other mrk gene products. In addition, the MrkD polypeptide did not cross the bacterial outer membrane unless a fimbrial chaperone protein was also present. Analysis of the frequency of the mrkD gene within the genus Klebsiella indicated that this gene is conserved in strains of Klebsiella oxytoca but not in other fimbriate Klebsiella species. In the small number of strains of Klebsiella pneumoniae that do possess a related mrkD gene, this determinant could be found on a plasmid in one strain. The ability of type 3 fimbriate bacteria to adhere to type V collagen was found to be a function of a specific MrkD polypeptide. This adhesin is frequently found in strains of K. oxytoca but is rarely associated with the type 3 fimbriae of K. pneumoniae.

Hemagglutination (fimbriae) and hydrophobicity in adherence of Serratia marcescens to urinary tract epithelium and contact lenses

The capacity of 59 isolates of Serratia marcescens, obtained from urinary tract infections, wounds, and contact lenses or their paraphernalia, to agglutinate erythrocytes from different animal species was tested. Three main patterns were found: mannose-sensitive agglutination of guinea-pig, fowl or horse erythrocyte; mannose-resistant agglutination of chicken or pigeon erythrocytes alone or in combination with mannose-sensitive agglutination; and no agglutination. Hemagglutination capacity was associated with isolates from urinary tract infection, but not with isolates associated with contact lenses. Adherence to human urinary tract epithelium did not correlate with the hemagglutination patterns nor with the origin of the isolates. Some strains of different hemagglutination pattern were selected for the study of hydrophobicity and adherence to contact lens polymers. Hydrophobicity, as determined by degree of partition in hexadecane and water (BATH-values), correlated neither with degree of adherence to contact lens polymers nor with the hemagglutination pattern. For a representative strain there was an excellent correlation (r2 = 0.98) between adherence and the water content (hydrophobicity) of the lens polymers. These results suggest that, as with tissues, other factors interact with hydrophobicity in causing adherence to plastics.

Type 3 fimbriae among enterobacteria and the ability of spermidine to inhibit MR/K hemagglutination

The distribution of the gene cluster encoding type 3 fimbriae among various isolates of the family Enterobacteriaceae was investigated by using 112 clinical and nonclinical isolates. Closely related DNA sequences were detected in all Klebsiella strains, in most Enterobacter isolates, in a smaller number of Escherichia coli and Salmonella spp., and in a single isolate each of Yersinia enterocolitica and Serratia liquefaciens but not in isolates of Morganella or Providencia species or Serratia marcescens. Except for E. coli and Salmonella strains, the presence of gene sequences was correlated with the phenotypic expression of either the MR/K hemagglutinin or fimbriae that reacted with specific antibodies. In one isolate of Y. enterocolitica the expression of type 3 fimbriae was plasmid determined. The polyamine spermidine was identified as an inhibitor of MR/K hemagglutinating activity, exhibiting an MIC of 1.2 mM. Spermidine inhibited the hemagglutination of 37 MR/K-positive clinical isolates from various genera. However, one clinical isolate of Enterobacter cloacae and most (four of five) nonclinical Klebsiella isolates were not completely inhibited.

Cleavage of immunoglobulin G (IgG) and IgA around the hinge region by proteases from Serratia marcescens

Seven clinical and two nonclinical isolates of Serratia marcescens were examined for their ability to produce extracellular enzymes that cleave immunoglobulin G (IgG) and IgA molecules. All seven clinical isolates excreted a large amount of a 56-kilodalton (kDa) protease (56K protease) and small amounts of a 60-kDa and a 73-kDa protease (60K and 73K proteases, respectively) in culture medium during growth. All purified proteases cleaved IgG and IgA effectively if the level of protease production exceeded 2 to 5 micrograms/ml. The proteolytic activity in the culture supernatant was inhibited by about 85% by a chelating agent (EDTA), which indicated that the major immunoglobulin-cleaving enzyme is the metalloprotease(s) reported previously. Immunological quantification of proteases by single radial immunodiffusion showed similar results: the amount of 56K protease was about 65% and those of the 60K and 73K proteases were about 20 and 5%, respectively. Incubation for 3 h at 37 degrees C was required to generate immunoreactive Fab and Fc fragments. Further analysis of the cleavage products of IgG or IgA demonstrated that the 56K protease, as well as the 60K and 73K proteases, cleaves only the heavy chain of these immunoglobulins near the hinge region to generate Fab and Fc fragments. The susceptibilities of the subclasses of IgG and IgA to the 56K protease were as follows: IgG3 greater than IgG1 greater than IgG2 greater than IgG4 and IgA1 greater than IgA2. IgG2, IgG4, and IgA2 were relatively resistant to the 56K protease.

Cell surface hydrophobicity of pigmented and nonpigmented clinical Serratia marcescens strains

The cell surface hydrophobicity of 10 pigmented and 4 nonpigmented clinical Serratia marcescens strains was studied, based on the ability of the strains to adhere to hydrocarbons and to polystyrene. The cell surface hydrophobicity depended greatly on growth temperature; all of the strains tested were adherent following growth at 30 degrees C, whereas none was adherent following growth at 38 degrees C. In previous studies, the pigment prodigiosin has been cited as responsible for cell surface hydrophobicity in various Serratia strains. However, the observed ability of the nonpigmented strains to adhere to the test hydrocarbons and to polystyrene indicates that Serratia strains can possess hydrophobic surface properties in the absence of this pigment. Moreover, strain 1785 cells were adherent whether they were grown at 30 or 36.5 degrees C, even though pigment was not synthesized at the higher temperature. In Escherichia coli correlations have been noted between increased cell surface hydrophobicity and the presence of mannose-specific adhesins; no such relationship was found in the S. marcescens strains tested. The expression of cell surface hydrophobicity in clinical S. marcescens strains at 30 degrees C and the loss of hydrophobicity at host temperatures raise the possibility that infective cells from the environment are initially hydrophobic, but lose this property upon subsequent proliferation within a host.

Relationships among broad-spectrum and narrow-spectrum mannose-resistant fimbrial hemagglutinins in different Yersinia species

When 117 strains of Yersinia were grown in serial broth culture at 22 or 30 C, 44 (38%) formed a broad-spectrum, mannose-resistant hemagglutinin (MR/Y-HA) associated with thick (8 nm) channelled (MR/Y) fimbriae; eight other strains (7%) formed a narrow-spectrum, mannose-resistant hemagglutinin (MR/K-like HA) associated with thin (4 nm) non-channelled (type 3-like) fimbriae. The distribution of these two fimbrial hemagglutinins in different Yersinia species is discussed and their properties are compared with those of other reported mannose-resistant hemagglutinins. The thick fimbriae of four Yersinia species were antigenically similar as judged by immunoelectronmicroscopy. Likewise, the thin fimbriae of three Yersinia species were antigenically similar, though different from the thick fimbriae.