1
|
Liu C, Li G, Qin X, Xu Y, Wang J, Wu G, Feng H, Ye J, Zhu C, Li X, Zheng X. Profiles of antibiotic- and heavy metal-related resistance genes in animal manure revealed using a metagenomic analysis. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 239:113655. [PMID: 35617901 DOI: 10.1016/j.ecoenv.2022.113655] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/26/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
Farmed animals produce excrement containing excessive amounts of toxic heavy metals as a result of consuming compound feed as well as receiving medical treatments, and the presence of these heavy metals may aggravate the risk of spreading drug-resistance genes through co-selection during manure treatment and application processes. However, research on the association between heavy metals and antimicrobial resistance is still lacking. In this study, metagenomic sequencing was used to explore the effects of the co-selection of environmentally toxic heavy metals on the resistome in manure. A relevance network analysis showed that metal-resistance genes (MRGs), especially for copper (Cu) and zinc (Zn), were positively correlated with multiple types of antibiotic-resistance genes (ARGs) and formed a complex network. Most bacteria that co-occurred with both MRGs and ARGs simultaneously are members of Proteobacteria and accounted for 54.7% of the total microbial species in the relevance network. The remaining bacteria belonged to Firmicutes, Bacteroidetes and Actinobacteria. Among the four phyla, Cu- and Zn-resistance genes had more complex correlations with ARGs than other MRG types, reflecting the occurrence of ARG co-selection under the selective pressure of high Cu and Zn levels. In addition, approximately 64.8%, 59.1% and 68.4% of MRGs that correlated with the presence of plasmids, viruses and prophages, respectively, are Cu- or Zn-resistant, and they co-occurred with various ARGs, indicating that mobile genetic elements participate in mediating ARG co-selection in response to Cu and Zn pressure. The results indicated that the use of heavy-metal additives in feed induces the increases of drug resistance genes in manure through co-selection, aggravating the risk of antimicrobial resistance diffusion from animal farm to manure land applications.
Collapse
Affiliation(s)
- Chong Liu
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Guichun Li
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Xiaobo Qin
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Yansheng Xu
- Biogas Institute of Ministry of Agriculture and Rual Affairs, Chengdu, China
| | - Jiarui Wang
- Agro-environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China
| | - Guosheng Wu
- Institute of Agricultural Resources and Regional Planning, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Huabing Feng
- Division of Veterinary Medicine and Devices, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Jing Ye
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Changxiong Zhu
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Xiaohua Li
- Agro-environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China; Rural Energy & Environment Agency, Ministry of Agriculture and Rural Affairs, Beijing, China.
| | - Xiangqun Zheng
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing, China; Agro-environmental Protection Institute, Ministry of Agriculture and Rural Affairs, Tianjin, China.
| |
Collapse
|
2
|
Li Y, Zhu D, Peng Y, Tong Z, Ma Z, Xu J, Sun S, Tang H, Xiu Q, Liang Y, Wang X, Lv X, Dai Y, Zhu Y, Qu Y, Xu K, Huang Y, Wu S, Lai G, Li X, Han X, Yang Z, Sheng J, Liu Z, Li H, Chen Y, Zhu H, Zhang Y. A randomized, controlled, multicenter clinical trial to evaluate the efficacy and safety of oral sitafloxacin versus moxifloxacin in adult patients with community-acquired pneumonia. Curr Med Res Opin 2021; 37:693-701. [PMID: 33534617 DOI: 10.1080/03007995.2021.1885362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of oral sitafloxacin versus oral moxifloxacin in the treatment of Chinese adults with community-acquired pneumonia (CAP). PATIENTS AND METHODS This is a multicenter, randomized, open-label, positive-controlled clinical trial (chinadrugtrials.org.cn identifier: CTR20130046). CAP patients received sitafloxacin tablets 100 mg once daily (qd) or 100 mg twice daily (bid) to compare with moxifloxacin tablets 400 mg qd, for 7-10 days. The primary outcome was non-inferiority of sitafloxacin to moxifloxacin in clinical cure rate at test of cure (TOC) visit in per-protocol set (PPS). RESULTS A total of 343 patients were randomized (sitafloxacin 100 mg qd, n = 117; sitafloxacin 100 mg bid, n = 116; moxifloxacin, n = 110), 291 patients were included in the PPS (sitafloxacin 100 mg qd, n = 96; sitafloxacin 100 mg bid, n = 94; moxifloxacin, n = 101). The clinical cure rate was 94.8% in the sitafloxacin 100 mg qd group, 96.8% in the sitafloxacin 100 mg bid group and 95.0% in the moxifloxacin group. At the TOC visit, the microbiological success rate was 97.0% (32/33) in the sitafloxacin 100 mg qd group, 97.1% (34/35) in the sitafloxacin 100 mg bid group and 94.9% (37/39) in the moxifloxacin group in the microbiological evaluable set (MES). The incidence of study-drug-related adverse events (AEs) was 23.3% (27/116) in the sitafloxacin 100 mg qd group, 29.8% (34/114) in the sitafloxacin 100 mg bid group and 28.2% (31/110) in the moxifloxacin group (p > .05). The common AEs related to study drug were dizziness, nausea, diarrhea, increased platelet count and alanine transaminase (ALT) elevation. All the AEs resolved completely after discontinuation of study drug. CONCLUSION Sitafloxacin 100 mg qd or 100 mg bid for 7-10 days is not inferior to moxifloxacin 400 mg qd for 7-10 days in clinical efficacy for adult CAP patients. Sitafloxacin provides a safety profile comparable to moxifloxacin.
Collapse
Affiliation(s)
- Ying Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Demei Zhu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Zhaohui Tong
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhuang Ma
- General Hospital of Northern Theater Command of the People's Liberation Army (PLA), Shenyang, China
| | - Jinfu Xu
- Shanghai Pulmonary Hospital, Shanghai, China
| | - Shenghua Sun
- The Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Qingyu Xiu
- Shanghai Changzheng Hospital, Shanghai, China
| | | | | | - Xiaoju Lv
- West China Hospital, Sichuan University, Chengdu, China
| | - Yuanrong Dai
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingqun Zhu
- The Third Hospital of Changsha, Changsha, China
| | - Yuejin Qu
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Kaifeng Xu
- Peking Union Medical College Hospital, Beijing, China
| | | | - Shiman Wu
- The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Guoxiang Lai
- No. 900 Hospital, Joint Logistics Support Force of PLA, Fuzhou, China
| | - Xi Li
- The First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Xiaowen Han
- Hebei Provincial People's Hospital, Shijiazhuang, China
| | - Zegang Yang
- Changde First People's Hospital, Changde, China
| | - Jifang Sheng
- The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuola Liu
- The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui Li
- Jilin Provincial People's Hospital, Changchun, China
| | - Yiqiang Chen
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huili Zhu
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yingyuan Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| |
Collapse
|
3
|
Aung MS, Urushibara N, Kawaguchiya M, Hirose M, Ike M, Ito M, Kobayashi N. Distribution of Virulence Factors and Resistance Determinants in Three Genotypes of Staphylococcus argenteus Clinical Isolates in Japan. Pathogens 2021; 10:pathogens10020163. [PMID: 33546443 PMCID: PMC7913748 DOI: 10.3390/pathogens10020163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Staphylococcus argenteus, a novel staphylococcal species independent of S. aureus, causes a wide spectrum of infectious diseases. As detection of this species from humans and animals has been increasingly reported worldwide, its growing virulence and drug resistance via external genetic determinants has become concerning. In this study, the prevalence and genetic characteristics of virulence factors and drug resistance determinants were investigated for 82 S. argenteus clinical isolates in Hokkaido, Japan, for a one-year period starting in August 2019. These S. argenteus isolates corresponded to 0.66% of the total number of S. aureus isolates collected in the same period. The most prevalent genotype was sequence type (ST) 2250 and staphylocoagulase (coa) genotype XId (45.1%, n = 37), followed by ST1223-coa XV (30.5%, n = 25) and ST2198-coa XIV (24.4%, n = 20). Panton-Valentine leukocidin genes (lukS-PV-lukF-PV) were identified in a single ST2250 isolate. Only ST1223 isolates had the enterotoxin gene cluster (egc-2), seb, and selw (detection rate; 100%, 60%, and 84%, respectively), while sec, sey, sel26-sel27, tst-1 were only detected in ST2250 isolates (detection rate; 10.8%, 100%, 67.6%, and 10.8%, respectively). ST2198 isolates harbored selx at a significantly higher rate (60%) than isolates of other STs. Although most of S. argenteus isolates were susceptible to antimicrobials examined, ST2198 showed higher resistance rates to penicillin, macrolides, and aminoglycosides than other STs, and it harbored various resistance genes such as blaZ, erm(C), msr(A), lnuA, and aac(6′)-Ie-aph(2″)-Ia. Only one ST2250 isolate possessed SCCmec-IVc, showing resistance to oxacillin. blaZ was the most prevalent determinant of resistance in the three STs and belonged to two plasmid groups and a chromosomal group, suggesting its diverse origin. lnu(A) in ST2198 isolates was assigned to a major cluster with various staphylococcal species. The present study indicates that the prevalence of virulence factors and drug resistance profile/determinants differ depending on the lineage (ST) of S. argenteus.
