Effects of tetracycline on the streptococcal flora of periodontal pockets

Molecular and antigenic characterization of a Streptococcus oralis coaggregation receptor polysaccharide by carbohydrate engineering in Streptococcus gordonii

The coaggregation receptor polysaccharides (RPS) of Streptococcus oralis and related species are recognized by lectin-like adhesins on other members of the oral biofilm community and by RPS-specific antibodies. The former interactions involve beta-GalNAc or beta-Gal containing host-like motifs in the oligosaccharide repeating units of these polysaccharides, whereas the latter involves features of these molecules that are immunogenic. In the present investigation, the molecular and corresponding structural basis for the serotype specificity of S. oralis ATCC 10557 RPS was determined by engineering the production of this polysaccharide in transformable Streptococcus gordonii 38. This involved the systematic replacement of genes in the rps cluster of strain 38 with different but related genes from S. oralis 10557 and structural characterization of the resulting polysaccharides. The results identify four unique genes in the rps cluster of strain 10557. These include wefI for an alpha-Gal transferase, wefJ for a GalNAc-1-phosphotransferase that has a unique acceptor specificity, wefK for an acetyl transferase that acts at two positions in the hexasaccharide repeating unit, and a novel wzy associated with the beta1-3 linkage between these units. The serotype specificity of engineered polysaccharides correlated with the wefI-dependent presence of alpha-Gal in these molecules rather than with partial O-acetylation or with the linkage between repeating units. The findings illustrate a direct approach for defining the molecular basis of polysaccharide structure and antigenicity.

Incidence and behaviour of Tn916-like elements within tetracycline-resistant bacteria isolated from root canals

INTRODUCTION

Tetracycline resistance is commonly found in endodontic bacteria. One of the most common tetracycline-resistance genes is tet(M), which is often encoded on the broad-host-range conjugative transposon Tn916. This study aimed to determine whether tet(M) was present in bacteria isolated from endodontic patients at the Eastman Dental Institute and whether this gene was carried on the transferable conjugative transposon Tn916.

METHODS

The cultivable microflora isolated from 15 endodontic patients was screened for resistance to tetracycline. Polymerase chain reactions for tet(M) and for unique regions of Tn916 were carried out on the DNA of all tetracycline-resistant bacteria. Filter-mating experiments were used to see if transfer of any Tn916-like elements could occur.

RESULTS

Eight out of 15 tetracycline-resistant bacteria isolated were shown to possess tet(M). Furthermore, four of these eight were shown to possess the Tn916-unique regions linked to the tet(M) gene. Transfer experiments demonstrated that a Neisseria sp. donor could transfer an extremely unstable Tn916-like element to Enterococcus faecalis.

CONCLUSIONS

The tet(M) gene is present in the majority of tetracycline-resistant bacteria isolated in this study and the conjugative transposon Tn916 has been shown to be responsible for the support and transfer of this gene in some of the bacteria isolated.

Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance

Tetracyclines were discovered in the 1940s and exhibited activity against a wide range of microorganisms including gram-positive and gram-negative bacteria, chlamydiae, mycoplasmas, rickettsiae, and protozoan parasites. They are inexpensive antibiotics, which have been used extensively in the prophlylaxis and therapy of human and animal infections and also at subtherapeutic levels in animal feed as growth promoters. The first tetracycline-resistant bacterium, Shigella dysenteriae, was isolated in 1953. Tetracycline resistance now occurs in an increasing number of pathogenic, opportunistic, and commensal bacteria. The presence of tetracycline-resistant pathogens limits the use of these agents in treatment of disease. Tetracycline resistance is often due to the acquisition of new genes, which code for energy-dependent efflux of tetracyclines or for a protein that protects bacterial ribosomes from the action of tetracyclines. Many of these genes are associated with mobile plasmids or transposons and can be distinguished from each other using molecular methods including DNA-DNA hybridization with oligonucleotide probes and DNA sequencing. A limited number of bacteria acquire resistance by mutations, which alter the permeability of the outer membrane porins and/or lipopolysaccharides in the outer membrane, change the regulation of innate efflux systems, or alter the 16S rRNA. New tetracycline derivatives are being examined, although their role in treatment is not clear. Changing the use of tetracyclines in human and animal health as well as in food production is needed if we are to continue to use this class of broad-spectrum antimicrobials through the present century.

Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance

Tetracyclines were discovered in the 1940s and exhibited activity against a wide range of microorganisms including gram-positive and gram-negative bacteria, chlamydiae, mycoplasmas, rickettsiae, and protozoan parasites. They are inexpensive antibiotics, which have been used extensively in the prophlylaxis and therapy of human and animal infections and also at subtherapeutic levels in animal feed as growth promoters. The first tetracycline-resistant bacterium, Shigella dysenteriae, was isolated in 1953. Tetracycline resistance now occurs in an increasing number of pathogenic, opportunistic, and commensal bacteria. The presence of tetracycline-resistant pathogens limits the use of these agents in treatment of disease. Tetracycline resistance is often due to the acquisition of new genes, which code for energy-dependent efflux of tetracyclines or for a protein that protects bacterial ribosomes from the action of tetracyclines. Many of these genes are associated with mobile plasmids or transposons and can be distinguished from each other using molecular methods including DNA-DNA hybridization with oligonucleotide probes and DNA sequencing. A limited number of bacteria acquire resistance by mutations, which alter the permeability of the outer membrane porins and/or lipopolysaccharides in the outer membrane, change the regulation of innate efflux systems, or alter the 16S rRNA. New tetracycline derivatives are being examined, although their role in treatment is not clear. Changing the use of tetracyclines in human and animal health as well as in food production is needed if we are to continue to use this class of broad-spectrum antimicrobials through the present century.

Development of resistance to metronidazole and minocycline in vitro

By local delivery of antibiotics to periodontal pockets, very high initial concentrations are often quickly succeeded by subinhibitory concentrations, which may facilitate development of bacterial resistance. The purpose of the present study was to investigate possible development of resistance in suspected periodontal pathogens after exposure to subinhibitory concentrations of metronidazole and minocycline. The minimal inhibitory concentration (MIC) of 18 reference strains and 12 clinical isolates was determined by a broth dilution method. Subsequently, all strains with MIC < 8 micrograms/ml were exposed to serial passage on plates containing subinhibitory and gradually increasing concentrations of antibiotics, until growth was inhibited. Initially, most strains were inhibited at < or = 0.250 microgram/ml of minocycline and < or = 0.5 microgram/ml of metronidazole, though A. actinomycetemcomitans was resistant to metronidazole. After growth at subinhibitory concentrations, 8 strains survived 1-2 x and 11 stains survived 8-32 x their initial MIC of metronidazole, growing at up to 8 micrograms/ml. All A. actinomycetemcomitans survived 8-64 x their initial MIC of minocycline, growing at > or = 2 micrograms/ml, while all other strains were inhibited at < or = 0.250 microgram/ml, corresponding to a 1-8 x increase in their initial MIC. Thus, development of resistance was observed for periodontal bacteria growing at up to 64 x their initial MIC, but the final level of resistance was moderate.

Clinical significance of bacterial resistance to tetracyclines in the treatment of periodontal diseases

Tetracyclines are frequently employed during the treatment of clinical infections in medicine and dentistry, however, emergence of resistant bacterial strains has decreased the utility of these drugs. Accordingly, there is concern that indiscriminant administration of tetracyclines during periodontal therapy will further contribute to the development of additional resistant microorganisms which can complicate infectious disease therapy. This review paper briefly discusses the utility of tetracyclines as an antimicrobial agent in the treatment of periodontal diseases. It then focuses on the clinical significance of bacterial resistance to tetracyclines. Patterns of resistance that may be associated with the following scenarios are addressed: short- and long-term antibiotic therapy, individuals with a history of prior tetracycline therapy, patients with refractory periodontitis, and following controlled local drug delivery. It appears that selection and development of bacterial resistant strains is an inevitable consequence of antibiotic therapy. Nevertheless, prudent administration of tetracyclines may help delay or prevent the emergence of resistant microorganisms.

