Experimental prediction of the evolution of ceftazidime resistance in the CTX-M-2 extended-spectrum beta-lactamase

The Drug-Resistant Variant P167S Expands the Substrate Profile of CTX-M β-Lactamases for Oxyimino-Cephalosporin Antibiotics by Enlarging the Active Site upon Acylation

CTX-M β-lactamases provide resistance against the β-lactam antibiotic, cefotaxime, but not a related antibiotic, ceftazidime. β-Lactamases that carry the P167S substitution, however, provide ceftazidime resistance. In this study, CTX-M-14 was used as a model to study the structural changes caused by the P167S mutation that accelerate ceftazidime turnover. X-ray crystallography was used to determine the structures of the P167S apoenzyme along with the structures of the S70G/P167S, E166A/P167S, and E166A mutant enzymes complexed with ceftazidime as well as the E166A/P167S apoenzyme. The S70G and E166A mutations allow capture of the enzyme-substrate complex and the acylated form of ceftazidime, respectively. The results showed a large conformational change in the Ω-loop of the ceftazidime acyl-enzyme complex of the P167S mutant but not in the enzyme-substrate complex, suggesting the change occurs upon acylation. The change results in a larger active site that prevents steric clash between the aminothiazole ring of ceftazidime and the Asn170 residue in the Ω-loop, allowing accommodation of ceftazidime for hydrolysis. In addition, the conformational change was not observed in the E166A/P167S apoenzyme, suggesting the presence of acylated ceftazidime influences the conformational change. Finally, the E166A acyl-enzyme structure with ceftazidime did not exhibit the altered conformation, indicating the P167S substitution is required for the change. Taken together, the results reveal that the P167S substitution and the presence of acylated ceftazidime both drive the structure toward a conformational change in the Ω-loop and that in CTX-M P167S enzymes found in drug-resistant bacteria this will lead to an increased level of ceftazidime hydrolysis.

Inhibitory activity of avibactam against selected β-lactamases expressed in an isogenic Escherichia coli strain

Avibactam restored the in-vitro antibacterial activity of ceftazidime, ceftaroline, and aztreonam against isogenic Escherichia coli expressing class A, class C, and class D β-lactamases. The enzymes included TEM and CTX-M extended spectrum β-lactamases, ACT, CMY and FOX AmpC-type enzymes, and carbapenemases including rarer KPC variants and OXA-139.

CTX-M expression and selection of ertapenem resistance in Klebsiella pneumoniae and Escherichia coli

In vitro selection of mutants with decreased susceptibility to ertapenem was performed using Escherichia coli and Klebsiella pneumoniae clinical strains producing either the bla(CTX-M-2), bla(CTX-M-3), bla(CTX-M-9), or bla(CTX-M-15) gene. Frequencies of mutants with decreased susceptibilities to ertapenem were similar for all beta-lactamases expressed.

Mutational events in cefotaximase extended-spectrum beta-lactamases of the CTX-M-1 cluster involved in ceftazidime resistance

CTX-M beta-lactamases, which show a high cefotaxime hydrolytic activity, constitute the most prevalent extended-spectrum beta-lactamase (ESBL) type found among clinical isolates. The recent explosive diversification of CTX-M enzymes seems to have taken place due to the appearance of more efficient enzymes which are capable of hydrolyzing both cefotaxime and ceftazidime, especially among the CTX-M-1 cluster. A combined strategy of in vitro stepwise evolution experiments using bla(CTX-M-1), bla(CTX-M-3), and bla(CTX-M-10) genes and site-directed mutagenesis has been used to evaluate the role of ceftazidime and other beta-lactam antibiotics in triggering the diversity found among enzymes belonging to this cluster. Two types of mutants, P167S and D240G, displaying high ceftazidime MICs but reduced resistance to cefotaxime and/or cefepime, respectively, were identified. Such an antagonistic pleiotropic effect was particularly evident with P167S/T mutations. The incompatibility between P167S and D240G changes was demonstrated, since double mutants reduced susceptibility to both ceftazidime and cefotaxime-cefepime; this may explain the absence of strains containing both mutations in the clinical environment. The role of A77V and N106S mutations, which are frequently associated with P167S/T and/or D240G, respectively, in natural strains, was investigated. The presence of A77V and N106S contributes to restore a high-level cefotaxime resistance phenotype, but only when associated with mutations P167S and D240G, respectively. However, A77V mutation increases resistance to both cefotaxime and ceftazidime when associated with CTX-M-10. This suggests that in this context this mutation might be considered a primary site involved in resistance to broad-spectrum cephalosporins.

Convergent in vivo and in vitro selection of ceftazidime resistance mutations at position 167 of CTX-M-3 beta-lactamase in hypermutable Escherichia coli strains

We report on a novel CTX-M extended-spectrum beta-lactamase (ESBL), designated CTX-M-42, with enhanced activity toward ceftazidime. CTX-M-42 was identified in a hypermutable Escherichia coli nosocomial isolate (isolate Irk2320) and is a Pro167Thr amino acid substitution variant of CTX-M-3. By molecular typing of ESBL-producing E. coli strains previously isolated in the same hospital ward, we were able to identify a putative progenitor (strain Irk1224) of Irk2320, which had a mutator phenotype and harbored the CTX-M-3 beta-lactamase. To reproduce the natural evolution of CTX-M-3, we selected for ceftazidime resistance mutations in bla CTX-M-3 gene in vitro both in clinical isolate Irk1224 and in laboratory-derived hypermutable (mutD5) strain GM2995. These experiments yielded CTX-M-3 Pro167Ser and CTX-M-3 Asn136Lys mutants which conferred higher levels of resistance to ceftazidime than to cefotaxime. CTX-M-3 Asn136Lys had a level of low activity toward ampicillin, which may explain its absence from clinical isolates. We conclude that the selection of CTX-M-42 could have occurred in vivo following treatment with ceftazidime and was likely facilitated by the hypermutable background.