Collapse
Affiliation(s)
- Meiji Soe Aung
- Department of Hygiene, Sapporo Medical University School of Medicine, Hokkaido, Sapporo 060-8556, Japan; (N.U.); (M.K.); (N.K.)
- Correspondence: ; Tel.: +81-11-611-2111
| | - Noriko Urushibara
- Department of Hygiene, Sapporo Medical University School of Medicine, Hokkaido, Sapporo 060-8556, Japan; (N.U.); (M.K.); (N.K.)
| | - Mitsuyo Kawaguchiya
- Department of Hygiene, Sapporo Medical University School of Medicine, Hokkaido, Sapporo 060-8556, Japan; (N.U.); (M.K.); (N.K.)
| | - Mina Hirose
- Division of Pediatric Dentistry, Department of Oral Growth and Development, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu 061-0293, Japan;
| | - Miyo Ike
- Sapporo Clinical Laboratory, Incorporated, Hokkaido, Sapporo 060-0005, Japan; (M.I.); (M.I.)
| | - Masahiko Ito
- Sapporo Clinical Laboratory, Incorporated, Hokkaido, Sapporo 060-0005, Japan; (M.I.); (M.I.)
| | - Nobumichi Kobayashi
- Department of Hygiene, Sapporo Medical University School of Medicine, Hokkaido, Sapporo 060-8556, Japan; (N.U.); (M.K.); (N.K.)
| |
Collapse
|
4
|
Bao M, Zhang L, Liu B, Li L, Zhang Y, Zhao H, Ji X, Chen Q, Hu M, Bai J, Pang G, Yi J, Tan Y, Lu C. Synergistic effects of anti-MRSA herbal extracts combined with antibiotics. Future Microbiol 2020; 15:1265-1276. [PMID: 33026882 DOI: 10.2217/fmb-2020-0001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
MRSA is a super drug-resistant bacterium. Developing new drug or therapeutic strategies against MRSA is urgently needed. Increasing evidence has shown that herbal extracts and antibiotics can have synergistic effects against MRSA. This review focuses on commonly used antibiotics combined with herbal extracts against MRSA and the corresponding mechanisms. Through systematic analysis, we found that herbal extracts combined with antibiotics, such as β-lactams, quinolones, aminoglycosides, tetracyclines and glycopeptides, could greatly enhance the antibacterial effects of the antibiotics, reduce the dosage and toxic side effects, and reverse MRSA resistance. Therefore, we conclude that herbal extracts combined with antibiotics may be a promising strategy to combat MRSA. This review provides a novel idea for overcoming antibiotic resistance.
Collapse
Affiliation(s)
- Mei Bao
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lulu Zhang
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bin Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yin Zhang
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Heru Zhao
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyu Ji
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qing Chen
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mingliang Hu
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China.,Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jingan Bai
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guoming Pang
- Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng, China
| | - Jianfeng Yi
- Key Laboratory for Research on Active Ingredients in Natural Medicine of Jiangxi Province, Yichun University, Yichun, China
| | - Yong Tan
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Cheng Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
5
|
Darboe KS, Oh TH, Choi SM, Kim HK, Kim SE, Kim UJ, Kang SJ, Jang HC, Jung SI, Park KH. Antimicrobial susceptibility of Staphylococcus species isolated from prosthetic joints with a focus on fluoroquinolone-resistance mechanisms. Diagn Microbiol Infect Dis 2020; 99:115173. [PMID: 32992142 DOI: 10.1016/j.diagmicrobio.2020.115173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/23/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
We investigated susceptibility to antimicrobials of 89 staphylococcal species from PJIs and analyzed fluoroquinolone (FQ)-resistance mechanisms. Staphylococcal isolates showed high resistance to oral antimicrobials, with the exception of TMP-STX and linezolid. The main mechanism of resistance to FQ was mutations in quinolone-resistance-determining-regions. Fifteen percent of Staphylococcus aureus overexpressed efflux-pump genes.
Collapse
Affiliation(s)
| | - Tae-Hoon Oh
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Su-Mi Choi
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hee-Kyung Kim
- Department of Biomedical Science, Chonnam National University Graduate School
| | - Seong Eun Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seung-Ji Kang
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Chang Jang
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
| |
Collapse
|
6
|
Kashef MT, Saleh NM, Assar NH, Ramadan MA. The Antimicrobial Activity of Ciprofloxacin-Loaded Niosomes against Ciprofloxacin-Resistant and Biofilm-Forming Staphylococcus aureus. Infect Drug Resist 2020; 13:1619-1629. [PMID: 32606813 PMCID: PMC7294563 DOI: 10.2147/idr.s249628] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The threat of Staphylococcus aureus antimicrobial resistance is increasing worldwide. Niosomes are a new drug delivery system that enhances the antimicrobial potential of antibiotics. We hereby aim to evaluate the antimicrobial and antibiofilm activity of ciprofloxacin-loaded niosomes. Methods The antimicrobial susceptibility of clinical S. aureus isolates (n=59) was determined by Kirby-Bauer disk diffusion method. Their biofilm formation activity was tested by Christensen's method. Two ciprofloxacin-loaded niosomal formulations were prepared by thin-film hydration method, and their minimum inhibitory concentrations (MIC) were determined by agar dilution method, against ciprofloxacin-resistant and biofilm-forming isolates (n=24). Their ability to inhibit biofilm formation and eradicate already formed biofilms was evaluated and further confirmed by scanning electron microscope images. Non-synonymous mutations, in a quinolone resistance-determining regions of S. aureus isolates, were detected by polymerase chain reaction. Results Most of the isolates were methicillin- (47/59) and ciprofloxacin-resistant (45/59). All except two isolates were capable of biofilm production. Niosomal preparation I reduced ciprofloxacin MIC by twofold in four isolates, whereas preparation II reduced ciprofloxacin MIC of most isolates by 8- to 32-fold, with three isolates that became ciprofloxacin-susceptible. Non-synonymous mutations were detected in isolates that maintained phenotypic ciprofloxacin resistance against ciprofloxacin-loaded niosomal preparation II. Ciprofloxacin-loaded niosomes reduced the minimum biofilm inhibitory concentration and the minimum biofilm eradication concentration in 58% and 62% of the tested isolates, respectively. Conclusion Ciprofloxacin-loaded niosomes can restore ciprofloxacin activity against resistant S. aureus isolates. To our knowledge, this is the first report on the inhibition of biofilm formation and eradication of formed biofilms by ciprofloxacin-loaded niosomes.
Collapse
Affiliation(s)
- Mona T Kashef
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Nehal M Saleh
- Department of Microbiology, National Organization for Drug Control and Research, Giza, Egypt
| | - Nouran H Assar
- Department of Microbiology, National Organization for Drug Control and Research, Giza, Egypt
| | - Mohammed A Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| |
Collapse
|
7
|
Saravolatz LD, Pawlak JM, Wegner C. Delafloxacin activity against Staphylococcus aureus with reduced susceptibility or resistance to methicillin, vancomycin, daptomycin or linezolid. J Antimicrob Chemother 2020; 75:2605-2608. [DOI: 10.1093/jac/dkaa209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/10/2020] [Accepted: 05/02/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Delafloxacin is a recently approved anionic fluoroquinolone antibiotic with broad-spectrum activity against Gram-positive and Gram-negative organisms. The drug has been approved for patients with acute bacterial skin and skin structure infections including those caused by MRSA. There are limited data available against MRSA blood isolates (MRSABIs), vancomycin-intermediate strains (VISA), vancomycin-resistant strains (VRSA), daptomycin-non-susceptible strains (DNSSA) and linezolid-resistant Staphylococcus aureus (LRSA).
Methods
Antimicrobial activity of delafloxacin, levofloxacin, vancomycin, daptomycin and linezolid was determined against 110 MRSABIs, 15 VRSA, 35 VISA, 40 DNSSA and 6 LRSA. Microdilution testing using CAMHB was used to determine MIC according to CLSI guidelines. FDA breakpoints were used to determine delafloxacin susceptibility, and CLSI breakpoints were used for all other antibiotics. PCR testing for molecular markers was performed.
Results
Delafloxacin demonstrated activity against MRSABIs with an MIC90 of 1 mg/L and 68% susceptibility. Against the other groups the MIC90 and susceptibility were 1 mg/L and 40%, respectively, for VISA, 4 mg/L and 7% for VRSA and 1 mg/L and 38% for DNSSA. None of the LRSA isolates was susceptible to delafloxacin. Delafloxacin was active against 94% of MRSA blood isolates that were genotype SCC IVa. For MRSABIs with a levofloxacin MIC ≥8 mg/L (55/110), suggesting multiple mutations in the QRDR, delafloxacin MIC90 was 1 mg/L with a 36.4% susceptibility rate.
Conclusions
Delafloxacin demonstrates superior activity to levofloxacin against recent MRSA blood isolates, VISA, VRSA and DNSSA, and demonstrates good activity against blood isolates most commonly found in the community.