Bacterial resistance following subgingival and systemic administration of minocycline

The aim of the present study was to compare total numbers of cultivable bacteria and prevalence of resistance to minocycline among periodontal bacteria following subgingival or systemic application of minocycline in patients suffering from periodontal disease. 10 adult patients were administered 2% minocycline ointment subgingivally into their periodontal pockets at baseline, week 2 and months 1, 3, 6 and 9. Patients had scaling/root planing at baseline and month 6. In addition, 10 patients undergoing scaling/root planing followed by a 10-day course of systemic minocycline therapy, were studied and compared with the subgingival application group. Bacterial samples were taken from the 4 deepest pockets before each subgingival application of the drug. The systemic administration group was sampled at baseline and at week 2, as well as months 1 and 3 after completing the antibiotic treatment. For each patient at each sampling, bacterial samples were pooled, diluted, seeded on parallel blood agar plates and incubated aerobically and anerobically. After incubation, 30 colonies were picked at random and transferred to blood agar plates supplemented with 10 micrograms/ml minocycline, to estimate prevalence of minocycline-resistant bacteria. The results of this study indicate that subgingival application of minocycline ointment resulted in an initial reduction in total numbers of cultivable bacteria, which then remained depressed during the full year of the study. No such observation was made in the systemic administration. Both in the subgingival and the systemic administration group, the % of cultivable aerobic and anaerobic minocycline-resistant bacterial strains increased transiently following administration of the drug, but returned to baseline levels within 3 months post-treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro antimicrobial susceptibility of different serotypes of Actinobacillus actinomycetemcomitans

In vitro susceptibility of Actinobacillus actinomycetemcomitans (A.a.) serotypes to selected antimicrobial agents was investigated by the agar dilution method on supplemented Mueller-Hinton test medium. Eighty-three A.a. strains, 80 recent isolates from 40 periodontally healthy or diseased subjects, and three type strains were included in the study. Serotype a represented 20, serotype b 32, serotype c 17, and serotype e 7 and nontypable 4 of the tested strains. The most effective drugs against all A.a. serotypes in vitro were cefaclor, cefuroxime, tetracycline hydrochloride, doxycycline, trimethoprim-sulfamethoxazole (cotrimoxazole), and ciprofloxacin, which inhibited 100% of the strains at 4.0 micrograms/ml, 4.0 micrograms/ml, 1.0 microgram/ml, 2.0 micrograms/ml, 0.06 microgram/ml, and 0.015 microgram/ml, respectively. Serotypes a and e were more susceptible to cefaclor and cefuroxime than were serotypes b and c; 100% of the first two groups were inhibited at 2.0 micrograms/ml and 1.0 microgram/ml. Ampicillin inhibited 92% of the tested strains at 1.0 microgram/ml. Serotype b was always susceptible to ampicillin. Metronidazole exhibited the best activity against serotype a strains. The lowest minimal inhibitory concentration values for benzylpenicillin, ampicillin, erythromycin, doxycycline, and metronidazole were encountered among serotype b isolates. The results of the present study indicate minor differences in the in vitro antimicrobial susceptibility patterns of different A.a. serotypes, except to metronidazole. Also, the new oral cephalosporins and cotrimoxazole, rare antimicrobial agents in periodontology, showed promising efficacy against all A.a. strains.

Identification of plasmids in Actinobacillus actinomycetemcomitans and construction of intergeneric shuttle plasmids

A collection of 39 isolates of Actinobacillus actinomycetemcomitans, obtained from laboratories located in 5 different geographical regions of the United States, was examined for the presence of plasmid DNA. Only 2 of the strains examined, designated VT736 and VT745, harbored detectable plasmids. Strain VT736 contained a 1.9 kb plasmid species (pVT736-1) and a larger ( > 30 kb) species (pVT736-2). Both plasmids were detected in the covalently closed circular DNA fraction of dye buoyant density gradients. However, only the smaller plasmid was observed in agarose gels containing plasmid-enriched cell lysates prepared by a rapid screening procedure. Strain VT745 contained a single, 24 kb, plasmid (pVT745) that was observed consistently in plasmid-enriched lysates, as well as in the plasmid band of dye buoyant density gradients. A restriction endonuclease map of pVT736-1 was constructed. The plasmid contained one site each for the enzymes HincII, KpnI and XhoI, located 600 to 700 bp from each other on the pVT736-1 map. HincII-digested pVT736-1 DNA could not be cloned in Escherichia coli. However, intact pVT736-1 digested with KpnI or XhoI could be cloned in E. coli on pUC19 or pGEM7Zf(-), respectively. KpnI-digested pVT736-1 was cloned in both orientations on pUC19, but XhoI-digested pVT736-1 was clonable in only one orientation on pGEM7Zf(-). Each of the 3 types of chimeric plasmid constructs provided a potential A. actinomycetemcomitans/E. coli shuttle plasmid for the development of a genetic transfer system in A. actinomycetemcomitans.