Characterisation of KLUA-9, a β-lactamase from extended-spectrum cephalosporin-susceptible Kluyvera ascorbata, and genetic organisation of blaKLUA-9

This study characterised the genetic environment of the chromosomally encoded bla(KLUA-9) gene from a clinical Kluyvera ascorbata isolate and performed a kinetic characterisation of KLUA-9. Purified KLUA-9 showed the highest catalytic efficacies towards benzylpenicillin, ampicillin, piperacillin, first-generation cephalosporins, cefuroxime and cefoperazone; like other 'cefotaximases', it showed a much higher rate of hydrolysis of cefotaxime than ceftazidime, whilst dicloxacillin, cefoxitin and imipenem behaved as poor substrates. A 9kb insert from K. ascorbata was cloned (Escherichia coli KK68C1) and sequenced. bla(KLUA-9) and its 266bp upstream flanking region (almost identical to the integron-associated bla(CTX-M-2)) are preceded by an aspat variant, a ypdABC-like operon and two open reading frames with unknown functions. Unlike ISCR1-associated bla(CTX-M-2) genes, we failed to detect the putative orf513 recombination sites. Instead, we were able to localise the 5bp target sites for insertion of ISEcp1B, suggesting that this element could be responsible for future (or still undetected) mobilisation of bla(KLUA-9) to more efficiently transferred elements.

Predictive analysis of ceftazidime hydrolysis in CTX-M-type beta-lactamase family members with a mutational substitution at position 167

The CTX-M family of extended-spectrum beta-lactamases has been increasing in number over recent years. Its members preferentially hydrolyse cefotaxime over ceftazidime. Recently, ceftazidime-hydrolysing CTX-M beta-lactamase producers with a mutation at Pro167Ser have been found. The aim of this study was to determine whether members of the CTX-M-type beta-lactamase family are capable of ceftazidime hydrolysis after introduction of the Pro167Ser point mutation. MICs of wild-type enzyme producers for cefotaxime were 2-4 times higher than those of their respective Pro167Ser mutants, whereas MICs of wild-type enzyme producers for ceftazidime were 4-32 times lower than those of their respective Pro167Ser mutants. The k(cat)/K(m) values for Pro167Ser mutants and their respective wild-type enzymes were identical for cefalothin, penicillin and nitrocefin. For cefotaxime, catalytic efficiency (k(cat)/K(m)) for wild-type enzymes was 3.13-7.12 times higher than that of their respective Pro167Ser mutants. As these enzymes exhibit a very high K(m) value (>680 mM) for ceftazidime, we measured initial hydrolysis rates for each enzyme at a low substrate concentration (10 microM) to obtain their k(cat) and k(cat)/K(m) values. Under these conditions, Pro167Ser mutants had k(cat)/K(m) values 1.73-2.21 times higher than those of their respective wild-type enzymes. These results indicate that the CTX-M-type beta-lactamase family can hydrolyse ceftazidime more efficiently because of the point mutation at position 167.

Development of high-level ceftazidime resistance via single-base substitutions of blaCTX-M-3 in hyper-mutable Escherichia coli

Mutations can increase the ceftazidimase activity of CTX-M-3 beta-lactamase, as seen with its widespread variant CTX-M-15. This study compared the frequencies of emerging ceftazidime resistance in isogenic wild-type and hyper-mutable mutS CTX-M-3-producing Escherichia coli strains, and sequenced the mutant bla(CTX-M) alleles selected. Ceftazidime resistance emerged more readily in the hyper-mutable background than in the wild-type strain. All selected CTX-M mutants, in both the wild-type and the mutS derivatives, had single amino-acid changes at position 167, including a novel Pro167Gln substitution. These data emphasise the potential for further diversification of CTX-M enzymes.

Non-invasive detection of antibiotics and physiological substances in the aqueous humor by raman spectroscopy

BACKGROUND AND OBJECTIVES

Laser Raman spectroscopy is an inelastic light scattering technique able to characterize molecules in aqueous environments. The purpose of this work is to develop a non-contact and non-invasive spectroscopic method to identify and eventually quantify the presence of medicines (e.g., antibiotics) and physiological substances (e.g., glucose) in the aqueous humor of the eye.

STUDY DESIGN/MATERIALS AND METHODS

A new laser light delivery probe has been developed and adapted to a Raman spectroscopic system with the ability of favorable collection of the Raman light at 90 degrees scattering geometry while scanning the anterior chamber of the eye. Different amounts of ceftazidime, amphotericin B, and glucose had been injected in the aqueous humor of porcine eyes, maximum 24 hours after death and extraction, in-vitro. Raman measurements were excited with a visible (514.5 nm) laser beam at a power of 25 mW and an exposure/acquisition time of 1 second.

RESULTS

The specific collection optics and Raman analysis components used in the present work have resolved the Raman signatures of probed molecules and low concentrations of ceftazidime (0.9 mg/mL), amphotericin B (9 microg/mL), and glucose (2 mg/ml) separately injected in the anterior chamber of porcine eyes were detected in vitro.

CONCLUSION

This special illumination design gives the opportunity of avoiding the direct exposure to the laser light of basic cordial tissues of the eye, like lens and retina, although an optimum collection of scattered light is accomplished. Concentrations close to the minimum inhibitory concentration (MIC) have been detected for ceftazidime and amphotericin b; the detection of glucose has been realized at concentrations close to the early pathological levels of patients with diabetes.