Collapse
Affiliation(s)
- Louis D Saravolatz
- Ascension-St. John Hospital, Grosse Pointe Woods, MI, USA
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Joan M Pawlak
- Ascension-St. John Hospital, Grosse Pointe Woods, MI, USA
| | - Corinne Wegner
- Ascension-St. John Hospital, Grosse Pointe Woods, MI, USA
| |
Collapse
|
8
|
de Oliveira TLR, Cavalcante FS, Chamon RC, Ferreira RBR, Dos Santos KRN. Genetic mutations in the quinolone resistance-determining region are related to changes in the epidemiological profile of methicillin-resistant Staphylococcus aureus isolates. J Glob Antimicrob Resist 2019; 19:236-240. [PMID: 31176072 DOI: 10.1016/j.jgar.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 05/07/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is an important causative agent of nosocomial infections. Mutations in the quinolone resistance-determining regions (QRDRs) of the gyr and par genes have been described. This study aimed to characterise phenotypic and genotypic fluoroquinolone resistance in 69 MRSA isolates of different clonal lineages from hospitals in Rio de Janeiro, Brazil. METHODS QRDR mutations in the gyrA, gyrB, parC and parE genes were detected by DNA sequencing. Minimum inhibitory concentrations (MICs) for ciprofloxacin and moxifloxacin were determined by broth microdilution. The occurrence of associations between mutations and MICs among the different clonal lineages of MRSA isolates was then verified. RESULTS Most isolates from the USA400/ST1/SCCmec IV lineage, but mainly USA100/ST5/SCCmec II isolates, which have been more recently found in Rio de Janeiro hospitals, showed different patterns of mutations, including double mutation in the QRDR of parC (Ser-80Tyr and Glu-84Lys/Gly) and/or gyrA (Ser-84Leu and/or Glu-88Lys) associated with higher moxifloxacin and ciprofloxacin MICs (MIC90, 8mg/L and 256mg/L, respectively). On the other hand, all USA800/ST5/SCCmec IV and the BEC/ST239/SCCmec III isolates, which have disappeared from hospitals, showed single mutations in parC (Ser-80Phe) and gyrA (Ser-84Leu or Glu-88Gly) and lower fluoroquinolones MICs (MIC90, 2mg/L and 16mg/L). CONCLUSION This study highlights an increase in the number and types of mutations in the QRDRs ofgyrA and parC associated with high fluoroquinolones MICs that may be related to changes in the epidemiological profile of MRSA isolates from hospitals in Rio de Janeiro.
Collapse
Affiliation(s)
- Tamara Lopes Rocha de Oliveira
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Raiane Cardoso Chamon
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Rosana Barreto Rocha Ferreira
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Kátia Regina Netto Dos Santos
- Laboratório de Infecção Hospitalar, Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
9
|
In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother 2017. [PMID: 28630189 DOI: 10.1128/aac.00772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Delafloxacin is an investigational anionic fluoroquinolone antibiotic with broad-spectrum in vitro activity, including activity against Gram-positive organisms, Gram-negative organisms, atypical organisms, and anaerobes. The in vitro activity of delafloxacin and the percent microbiological response in subjects infected with fluoroquinolone-susceptible and nonsusceptible Staphylococcus aureus isolates were determined from two global phase 3 studies of delafloxacin versus vancomycin plus aztreonam in patients with acute bacterial skin and skin structure infections (ABSSSI). Patients from 23 countries, predominately the United States but also Europe, South America, and Asia, were enrolled. The microbiological intent-to-treat (MITT) population included 1,042 patients from which 685 S. aureus isolates were submitted for identification and susceptibility testing per CLSI guidelines at the central laboratory (JMI Laboratories, North Liberty, IA). The comparator fluoroquinolone antibiotics included levofloxacin and ciprofloxacin. Nonsusceptibility to these antibiotics was determined using CLSI breakpoints. S. aureus isolates were 33.7% levofloxacin nonsusceptible (LVX-NS). The delafloxacin MIC90 values against levofloxacin-nonsusceptible S. aureus, methicillin-resistant S. aureus (MRSA), and methicillin-susceptible S. aureus isolates were all 0.25 μg/ml. Delafloxacin demonstrated high rates of microbiological response against LVX-NS isolates as well as isolates with documented mutations in the quinolone resistance-determining region (QRDR). S. aureus was eradicated or presumed eradicated in 98.4% (245/249) of delafloxacin-treated patients. Similar eradication rates were observed for delafloxacin-treated subjects with levofloxacin-nonsusceptible S. aureus isolates (80/81; 98.8%) and MRSA isolates (70/71; 98.6%). Microbiological response rates of 98.6% were observed with delafloxacin-treated subjects with S. aureus isolates with the S84L mutation in gyrA and the S80Y mutation in parC, the most commonly observed mutations in global phase 3 studies. The data suggest that delafloxacin could be a good option for the treatment of infections caused by S. aureus isolates causing ABSSSI, including MRSA isolates, where high rates of ciprofloxacin and levofloxacin nonsusceptibility are observed. (The phase 3 studies described in this paper have been registered at ClinicalTrials.gov under identifiers NCT01984684 and NCT01811732.).
Collapse
|
10
|
In Vitro Activity of Delafloxacin and Microbiological Response against Fluoroquinolone-Susceptible and Nonsusceptible Staphylococcus aureus Isolates from Two Phase 3 Studies of Acute Bacterial Skin and Skin Structure Infections. Antimicrob Agents Chemother 2017. [PMID: 28630189 PMCID: PMC5571289 DOI: 10.1128/aac.00772-17] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Delafloxacin is an investigational anionic fluoroquinolone antibiotic with broad-spectrum in vitro activity, including activity against Gram-positive organisms, Gram-negative organisms, atypical organisms, and anaerobes. The in vitro activity of delafloxacin and the percent microbiological response in subjects infected with fluoroquinolone-susceptible and nonsusceptible Staphylococcus aureus isolates were determined from two global phase 3 studies of delafloxacin versus vancomycin plus aztreonam in patients with acute bacterial skin and skin structure infections (ABSSSI). Patients from 23 countries, predominately the United States but also Europe, South America, and Asia, were enrolled. The microbiological intent-to-treat (MITT) population included 1,042 patients from which 685 S. aureus isolates were submitted for identification and susceptibility testing per CLSI guidelines at the central laboratory (JMI Laboratories, North Liberty, IA). The comparator fluoroquinolone antibiotics included levofloxacin and ciprofloxacin. Nonsusceptibility to these antibiotics was determined using CLSI breakpoints. S. aureus isolates were 33.7% levofloxacin nonsusceptible (LVX-NS). The delafloxacin MIC90 values against levofloxacin-nonsusceptible S. aureus, methicillin-resistant S. aureus (MRSA), and methicillin-susceptible S. aureus isolates were all 0.25 μg/ml. Delafloxacin demonstrated high rates of microbiological response against LVX-NS isolates as well as isolates with documented mutations in the quinolone resistance-determining region (QRDR). S. aureus was eradicated or presumed eradicated in 98.4% (245/249) of delafloxacin-treated patients. Similar eradication rates were observed for delafloxacin-treated subjects with levofloxacin-nonsusceptible S. aureus isolates (80/81; 98.8%) and MRSA isolates (70/71; 98.6%). Microbiological response rates of 98.6% were observed with delafloxacin-treated subjects with S. aureus isolates with the S84L mutation in gyrA and the S80Y mutation in parC, the most commonly observed mutations in global phase 3 studies. The data suggest that delafloxacin could be a good option for the treatment of infections caused by S. aureus isolates causing ABSSSI, including MRSA isolates, where high rates of ciprofloxacin and levofloxacin nonsusceptibility are observed. (The phase 3 studies described in this paper have been registered at ClinicalTrials.gov under identifiers NCT01984684 and NCT01811732.)
Collapse
|
11
|
Takoudju EM, Guillouzouic A, Kambarev S, Pecorari F, Corvec S. In vitro emergence of fluoroquinolone resistance in Cutibacterium (formerly Propionibacterium) acnes and molecular characterization of mutations in the gyrA gene. Anaerobe 2017; 47:194-200. [PMID: 28602804 DOI: 10.1016/j.anaerobe.2017.06.005] [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: 02/23/2017] [Revised: 06/02/2017] [Accepted: 06/07/2017] [Indexed: 12/11/2022]
Abstract
In vitro occurrence of levofloxacin (LVX) resistance in C. acnes and characterization of its molecular background were investigated. The mutation frequency was determined by inoculation of 108 cfu of C. acnes ATCC 11827 (LVX MIC = 0.25 mg/L) on LVX-containing agar plates. The progressive emergence of resistance was studied by a second exposure to increasing LVX concentrations. For mutants, the QRDR regions including the gyrA and parC genes were sequenced and compared to both C. acnes ATCC 11827 and C. acnes KPA171202 reference sequences (NC006085). The importance of the efflux pump system in resistance was investigated by using inhibitors on selected resistant mutants with no mutation in the QRDR. C. acnes growth was observed on LVX-containing plates with mutation frequencies of 3. 8 cfu × 10-8 (8 × MIC) and 1.6 cfu × 10-7 (4 × MIC). LVX resistance emerged progressively after one-step or two-step assays. In LVX-resistant isolates, the MIC ranged from 0.75 to >32 mg/L. Mutations were detected exclusively in the gyrA gene. Ten genotypes were identified: G99 C, G99 D, D100N, D100 H, D100 G, S101L, S101W, A102 P, D105 H and A105 G. Mutants S101L and S101W were always associated with a high level of resistance. Mutants with no mutation in the QRDR were more susceptible when incubated with an efflux pump inhibitor (phenyl-arginine β-naphthylamide) only, suggesting, for the first time, the expression of such a system in C. acnes LVX-resistant mutants.