Antibiotic resistance of the subgingival microbiota following local tetracycline therapy

The antibiotic resistance of the subgingival microbiota was studied by 3 approaches. First, we assessed the ability of subgingival isolates taken following therapy to grow on media containing tetracycline (TC). Higher percentages of TC-resistant organisms appeared at TC fiber-treated periodontal sites and within the saliva 1 week after treatment as compared with pre-treatment levels. By 1 month, the percentage of TC-resistant organisms had returned to levels comparable to those seen before treatment. In the second approach, subgingival isolates taken following therapy were grown on media without antibiotics, and isolates were selected for Gram-stain and cell morphology determination. This study indicated that subgingival sites became colonized with gram-positive cocci in the same time period that an increase of TC-resistant isolates was observed in the first study. This may account for the transient increase in TC resistance, because many gram-positive cocci are intrinsically resistant to TC. In the third approach, the antibiotic resistance of subgingival gram-negative species was determined. The predominant cultivable microbiota of 9 sites from 3 subjects were isolated immediately before and 6 months after TC fiber treatment. Gram-negative rods were characterized and tested for sensitivity to TC (minimum inhibitory concentration [MIC] 1-128 micrograms/ml), penicillin at 80 micrograms/ml, and erythromycin at 8 micrograms/ml. None of the gram-negative rods were resistant to TC (MIC greater than or equal to 16 micrograms/ml), either before or after treatment. Before treatment 98% of the gram-negative rods were susceptible to TC at 1-2 micrograms/ml and after therapy 88% were susceptible.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization of unusual tetracycline-resistant gram-positive bacteria

Tetracycline-resistant Tet M-negative isolates of Actinomyces viscosus, Eubacterium lentum, Mobiluncus curtisii, and Mobiluncus mulieris were screened with the Tet K, Tet L, and Tet O DNA probes. Ten (71%) of the resistant Mobiluncus strains hybridized with the Tet O probe, two of the three E. lentum strains hybridized with the Tet K probe, and the A. viscosus isolate hybridized with the Tet L probe.

Occurrence of doxycycline resistant bacteria in the oral cavity after local administration of doxycycline in patients with periodontal disease

Topical antimicrobial treatment is appearing as a means of therapy in patients with advanced periodontal disease. The purpose of the present study was to examine the occurrence of doxycycline resistant bacteria in subgingival plaque and oral cavity after local administration of doxycycline. Five patients with advanced marginal periodontitis were scaled, and one approximal pocket in each patient was additionally treated with locally delivered doxycycline. Microbiological samples were obtained from the test site, a contralateral control site and tongue and tonsils before treatment and 3, 13, 26 and 52 weeks after treatment. The occurrence and morphological distribution of doxycycline resistant bacteria was determined after anaerobic cultivation on enriched tryptic soy agar with and without doxycycline incorporated. At the test site and on tongue and tonsils the percentage of doxycycline resistant bacteria increased from less than 1% before treatment to 22% and 35%, respectively, immediately after treatment, but decreased again at week 13. At the control site no increase was observed. Gram-positive cocci constituted the majority of doxycycline resistant bacteria at all 3 sampling sites (73-94%). The morphological distribution of resistant bacteria was not affected by the doxycycline therapy. Thus, local doxycycline therapy resulted only in a transient increase in resistance in the oral microflora.