Collapse
Affiliation(s)
- Eve-Marie Takoudju
- Service de Bactériologie-Hygiène Hospitalière, CHU NANTES, Nantes, France
| | | | - Stanimir Kambarev
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Frédéric Pecorari
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Stéphane Corvec
- Service de Bactériologie-Hygiène Hospitalière, CHU NANTES, Nantes, France; CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France; Nantes Study Group Member of CRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest), Nantes, France.
| |
Collapse
|
12
|
Matos AC, Pinto RV, Bettencourt AF. Easy-Assessment of Levofloxacin and Minocycline in Relevant Biomimetic Media by HPLC–UV Analysis. J Chromatogr Sci 2017; 55:757-765. [DOI: 10.1093/chromsci/bmx033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/04/2017] [Indexed: 11/14/2022]
|
13
|
Argudín MA, Mendoza MC, Martín MC, Rodicio MR. Molecular basis of antimicrobial drug resistance in Staphylococcus aureus isolates recovered from young healthy carriers in Spain. Microb Pathog 2014; 74:8-14. [DOI: 10.1016/j.micpath.2014.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 06/06/2014] [Accepted: 06/17/2014] [Indexed: 12/16/2022]
|
14
|
Surivet JP, Zumbrunn C, Rueedi G, Hubschwerlen C, Bur D, Bruyère T, Locher H, Ritz D, Keck W, Seiler P, Kohl C, Gauvin JC, Mirre A, Kaegi V, Dos Santos M, Gaertner M, Delers J, Enderlin-Paput M, Boehme M. Design, Synthesis, and Characterization of Novel Tetrahydropyran-Based Bacterial Topoisomerase Inhibitors with Potent Anti-Gram-Positive Activity. J Med Chem 2013; 56:7396-415. [DOI: 10.1021/jm400963y] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Cornelia Zumbrunn
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Georg Rueedi
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | | | - Daniel Bur
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Thierry Bruyère
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Hans Locher
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Daniel Ritz
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Wolfgang Keck
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Peter Seiler
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Christopher Kohl
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | | | - Azely Mirre
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Verena Kaegi
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Marina Dos Santos
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Mika Gaertner
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Jonathan Delers
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | | | - Maria Boehme
- Actelion Pharmaceuticals Ltd, Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| |
Collapse
|
15
|
Costa SS, Viveiros M, Amaral L, Couto I. Multidrug Efflux Pumps in Staphylococcus aureus: an Update. Open Microbiol J 2013; 7:59-71. [PMID: 23569469 PMCID: PMC3617543 DOI: 10.2174/1874285801307010059] [Citation(s) in RCA: 230] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 11/22/2022] Open
Abstract
The emergence of infections caused by multi- or pan-resistant bacteria in the hospital or in the community settings is an increasing health concern. Albeit there is no single resistance mechanism behind multiresistance, multidrug efflux pumps, proteins that cells use to detoxify from noxious compounds, seem to play a key role in the emergence of these multidrug resistant (MDR) bacteria. During the last decades, experimental data has established their contribution to low level resistance to antimicrobials in bacteria and their potential role in the appearance of MDR phenotypes, by the extrusion of multiple, unrelated compounds. Recent studies suggest that efflux pumps may be used by the cell as a first-line defense mechanism, avoiding the drug to reach lethal concentrations, until a stable, more efficient alteration occurs, that allows survival in the presence of that agent. In this paper we review the current knowledge on MDR efflux pumps and their intricate regulatory network in Staphylococcus aureus, a major pathogen, responsible from mild to life-threatening infections. Particular emphasis will be given to the potential role that S. aureus MDR efflux pumps, either chromosomal or plasmid-encoded, have on resistance towards different antimicrobial agents and on the selection of drug - resistant strains. We will also discuss the many questions that still remain on the role of each specific efflux pump and the need to establish appropriate methodological approaches to address all these questions.
Collapse
Affiliation(s)
- Sofia Santos Costa
- 1Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Portugal
- 2Centro de Recursos Microbiológicos (CREM), UNL, Portugal
| | - Miguel Viveiros
- 1Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Portugal
- 3COST ACTION BM0701 (ATENS), Brussels, Belgium
| | - Leonard Amaral
- 1Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Portugal
- 3COST ACTION BM0701 (ATENS), Brussels, Belgium
| | - Isabel Couto
- 1Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Portugal
- 2Centro de Recursos Microbiológicos (CREM), UNL, Portugal
| |
Collapse
|
16
|
Costa SS, Junqueira E, Palma C, Viveiros M, Melo-Cristino J, Amaral L, Couto I. Resistance to Antimicrobials Mediated by Efflux Pumps in Staphylococcus aureus. Antibiotics (Basel) 2013; 2:83-99. [PMID: 27029294 PMCID: PMC4790300 DOI: 10.3390/antibiotics2010083] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 12/20/2022] Open
Abstract
Resistance mediated by efflux has been recognized in Staphylococcus aureus in the last few decades, although its clinical relevance has only been recognized recently. The existence of only a few studies on the individual and overall contribution of efflux to resistance phenotypes associated with the need of well-established methods to assess efflux activity in clinical isolates contributes greatly to the lack of solid knowledge of this mechanism in S. aureus. This study aims to provide information on approaches useful to the assessment and characterization of efflux activity, as well as contributing to our understanding of the role of efflux to phenotypes of antibiotic resistance and biocide tolerance in S. aureus clinical isolates. The results described show that efflux is an important contributor to fluoroquinolone resistance in S. aureus and suggest it as a major mechanism in the early stages of resistance development. We also show that efflux plays an important role on the reduced susceptibility to biocides in S. aureus, strengthening the importance of this long neglected resistance mechanism to the persistence and proliferation of antibiotic/biocide-resistant S. aureus in the hospital environment.
Collapse
Affiliation(s)
- Sofia S Costa
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), 1349-008 Lisbon, Portugal.
- Centro de Recursos Microbiológicos (CREM), UNL, 2829-516 Caparica, Portugal.
| | - Elisabete Junqueira
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), 1349-008 Lisbon, Portugal.
| | - Cláudia Palma
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), 1349-008 Lisbon, Portugal.
| | - Miguel Viveiros
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), 1349-008 Lisbon, Portugal.
| | - José Melo-Cristino
- Centro Hospitalar Lisboa Norte E.P.E., Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal.
| | - Leonard Amaral
- Grupo de Medicina Tropical e do Viajante, Centro de Malária e Doenças Tropicais (CMDT), IHMT, UNL, 1349-008 Lisbon, Portugal.
| | - Isabel Couto
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), 1349-008 Lisbon, Portugal.
- Centro de Recursos Microbiológicos (CREM), UNL, 2829-516 Caparica, Portugal.
| |
Collapse
|
17
|
Activity of JNJ-Q2 against Staphylococcus aureus isolated from patients with acute bacterial skin and skin-structure infection obtained during a Phase 2 clinical trial. Diagn Microbiol Infect Dis 2012; 74:73-4. [DOI: 10.1016/j.diagmicrobio.2012.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 05/25/2012] [Indexed: 11/23/2022]
|
18
|
Cormier R, Burda WN, Harrington L, Edlinger J, Kodigepalli KM, Thomas J, Kapolka R, Roma G, Anderson BE, Turos E, Shaw LN. Studies on the antimicrobial properties of N-acylated ciprofloxacins. Bioorg Med Chem Lett 2012; 22:6513-20. [PMID: 22995622 DOI: 10.1016/j.bmcl.2012.05.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/30/2012] [Accepted: 05/08/2012] [Indexed: 11/18/2022]
Abstract
Fluoroquinolone antibiotics have been a mainstay in the treatment of bacterial diseases. The most notable representative, ciprofloxacin, possesses potent antimicrobial activity; however, a rise in resistance to this agent necessitates development of novel derivatives to prolong the clinical lifespan of these antibiotics. Herein we have synthesized and analyzed the antimicrobial properties of a library of N-acylated ciprofloxacin analogues. We find that these compounds are broadly effective against Gram-positive and Gram-negative bacteria, with many proving more effective than the parental drug, and several possessing MICs ≤1.0 μg/ml against methicillin-resistant Staphylococcus aureus and Bartonella species. An analysis of spontaneous mutation frequencies reveals very low potential for resistance in MRSA compared to existing fluoroquinolones. Mode of action profiling reveals that modification of the piperazinyl nitrogen by acylation does not alter the effect of these molecules towards their bacterial target. We also present evidence that these N-acylated compounds are highly effective at killing intracellular bacteria, suggesting the suitability of these antibiotics for therapeutic treatment.
Collapse
Affiliation(s)
- Ryan Cormier
- Center for Molecular Diversity in Drug Design, Discovery, and Delivery, Department of Chemistry, University of South Florida, Tampa, FL 33620, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Juárez-Verdayes MA, Parra-Ortega B, Hernández-Rodríguez C, Betanzos-Cabrera G, Rodríguez-Martínez S, Cancino-Diaz ME, Cancino-Diaz JC. Identification and expression of nor efflux family genes in Staphylococcus epidermidis that act against gatifloxacin. Microb Pathog 2012; 52:318-25. [DOI: 10.1016/j.micpath.2012.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 02/25/2012] [Accepted: 03/01/2012] [Indexed: 11/26/2022]
|
20
|
Aligholi M, Mirsalehian A, Halimi S, Imaneini H, Taherikalani M, Jabalameli F, Asadollahi P, Mohajer B, Abdollahi A, Emaneini M. Phenotypic and genotypic evaluation of fluoroquinolone resistance in clinical isolates of Staphylococcus aureus in Tehran. Med Sci Monit 2011; 17:PH71-4. [PMID: 21873957 PMCID: PMC3560520 DOI: 10.12659/msm.881920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fluoroquinolones are broad-spectrum antibiotics widely used in the treatment of bacterial infections such as Staphylococcus aureus isolates. Resistance to these antibiotics is increasing. Material/Methods The occurrence of mutations in the grlA and gyrA loci were evaluated in 69 fluoroquinolone-resistant S. aureus isolates from 2 teaching hospitals of Tehran University of Medical Sciences. Results Out of the 165 S. aureus isolates, 87 (52.7%) were resistant to methicillin and 69 (41.8%) were resistant to fluoroquinolone. Fluoroquinolone-resistant S. aureus isolates had a mutation at codon 80 in the grlA gene and different mutational combinations in the gyrA gene. These mutational combinations included 45 isolates at codons 84 and 86, 23 isolates at codons 84, 86 and 106 and 1 isolate at codons 84, 86 and 90. Fluoroquinolone-resistant S. aureus isolates were clustered into 33 PFGE types. Conclusions The findings of this study show that the fluoroquinolone-resistant S. aureus strains isolated in the teaching hospitals in Tehran had multiple mutations in the QRDRs region of both grlA and gyrA genes.
Collapse
Affiliation(s)
- Marzieh Aligholi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Costa SS, Falcão C, Viveiros M, Machado D, Martins M, Melo-Cristino J, Amaral L, Couto I. Exploring the contribution of efflux on the resistance to fluoroquinolones in clinical isolates of Staphylococcus aureus. BMC Microbiol 2011; 11:241. [PMID: 22032541 PMCID: PMC3226646 DOI: 10.1186/1471-2180-11-241] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 10/27/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Antimicrobial resistance mediated by efflux systems is still poorly characterized in Staphylococcus aureus, despite the description of several efflux pumps (EPs) for this bacterium. In this work we used several methodologies to characterize the efflux activity of 52 S. aureus isolates resistant to ciprofloxacin collected in a hospital in Lisbon, Portugal, in order to understand the role played by these systems in the resistance to fluoroquinolones. RESULTS Augmented efflux activity was detected in 12 out of 52 isolates and correlated with increased resistance to fluoroquinolones. Addition of efflux inhibitors did not result in the full reversion of the fluoroquinolone resistance phenotype, yet it implied a significant decrease in the resistance levels, regardless of the type(s) of mutation(s) found in the quinolone-resistance determining region of grlA and gyrA genes, which accounted for the remaining resistance that was not efflux-mediated. Expression analysis of the genes coding for the main efflux pumps revealed increased expression only in the presence of inducing agents. Moreover, it showed that not only different substrates can trigger expression of different EP genes, but also that the same substrate can promote a variable response, according to its concentration. We also found isolates belonging to the same clonal type that showed different responses towards drug exposure, thus evidencing that highly related clinical isolates may diverge in the efflux-mediated response to noxious agents. The data gathered by real-time fluorometric and RT-qPCR assays suggest that S. aureus clinical isolates may be primed to efflux antimicrobial compounds. CONCLUSIONS The results obtained in this work do not exclude the importance of mutations in resistance to fluoroquinolones in S. aureus, yet they underline the contribution of efflux systems for the emergence of high-level resistance. All together, the results presented in this study show the potential role played by efflux systems in the development of resistance to fluoroquinolones in clinical isolates of S. aureus.
Collapse
Affiliation(s)
- Sofia Santos Costa
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- Centro de Recursos Microbiológicos (CREM), Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Quinta da Torre, 2829-516 Caparica, Portugal
| | - Celeste Falcão
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Miguel Viveiros
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- COST ACTION BM0701 (ATENS
| | - Diana Machado
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- Unidade de Parasitologia e Microbiologia Médica (UPMM), Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa; Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Marta Martins
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- Unidade de Parasitologia e Microbiologia Médica (UPMM), Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa; Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- UCD School of Public Health, Physiotherapy and Population Science, UCD Centre for Food Safety, Veterinary Sciences Centre, University College Dublin, Belfield Dublin 4, Ireland
| | - José Melo-Cristino
- Centro Hospitalar Lisboa Norte E.P.E., Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Leonard Amaral
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- COST ACTION BM0701 (ATENS
- Unidade de Parasitologia e Microbiologia Médica (UPMM), Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa; Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Isabel Couto
- Grupo de Micobactérias, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (IHMT, UNL), Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
- Centro de Recursos Microbiológicos (CREM), Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Quinta da Torre, 2829-516 Caparica, Portugal
| |
Collapse
|
22
|
|
23
|
Haas W, Pillar CM, Hesje CK, Sanfilippo CM, Morris TW. Bactericidal activity of besifloxacin against staphylococci, Streptococcus pneumoniae and Haemophilus influenzae. J Antimicrob Chemother 2010; 65:1441-7. [PMID: 20435780 PMCID: PMC2882870 DOI: 10.1093/jac/dkq127] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Besifloxacin is a novel fluoroquinolone that was recently approved for topical treatment of bacterial conjunctivitis. The compound was shown to be active in vitro against a broad spectrum of bacteria, including isolates resistant to other antibacterials. Here, the bactericidal activity of besifloxacin was evaluated against the most common bacterial conjunctivitis pathogens. METHODS MIC, MBC and time-kill experiments with besifloxacin and comparators were performed according to CLSI guidelines. Quinolone resistance-determining regions (QRDRs) were sequenced using standard PCR-based techniques. RESULTS MIC and MBC data indicated that besifloxacin was the most potent fluoroquinolone tested against Staphylococcus aureus (n = 30), Staphylococcus epidermidis (n = 15) and Streptococcus pneumoniae (n = 35), while all fluoroquinolones were highly active against Haemophilus influenzae (n = 40). Besifloxacin MBC:MIC ratios were < or = 4 for 97.5% of all isolates tested (n = 120). All fluoroquinolones tested, as well as tobramycin, were bactericidal, while azithromycin was bactericidal against S. pneumoniae and H. influenzae, but bacteriostatic against the staphylococci. Time-kill assays with all four species showed that besifloxacin caused > or = 1000-fold killing within 2 h for 11 of 12 isolates. Only one isolate treated with moxifloxacin and three ciprofloxacin-treated isolates achieved the same level of bactericidal activity under the same conditions. Unlike the comparator fluoroquinolones, besifloxacin maintained a high potency and bactericidal activity even against strains that contained multiple mutations in the genes encoding DNA gyrase and topoisomerase IV. CONCLUSIONS Overall, besifloxacin demonstrated rapid bactericidal activity against the four major human pathogens tested here, including isolates that showed in vitro resistance to other fluoroquinolones, beta-lactams, macrolides or aminoglycosides.
Collapse
|
24
|
Abstract
Many emerging pathogens present in the skin and are of interest to dermatologists. Recent epidemics of measles, avian flu, and SARS demonstrated how an organism can rapidly spread worldwide because of airline travel. Travelers are often contagious before they are aware that they have the disease, contributing to the spread. This article reviews bacterial, mycobacterial, fungal, and viral pathogens important to dermatologists.
Collapse
Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17821, USA.
| |
Collapse
|
25
|
Tattevin P, Basuino L, Chambers HF. Subinhibitory fluoroquinolone exposure selects for reduced beta-lactam susceptibility in methicillin-resistant Staphylococcus aureus and alterations in the SOS-mediated response. Res Microbiol 2009; 160:187-92. [DOI: 10.1016/j.resmic.2009.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 03/10/2009] [Accepted: 03/23/2009] [Indexed: 11/25/2022]
|
26
|
Saiful AJ, Mastura M, Zarizal S, Mazurah MI, Shuhaimi M, Ali AM. Efflux genes and active efflux activity detection in Malaysian clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA). J Basic Microbiol 2008; 48:245-51. [PMID: 18720500 DOI: 10.1002/jobm.200700387] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Efflux-mediated resistance has been recognized as an important contributor of antibiotic resistance in bacteria, especially in methicillin-resistant Staphylococcus aureus (MRSA) isolates. This study was carried out to detect and analyze efflux genes (norA and mdeA) and active efflux activity in a collection of Malaysian MRSA and methicillin-sensitive S. aureus (MSSA) clinical isolates. Nineteen isolates including three ATCC S. aureus reference strains were subjected to PCR detection and DNA sequence analysis for norA and mdeA and active efflux detection using modified minimum inhibitory concentration (MIC) assay. From the 19 isolates, 18 isolates harboured the mdeA gene while 16 isolates contained norA gene. DNA sequence analysis reveals 98-100% correlation between the PCR product and the published DNA sequences in GenBank. In addition, 16 isolates exhibited active efflux activity using the ethidium bromide (EtBr)-reserpine combination MIC assay. To our knowledge, this is the first report on the detection of efflux genes and active efflux activity amongst Malaysian clinical isolates of MRSA/MSSA. Detection of active efflux activity may explain the previous report on efflux-mediated drug resistance profile amongst the local clinical isolates.