Doxycycline-resistant bacteria in periodontally diseased individuals after systemic doxycycline therapy and in healthy individuals

The occurrence of doxycycline-resistant bacteria was examined in subgingival plaque and on the tonsils of 12 periodontally healthy and 12 periodontally diseased individuals. The healthy group was examined 6 times at intervals of one month. The diseased group was examined before and 1, 5, 15, 26, 39, and 52 weeks after conventional periodontal therapy supplemented with systemic doxycycline for 3 weeks. The occurrence of doxycycline-resistant bacteria in the healthy group varied on average between 2.0% and 6.6% in subgingival plaque and between 3.0% and 12.4% in the tonsil samples over a 6-month period. In the diseased group the percentage of resistant bacteria increased from 10-20 times for tonsil and subgingival plaque, respectively. About half a year after therapy the values returned to the baselines. For both groups the morphological distributions of resistant bacteria were similar and unaffected by the doxycycline therapy.

Antibiotics in periodontal therapy: advantages and disadvantages

Antibiotic treatment of periodontitis aims at eradicating or controlling specific pathogens. Prime candidates for antibiotic therapy are patients with recently diagnosed active periodontitis or a history of recurrent disease who fail to stabilize following mechanical/surgical therapy. Since a variety of microbes with differing antimicrobial susceptibility profiles may cause periodontitis, selection of antimicrobial agents should be based on proper microbial diagnosis and sensitivity testing, as well as consideration of the patient's medical status. The risk of treating chemotherapeutically solely on the basis of clinical features, radiographic findings or a limited microbiological analysis, is failure to control the pathogens or overgrowth of new pathogens. A review of published papers reveals that appropriate systemic antibiotic therapy may enhance healing in patients with recent or high risk of periodontal breakdown. Systemic antibiotic therapy seems more predictable than topical administration in eradicating periodontal pathogens from deep periodontal pockets. Several promising antimicrobial agents for periodontitis treatment need testing in placebo-controlled, double-blind, randomized clinical trials.

Tetracycline resistance and TetM in oral anaerobic bacteria and Neisseria perflava-N. sicca

Tetracycline-resistant organisms isolated from six patients with periodontal disease included Bacteroides spp., Eubacterium spp., Fusobacterium nucleatum, Neisseria perflava-N. sicca, Peptostreptococcus anaerobius, Veillonella parvula, and facultative streptococci. All but the Bacteroides spp. and Eubacterium spp. hybridized with the TetM determinant. An additional 417 bacterial strains were screened, and 4% of both the oral streptococci and the Fusobacterium spp. hybridized with the TetM probe.

A conjugative transposon (Tn919) in Streptococcus sanguis

Streptococcus sanguis FC1, originally isolated from dental plaque, was found to be naturally resistant to tetracycline. Although no plasmid DNA could be detected, tetracycline resistance was transferable in filter matings to Streptococcus faecalis FA2-2. Again, no plasmid DNA was detectable in transconjugants, and the latter could donate tetracycline resistance to S. faecalis, S. sanguis, and Streptococcus lactis. The tetracycline resistance element was able to transpose to several sites on the S. faecalis hemolysin plasmid pAD1 and in each case resulted in a 15-kilobase insert. DNA filter blot hybridization studies showed that the element bears significant homology with the conjugative transposon Tn916. Designated Tn919, it was cloned into an Escherichia coli plasmid vector (pGL101) and, as has been shown for Tn916, excised readily in the absence of selective pressure.

Characterization and expression of a cloned tetracycline resistance determinant from the chromosome of Streptococcus mutans

A chromosomal tetracycline resistance (Tcr) determinant previously cloned from Streptococcus mutans into Streptococcus sanguis (Tobian and Macrina, J. Bacteriol. 152:215-222, 1982) was characterized by using restriction endonuclease mapping, deletion analysis, and Southern blot hybridization. Deletion analysis allowed localization of the Tcr determinant to a 2.8-kilobase region of the originally cloned 10.4-kilobase sequence. This cloned determinant hybridized to a representative of the tetM class of streptococcal Tcr determinants but not to representatives of the tetL and tetN classes and, like other tetM determinants, mediated high-level resistance to tetracycline and low-level resistance to minocycline. A portion (approximately 3 kilobases) of the isolated streptococcal fragment was subcloned into Escherichia coli, where it conferred resistance to tetracycline and minocycline. Two proteins with apparent molecular weights of 33,000 and 35,000, encoded by the S. mutans DNA, were synthesized in E. coli minicells. Insertion of DNA into a unique SstI site of the cloned S. mutans fragment resulted in inactivation of Tcr expression in E. coli and S. sanguis, as well as loss of production of both the 33,000- and 35,000-dalton proteins in E. coli minicells. Incubation of minicells in subinhibitory concentrations of tetracycline did not result in changes in the levels of synthesis of either protein. Our data suggest that at least one of these proteins is involved in the expression of Tcr.