Collapse
Affiliation(s)
- Azmi Johari Saiful
- Antimicrobial Laboratory, Medicinal Plants Programme, Forest Biotechnology Division, Forest Research Institute Malaysia (FRIM), Selangor, Malaysia.
| | | | | | | | | | | |
Collapse
|
27
|
Antimicrobial activity of DC-159a, a new fluoroquinolone, against 1,149 recently collected clinical isolates. Antimicrob Agents Chemother 2008; 52:3763-75. [PMID: 18573936 DOI: 10.1128/aac.00294-08] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The activity of DC-159a, a novel orally administered fluorinated quinolone, was evaluated by reference broth microdilution or agar dilution methods against 1,149 recently collected clinical isolates from five continents. Against pathogens associated with community-acquired respiratory tract infections (CA-RTIs), the MIC(90)s were 0.12 microg/ml for Streptococcus pneumoniae, 0.015 to 0.03 microg/ml for Haemophilus influenzae, 0.03 microg/ml for Moraxella catarrhalis, and 0.12 microg/ml for beta-hemolytic streptococci. Similarly, DC-159a was potent against various types of staphylococci (MIC(90) range, 0.03 to 2 microg/ml), Enterococcus faecalis (MIC(90), 4 microg/ml), wild-type isolates of the family Enterobacteriaceae (MIC(90) range, 0.06 to 2 microg/ml), wild-type Pseudomonas aeruginosa (MIC(90), 2 microg/ml), and Acinetobacter spp. (MIC(90), 0.12 microg/ml). Fluoroquinolone-nonsusceptible organism subsets usually had elevated DC-159a MICs, but the MICs were often two- to fourfold lower than those of levofloxacin and moxifloxacin. In conclusion, DC-159a appears to possess a balanced broad spectrum of activity that exceeds the activities of the currently marketed fluoroquinolones, especially against pathogens that cause CA-RTIs.
Collapse
|
28
|
Couto I, Costa SS, Viveiros M, Martins M, Amaral L. Efflux-mediated response of Staphylococcus aureus exposed to ethidium bromide. J Antimicrob Chemother 2008; 62:504-13. [PMID: 18511413 DOI: 10.1093/jac/dkn217] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES By adapting an antibiotic-susceptible Staphylococcus aureus strain to increasing concentrations of ethidium bromide, a known substrate of efflux pumps (EPs), and by phenotypically and genotypically analysing the resulting progeny, we characterized the molecular mechanisms of S. aureus adaptation to ethidium bromide. METHODS S. aureus ATCC 25923 was grown in increasing concentrations of ethidium bromide. The MICs of representatives of eight classes of antibiotics, eight biocides and two dyes against ATCC 25923 and its ethidium bromide-resistant progeny ATCC 25923(EtBr) were determined with or without six efflux pump inhibitors (EPIs). Efflux activity in the presence/absence of EPIs was evaluated by real-time fluorometry. The presence and expression of eight EP genes were assayed by PCR and quantitative RT-PCR (qRT-PCR), respectively. Mutations in grlA, gyrA and norA promoter regions were screened by DNA sequencing. RESULTS Compared with its parental strain, ATCC 25923(EtBr) was 32-fold more resistant to ethidium bromide and also more resistant to biocides and hydrophilic fluoroquinolones. Resistance to these could be reduced by the EPIs chlorpromazine, thioridazine and reserpine. Increased efflux of ethidium bromide by ATCC 25923(EtBr) could be inhibited by the same EPIs. qRT-PCR showed that norA was 35-fold over-expressed in ATCC 25923(EtBr), whereas the remaining EP genes showed no significant increase in their expression. Sequencing of the norA promoter region revealed a 70 bp deletion in ATCC 25923(EtBr). CONCLUSIONS Exposure of S. aureus to quaternary compounds such as ethidium bromide results in decreased susceptibility of the organism to a wide variety of compounds, including quinolones and biocides through an efflux-mediated response, which for strain ATCC 25923 is mainly NorA-mediated. This altered expression may result from alterations in the norA promoter region.
Collapse
Affiliation(s)
- Isabel Couto
- Unidade de Micobacterias, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa (UNL), Portugal
| | | | | | | | | |
Collapse
|
29
|
Yamada M, Yoshida J, Hatou S, Yoshida T, Minagawa Y. Mutations in the quinolone resistance determining region in Staphylococcus epidermidis recovered from conjunctiva and their association with susceptibility to various fluoroquinolones. Br J Ophthalmol 2008; 92:848-51. [PMID: 18460536 PMCID: PMC2771781 DOI: 10.1136/bjo.2007.129858] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Staphylococcus epidermidis is one of the prominent pathogens in ocular infection. The prevalence of mutations in the quinolone resistance determining region (QRDR) area in S epidermidis isolated from the ocular surface and its association with fluoroquinolone resistance has not been fully elucidated. METHODS Mutations in the QRDR of gyrA, gyrB, parC, and parE genes of 138 isolates of S epidermidis recovered from the human conjunctival flora were analysed. The minimal inhibitory concentrations (MICs) of four fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin and tosufloxacin) against these isolates were also determined using agar dilution methods. RESULTS The MIC(90) values of levofloxacin, gatifloxacin, moxifloxacin and tosufloxacin were 3.13, 1.56, 0.78 and 3.13 microg/ml, respectively. The MIC values of all fluoroquinolones showed a bimodal distribution (susceptible strain and less susceptible strain). Mutations with amino acid substitution in the QRDR were present in 70 (50.7%) isolates. 19 different combinations of mutations were detected: 3 isolates (2.2%) had four mutations, 8 (5.8%) had three mutations, 43 (31.2%) had double mutations and 16 (11.6%) had single mutations. Isolates with mutations in the QRDR of both gyrA and parC (n = 53) were less susceptible to fluoroquinolones. CONCLUSIONS The present findings show that approximately half the S epidermidis isolates from the normal human conjunctiva have mutation(s) in the QRDR. The presence of mutations in both gyrA and parC is strongly associated with reduced susceptibility to fluoroquinolones.
Collapse
Affiliation(s)
- M Yamada
- Division for Vision Research, National Institute of Sensory Organs, National Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.
| | | | | | | | | |
Collapse
|
30
|
Characterization of new staphylococcal cassette chromosome mec (SCCmec) and topoisomerase genes in fluoroquinolone- and methicillin-resistant Staphylococcus pseudintermedius. J Clin Microbiol 2008; 46:1818-23. [PMID: 18305127 DOI: 10.1128/jcm.02255-07] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fluoroquinolone- and methicillin-resistant Staphylococcus pseudintermedius isolates harbor two new staphylococcal cassette chromosome mec (SCCmec) elements that belong to class A, allotype 3 (SCCmec II-III), and to the new allotype 5 (SCCmec VII). Analysis of the complete nucleotide sequences of the topoisomerase loci gyrB/gyrA and grlB/grlA revealed mutations involved in fluoroquinolone resistance.
Collapse
|
31
|
Cheng J, Thanassi JA, Thoma CL, Bradbury BJ, Deshpande M, Pucci MJ. Dual targeting of DNA gyrase and topoisomerase IV: target interactions of heteroaryl isothiazolones in Staphylococcus aureus. Antimicrob Agents Chemother 2007; 51:2445-53. [PMID: 17502409 PMCID: PMC1913236 DOI: 10.1128/aac.00158-07] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Heteroaryl isothiazolones (HITZs) are antibacterial agents that display excellent in vitro activity against Staphylococcus aureus. We recently identified a series of these compounds that show potent bactericidal activities against methicillin-resistant Staphylococcus aureus (MRSA). We report here the results of in vitro resistance studies that reveal potential underlying mechanisms of action. HITZs selected gyrA mutations exclusively in first-step mutants of wild-type S. aureus, indicating that in contrast to the case with most quinolones, DNA gyrase is the primary target. The compounds displayed low mutation frequencies (10(-9) to 10(-10)) at concentrations close to the MICs and maintained low MICs (< or =0.016 microg/ml) against mutants with single mutations in either gyrA or grlA (parC). These data suggested that HITZs possess significant inhibitory activities against target enzymes, DNA gyrase and topoisomerase IV. This dual-target inhibition was supported by low 50% inhibitory concentrations against topoisomerase IV as measured in a decatenation activity assay and against DNA gyrase as measured in a supercoiling activity assay. Good antibacterial activities (< or =1 microg/ml) against staphylococcal gyrA grlA double mutants, as well as low frequencies (10(-9) to 10(-10)) of selection of still higher-level mutants, also suggested that HITZs remained active against mutant enzymes. We further demonstrated that HITZs exhibit good inhibition of both S. aureus mutant enzymes and thus continue to possess a novel dual-targeting mode of action against these mutant strains. In stepwise acquisition of mutations, HITZs selected quinolone resistance determining region mutations gyrA(Ser84Leu), grlA(Ser80Phe), grlA(Ala116Val), and gyrA(Glu88Lys) sequentially, suggesting that the corresponding amino acids are key amino acids involved in the binding of HITZs to topoisomerases. The overall profile of these compounds suggests the potential utility of HITZs in combating infections caused by S. aureus, including multidrug-resistant MRSA.
Collapse
Affiliation(s)
- Jijun Cheng
- Achillion Pharmaceuticals, New Haven, CT 06511, USA
| | | | | | | | | | | |
Collapse
|
32
|
Methicillin-Sensitive and Methicillin-Resistant Staphylococcus aureus: Management Principles and Selection of Antibiotic Therapy. Dermatol Clin 2007; 25:157-64, vi. [DOI: 10.1016/j.det.2007.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
33
|
Credito K, Lin G, Appelbaum PC. Antistaphylococcal activity of DX-619 alone and in combination with vancomycin, teicoplanin, and linezolid assessed by time-kill synergy testing. Antimicrob Agents Chemother 2007; 51:1508-11. [PMID: 17261625 PMCID: PMC1855475 DOI: 10.1128/aac.01517-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Time-kill synergy studies testing in vitro activity of DX-619 alone and with added vancomycin, teicoplanin, or linezolid against 101 Staphylococcus aureus strains showed synergy between DX-619 and teicoplanin at 12 to 24 h in 72 strains and between DX-619 and vancomycin in 28 strains. No synergy was found with linezolid, and no antagonism was observed with any combination.
Collapse
Affiliation(s)
- Kim Credito
- Department of Pathology, Hershey Medical Center, P.O. Box 850, Hershey, PA 17033, USA
| | | | | |
Collapse
|
34
|
Horii T, Suzuki Y, Takeshita A, Maekawa M. Molecular characterization of 8-methoxyfluoroquinolone resistance in a clinical isolate of methicillin-resistant Staphylococcus aureus. Chemotherapy 2007; 53:104-9. [PMID: 17202817 DOI: 10.1159/000098427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 01/17/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Activity of gatifloxacin against clinical isolates of fluoroquinolone-resistant Staphylococcus aureus is more potent than that of other fluoroquinolones such as norfloxacin and levofloxacin. To date, few reports have described high-level resistance to gatifloxacin in clinical isolates of S. aureus, although in vitro studies have shown that mutations in both DNA gyrase and topoisomerase IV were required for gatifloxacin resistance in S. aureus. METHODS Minimum inhibitory concentrations were determined for fluoroquinolones and other antimicrobials in a methicillin-resistant S. aureus isolate that was cultured from blood of a patient with septicemia. Fluoroquinolone resistance was characterized by DNA sequencing and microbiologic assay. RESULTS The isolate showed high-level resistance to fluoroquinolones including an 8-methoxyfluoroquinolone, gatifloxacin (minimum inhibitory concentration 64 microg/ml). Amino acid mutations of Ser80Tyr and Glu84Lys in GrlA and Ser84Leu and Ser85Pro in GyrA were possibly related to this resistance in methicillin-resistant S. aureus HU2000-062, although efflux may play a minor role in resistance as well. CONCLUSION GyrA and GrlA mutations mainly conferred to 8-methoxyfluoroquinolone resistance in this isolate.
Collapse
Affiliation(s)
- Toshinobu Horii
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | | | | | | |
Collapse
|
35
|
Lee SY, Fan HW, Sutherland C, DeRyke AC, Nicolau DP. Antibacterial Effects of Moxifloxacin and Levofloxacin Simulating Epithelial Lining Fluid Concentrations against Community-Acquired Methicillin-Resistant Staphylococcus aureus. Drugs R D 2007; 8:69-77. [PMID: 17324004 DOI: 10.2165/00126839-200708020-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Current North American guidelines advocate the use of respiratory fluoroquinolones for the empirical management of community-acquired pneumonia (CAP). While community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a pathogen frequently encountered in skin and skin structure infections, it has also now been recognised as a causative pathogen in CAP. Since fluoroquinolones may be used empirically to treat unsuspected CA-MRSA pneumonia, the objective of this study was to evaluate the antibacterial properties of levofloxacin and moxifloxacin using human simulated drug exposures in epithelial lining fluid (ELF). METHODS An in vitro model was used to simulate the ELF concentrations, previously determined in older adults receiving multiple doses, of levofloxacin 500 mg once daily and moxifloxacin 400mg once daily. Four CA-MRSA isolates were studied at a starting inoculum of 10(6) colony-forming units (CFU)/mL; selected isolates were also studied at 10(8) CFU/mL. Bacterial density and resistance were quantitatively assessed over 48 hours. Drug exposure (area under the concentration-time curve [AUC]) was confirmed using validated drug assays. RESULTS At a standard 10(6) starting inoculum, sustained bacterial kill (3.6-4.5 log) with both fluoroquinolones was noted for CA-MRSA isolates 27 and 44 (AUC/minimum inhibitory concentration [MIC] = 383-3923). Despite an MIC of 8 microg/mL (AUC/MIC = 25) for isolate 3, levofloxacin displayed a 2.8 log kill, while moxifloxacin (MIC 1 microg/mL) sustained a 4.5 log kill (AUC/MIC = 207) over 48 hours. Against isolate 59, levofloxacin displayed no antibacterial effect (AUC/MIC = 3), while moxifloxacin with an MIC of 8 microg/mL (AUC/MIC = 31) killed 4.6 log. At a high inoculum (10(8)), both fluoroquinolones showed 5.2-5.6 log kill for the susceptible isolate (44), while moxifloxacin showed no antibacterial activity against isolate 59. Drug exposure (AUC/MIC) appeared to correlate well (r(2) = 0.99) with the change in log CFU/mL. Maximal activity was observed for both drugs at an AUC/MIC of approximately 30. CONCLUSION When evaluated at human simulated ELF concentrations, both levofloxacin and moxifloxacin appeared to demonstrate sustained antibacterial activity for CA-MRSA isolates with MICs <or=8 microg/mL at a starting inoculum of 10(6). Use of a high inoculum (10(8)) appeared to compromise the antimicrobial activity of the fluoroquinolones when the MIC was 8 microg/mL, but did not mitigate antibacterial kill for susceptible isolates.
Collapse
Affiliation(s)
- Su Young Lee
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA
| | | | | | | | | |
Collapse
|
36
|
Elston DM. Community-acquired methicillin-resistant Staphylococcus aureus. J Am Acad Dermatol 2007; 56:1-16; quiz 17-20. [PMID: 17190619 DOI: 10.1016/j.jaad.2006.04.018] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Revised: 04/05/2006] [Accepted: 04/11/2006] [Indexed: 12/11/2022]
Abstract
UNLABELLED Published data confirm that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in incidence in both urban and rural settings. The statistical risk is higher for athletes, military personnel, prison inmates, intravenous drug abusers, the homeless, children in daycare, and certain Native American groups, but the infections are by no means restricted to these populations. Roughly 85% of the infections involve the skin and subcutaneous tissue, with the most common presentations being an abscess or folliculitis. The typical associated gene cassette is quite small and codes only for methicillin resistance. Abscesses generally respond to drainage. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should recognize groups at high risk for community-acquired MSRA infections and manage these infections appropriately.
Collapse
Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Geisinger Medical Center, Danville, PA 17821, USA.
| |
Collapse
|
37
|
Iihara H, Suzuki T, Kawamura Y, Ohkusu K, Inoue Y, Zhang W, Monir Shah M, Katagiri Y, Ohashi Y, Ezaki T. Emerging multiple mutations and high-level fluoroquinolone resistance in methicillin-resistant Staphylococcus aureus isolated from ocular infections. Diagn Microbiol Infect Dis 2006; 56:297-303. [PMID: 16769192 DOI: 10.1016/j.diagmicrobio.2006.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 04/26/2006] [Accepted: 04/29/2006] [Indexed: 10/24/2022]
Abstract
We investigated the prevalence of mutations in the gyrA, gyrB, grlA, and grlB genes in 21 clinical isolates of methicillin-resistant Staphylococcus aureus recovered from ocular infections. These isolates were classified into 16 groups on the basis of pulsed-field gel electrophoresis (PFGE) patterns. Among these nonidentical strains, 9 different combinations of mutations were observed. We observed an unusually high frequency of mutations: 10 (62.5%) of the isolates had four or five mutations, 5 (31.3%) of the isolates had double mutations, and 1 isolate had a single mutation. Different mutations were detected in strains of the same PFGE type, and this is consistent with the independent acquisition of mutations. The minimun inhibitory concentrations values ranged from 0.5 to 512 microg/mL for levofloxacin and 0.125 to 128 microg/mL for gatifloxacin. Only 1 isolate was found to be susceptible to both agents. These results suggest that application of high concentration fluoroquinolone ophthalmic solutions selects for isolates presenting such mutations that may result in a high level of resistance to fluoroquinolones.
Collapse
Affiliation(s)
- Hirotoshi Iihara
- Department of Microbiology, Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Nagaoka T, Horii T, Satoh T, Ito T, Monji A, Takeshita A, Maekawa M. Use of a three-dimensional microarray system for detection of levofloxacin resistance and the mec A gene in Staphylococcus aureus. J Clin Microbiol 2005; 43:5187-94. [PMID: 16207982 PMCID: PMC1248431 DOI: 10.1128/jcm.43.10.5187-5194.2005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We evaluated a novel three-dimensional microarray (Pam Chip microarray) system to detect the presence of levofloxacin-related resistance mutations and the mec A gene. The results were compared to those obtained for 27 Staphylococcus aureus isolates by conventional DNA sequencing or PCR methods. Hybridization and fluorescence detection were performed using an FD 10 system designed for Pam Chip microarray under conditions optimized for each target/probe on the array. In dilution series analysis using multiplex PCR samples, the sensitivity of the microarray was about 10 times greater than that of conventional PCR methods. A high level of data reproducibility was also confirmed in those analyses. Various point mutations in quinolone resistance-determining regions detected by our system corresponded perfectly to the results obtained by conventional DNA sequencing. The results of the mec A gene detection using our system also corresponded to the PCR method; that is, signal/band was detected in all isolates of methicillin-resistant S. aureus, and no signal/band was detected in any isolate of methicillin-susceptible S. aureus. In conclusion, our novel three-dimensional microarray system provided rapid, specific, easy, and reproducible results for the simultaneous detection of levofloxacin resistance and the mec A gene in S. aureus.