Disseminated tetracycline resistance in oral streptococci: implication of a conjugative transposon

A DNA sequence specifying tetracycline resistance (Tcr) has been previously cloned from a clinical isolate of Streptococcus mutans designated U202 (J. A. Tobian and F. L. Macrina, J. Bacteriol. 152:215-222, 1982). We used this sequence as a molecular probe in studying the dissemination of Tcr among oral streptococcal species isolated from patients treated with tetracycline. Eleven strains (including S. sanguis I, S. sanguis II, S. mitis, and S. salivarius) from seven patients were examined by Southern blot analysis. Seven strains showed strong hybridization to the Tcr probe, two showed weak hybridization, and two did not display detectable hybridization. Based on previous characterization of the cloned sequence, our data suggest the dissemination of the tetM class of resistance determinants among these oral streptococci. One of the clinical S. sanguis I isolates studied was able to transfer its Tcr phenotype to other oral streptococci and to enteric streptococci in the absence of plasmid DNA. This transfer appeared to be conjugation-like on the basis of its insensitivity to DNase and its dependence on intimate cell-to-cell contact. Using the cloned Tcr sequence, we were able to study the progeny of the matings. Our data suggest that this resistance transfer element occupies a chromosomal location in streptococcal cells and that it strongly resembles the conjugative transposon Tn916 in its behavior.

Chemotherapy and periodontal disease--a review

Periodontal diseases are common, inflammatory infections of the mouth of microbiological etiology. Therapy traditionally focuses on professional tooth cleaning and debridement. Recent research has investigated the efficacy of antibiotic therapy, as well as the use of various other agents. Although protocols still are being developed, pharmacists can expect increasing use of these medications by dentists in the future.

A rationale for the management of periodontal diseases: effects of tetracycline on subgingival bacteria

Microbiologic criteria obtained with phase-contrast microscopy were used in a short-term, double-blind study to measure the effects of systemic tetracycline HCl on subgingival bacterial populations in advanced periodontal pockets refractory to local therapy (repeated scaling, root planing, and the subgingival administration of chemotherapeutic agents [H2O2, NaHCO3, NaCl, MgSO4]). Twenty-one subjects, selected for study, had at least one of the following conditions present after local therapy: spirochetes, motile rods, or crevicular leukocytes greater than or equal to 125 per phase-contrast microscopic field. Tetracycline HCl (1 gm/day for 14 days) was randomly distributed to 11 subjects and a placebo to ten subjects, so that neither the subjects nor investigators were aware of the prescription contents. Evaluations after two weeks disclosed that tetracycline HCl significantly reduced elevated levels of spirochetes, motile rods, and crevicular leukocytes to low or undetectable levels, whereas levels in the placebo subjects remained generally unchanged. The results clearly demonstrate the value of tetracycline HCl as an adjunct to periodontal therapy in reducing remaining suspected periodontopathic bacterial populations in advanced lesions after local therapy of scaling, root planing, and topically applied chemotherapy.

Heterogeneity of tetracycline resistance determinants in Streptococcus

We found that naturally occurring tetracycline resistance in streptococci is encoded by more than one genetic determinant. Two of these distinct determinants were cloned, and the regions that are necessary and sufficient for expression of tetracycline resistance were defined by deletion analysis. These cloned determinants were further characterized by DNA-DNA hybridization experiments which also identified a third genetically unrelated tetracycline resistance determinant. Some of these genetic differences appear to represent mechanistic differences. The tetL determinant was associated with small nonconjugative plasmids and mediated resistance to tetracycline. The tetM determinant was most often "nonplasmid" associated and mediated resistance to minocycline as well as tetracycline. The tetN determinant was represented on a large conjugative plasmid and was genetically distinct from tetL and tetM, although phenotypically it resembled tetM.