Collapse
Affiliation(s)
- Tomonori Nagaoka
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Hamamatsu 431-3192, Japan
| | | | | | | | | | | | | |
Collapse
|
39
|
Horii T, Monji A, Uemura K, Nagura O. Rapid detection of fluoroquinolone resistance by isothermal chimeric primer-initiated amplification of nucleic acids from clinical isolates of Neisseria gonorrhoeae. J Microbiol Methods 2005; 65:557-61. [PMID: 16278026 DOI: 10.1016/j.mimet.2005.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 09/15/2005] [Accepted: 10/03/2005] [Indexed: 11/29/2022]
Abstract
To ensure a complete response to fluoroquinolone therapy against Neisseria gonorrhoeae infections, rapid susceptibility determinations are required. We assessed a new approach, an isothermal chimeric primer-initiated amplification of nucleic acids (ICAN)/hybrid-chromatography method to detect rapidly fluoroquinolone resistance in N. gonorrhoeae. Comparison of the amplification results with fluoroquinolone minimum inhibitory concentrations (MICs), which were determined by an agar dilution method, showed that the new method accurately determined fluoroquinolone resistance in all ciprofloxacin- and/or gatifloxacin-resistant isolates, but agreed with results based on MICs in only 6 of 8 (75.0%) ciprofloxacin-susceptible and 7 of 12 (58.3%) gatifloxacin-susceptible isolates. Our results suggest that this method can rapidly and reliably detect point mutations in the gyrA gene as well as fluoroquinolone resistance in resistant isolates of N. gonorrhoeae.
Collapse
Affiliation(s)
- Toshinobu Horii
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Japan.
| | | | | | | |
Collapse
|
40
|
Bogdanovich T, Esel D, Kelly LM, Bozdogan B, Credito K, Lin G, Smith K, Ednie LM, Hoellman DB, Appelbaum PC. Antistaphylococcal activity of DX-619, a new des-F(6)-quinolone, compared to those of other agents. Antimicrob Agents Chemother 2005; 49:3325-33. [PMID: 16048943 PMCID: PMC1196248 DOI: 10.1128/aac.49.8.3325-3333.2005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro activity of DX-619, a new des-F(6)-quinolone, was tested against staphylococci and compared to those of other antimicrobials. DX-619 had the lowest MIC ranges/MIC(50)s/MIC(90)s (microg/ml) against 131 Staphylococcus aureus strains (</=0.002 to 2.0/0.06/0.5) and 128 coagulase-negative staphylococci (0.004 to 0.25/0.016/0.125). Among strains tested, 76 S. aureus strains and 51 coagulase-negative staphylococci were resistant to ciprofloxacin. DX-619 had the lowest MIC(50)/MIC(90) values against 127 quinolone-resistant staphylococci (0.125/0.5), followed by sitafloxacin (0.5/4), moxifloxacin (2/8), gatifloxacin (4/16), levofloxacin (16/>32), and ciprofloxacin (>32/>32). Raised quinolone MICs were associated with mutations in GyrA (S84L) and single or double mutations in GrlA (S80F or Y; E84K, G, or V) in all S. aureus strains tested. A recent vancomycin-resistant S. aureus (VRSA) strain (Hershey) was resistant to available quinolones and was inhibited by DX-619 at 0.25 microg/ml and sitafloxacin at 1.0 microg/ml. Vancomycin (except VRSA), linezolid, ranbezolid, tigecycline, and quinupristin-dalfopristin were active against all strains, and teicoplanin was active against S. aureus but less active against coagulase-negative staphylococci. DX-619 produced resistant mutants with MICs of 1 to >32 microg/ml after <50 days of selection compared to 16 to >32 microg/ml for ciprofloxacin, sitafloxacin, moxifloxacin, and gatifloxacin. DX-619 and sitafloxacin were also more active than other tested drugs against selected mutants and had the lowest mutation frequencies in single-step resistance selection. DX-619 and sitafloxacin were bactericidal against six quinolone-resistant (including the VRSA) and seven quinolone-susceptible strains tested, whereas gatifloxacin, moxifloxacin, levofloxacin, and ciprofloxacin were bactericidal against 11, 10, 7, and 5 strains at 4x MIC after 24 h, respectively. DX-619 was also bactericidal against one other VRSA strain, five vancomycin-intermediate S. aureus strains, and four vancomycin-intermediate coagulase-negative staphylococci. Linezolid, ranbezolid, and tigecycline were bacteriostatic and quinupristin-dalfopristin, teicoplanin, and vancomycin were bactericidal against two, eight, and nine strains, and daptomycin and oritavancin were rapidly bactericidal against all strains, including the VRSA. DX-619 has potent in vitro activity against staphylococci, including methicillin-, ciprofloxacin-, and vancomycin-resistant strains.
Collapse
Affiliation(s)
- Tatiana Bogdanovich
- Department of Pathology, Hershey Medical Center, P.O. Box 850, Hershey, PA 17033, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Korzheva N, Davies TA, Goldschmidt R. Novel Ser79Leu and Ser81Ile substitutions in the quinolone resistance-determining regions of ParC topoisomerase IV and GyrA DNA gyrase subunits from recent fluoroquinolone-resistant Streptococcus pneumoniae clinical isolates. Antimicrob Agents Chemother 2005; 49:2479-86. [PMID: 15917550 PMCID: PMC1140505 DOI: 10.1128/aac.49.6.2479-2486.2005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Resistance of Streptococcus pneumoniae to fluoroquinolones is caused predominantly by amino acid substitutions at positions Ser79 of ParC and Ser81 of GyrA to either Phe or Tyr encoded in the quinolone resistance-determining regions of the parC topoisomerase IV and gyrA DNA gyrase genes. Analysis of highly resistant clinical isolates identified novel second-step substitutions, Ser79Leu (ParC) and Ser81Ile (GyrA). To determine contributions of these new mutations to fluoroquinolone resistance either alone or in combination with other Ser79/81 alleles, the substitutions Ser79Leu/Phe/Tyr in ParC and Ser81Ile/Phe/Tyr in GyrA were introduced into the R6 background, resulting in 15 isogenic strains. Their level of fluoroquinolone resistance was determined by susceptibility testing for ciprofloxacin, levofloxacin, moxifloxacin, gatifloxacin, gemifloxacin, garenoxacin, and norfloxacin. Leu79 and Ile81 alone as well as 79/81Phe/Tyr substitutions did not contribute significantly to resistance, with fluoroquinolone MICs increasing two- to fourfold compared to wild type for all agents tested. Fluoroquinolone MICs for double transformants ParC Ser79Phe/Tyr/Leu-GyrA Ser81Phe/Tyr were uniformly increased by 8- to 64-fold regardless of pairs of amino acid substitutions. However, combinations including Ile81 conferred two- to fourfold-higher levels of resistance than did combinations including any other Ser81 GyrA substitution, thus demonstrating the differential effects of diverse amino acid substitutions at particular hotspots on fluoroquinolone MICs.
Collapse
Affiliation(s)
- Nataliya Korzheva
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., 1000 Route 202, Raritan, NJ 08869-0602, USA
| | | | | |
Collapse
|
42
|
Yamaguchi K, Ohno A. Investigation of the susceptibility trends in Japan to fluoroquinolones and other antimicrobial agents in a nationwide collection of clinical isolates: a longitudinal analysis from 1994 to 2002. Diagn Microbiol Infect Dis 2005; 52:135-43. [PMID: 15964502 DOI: 10.1016/j.diagmicrobio.2005.02.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2004] [Accepted: 02/09/2005] [Indexed: 02/02/2023]
Abstract
The susceptibilities of clinical isolates to fluoroquinolones (FQs) and other antimicrobial agents were surveyed to obtain an accurate understanding of the trends in incidence and antimicrobial resistance. The samples were collected from across Japan, biennially, between 1994 and 2002 and a defined level of resistance to FQ determined. Streptococcus pneumoniae and Haemophilus influenzae exhibited stable and high rates of susceptibility to FQ over the period examined. For methicillin-resistant Staphylococcus aureus the rate of resistance to FQ was 80%-90%, markedly higher than that of methicillin-susceptible S. aureus. The rate of FQ-resistant Escherichia coli increased rapidly to approximately 10% for samples after 2000. Of 696 E. coli isolates collected in 2002, 13 produced an extended-spectrum beta-lactamase (ESBL), with 6 of 13 ESBL-producing isolates being FQ-resistant. No FQ resistance in clinical isolates of Salmonella spp. was detected in any of the surveys. The rate of FQ resistance to Pseudomonas aeruginosa isolated from urinary tract and respiratory tract infections was 40%-60% and 15%-25%, respectively.
Collapse
Affiliation(s)
- Keizo Yamaguchi
- Department of Microbiology, Toho University, School of Medicine, Tokyo 143-8540, Japan
| | | |
Collapse
|