The new threats of Gram positive pathogens: re-emergence of things past

Quality parameters and antioxidant and antibacterial properties of some Mexican honeys

A total of 14 Mexican honeys were screened for quality parameters including color, moisture, proline, and acidity. Antioxidant properties of complete honey and its methanolic extracts were evaluated by the DPPH, ABTS, and FRAP assays. In addition, the antimicrobial activity of complete honeys against Bacillus cereus ATCC 10876, Listeria monocytogenes Scott A, Salmonella Typhimurium ATCC 14028, and Sthapylococcus aureus ATCC 6538 was determined. Most of honeys analyzed showed values within quality parameters established by the Codex Alimentarius Commission in 2001. Eucalyptus flower honey and orange blossom honey showed the highest phenolic contents and antioxidant capacity. Bell flower, orange blossom, and eucalyptus flower honeys inhibited the growth of the 4 evaluated microorganisms. The remaining honeys affected at least 1 of the estimated growth parameters (increased lag phase, decreased growth rate, and/or maximum population density). Microorganism sensitivity to the antimicrobial activity of honeys followed the order B. cereus > L. monocytogenes > Salmonella Typhimurium > S. aureus. The monofloral honey samples from orange blossoms, and eucalyptus flowers demonstrated to be good sources of antioxidant and antimicrobial compounds. All the Mexican honey samples examined proved to be good sources of antioxidants and antimicrobial agents that might serve to maintain health and protect against several diseases.

PRACTICAL APPLICATION

The results of the study showed that Mexican honeys display good quality parameters and antioxidant and antimicrobial activities. Mexican honey can be used as an additive in the food industry to increase the nutraceutical value of products.

The antimicrobial activity of thyme essential oil against multidrug resistant clinical bacterial strains

AIM

The aim of this work was to investigate the antimicrobial activity of thyme essential oil against clinical multidrug resistant strains of Staphylococcus, Enterococcus, Escherichia, and Pseudomonas genus.

MATERIALS

The antibacterial activity of oil was tested against standard strains of bacteria and 120 clinical strains isolated from patients with infections of the oral cavity, abdominal cavity, respiratory and genitourinary tracts, skin, and from the hospital environment.

METHODS

Agar diffusion was used to determine the microbial growth inhibition of bacterial growth at various concentrations of oil from Thymus vulgaris. Susceptibility testing to antibiotics was carried out using disk diffusion.

RESULTS

Thyme essential oil strongly inhibited the growth of the clinical strains of bacteria tested.

CONCLUSIONS

The use of phytopharmaceuticals based on an investigated essential oil from thyme in the prevention and treatment of various human infections may be reasonable.

ATP binding enables broad antibiotic selectivity of aminoglycoside phosphotransferase(3')-IIIa: an elastic network analysis

The bacterial enzyme aminoglycoside phosphotransferase(3')-IIIa (APH) confers resistance against a wide range of aminoglycoside antibiotics. In this study, we use the Gaussian network model to investigate how the binding of nucleotides and antibiotics influences the dynamics and thereby the ligand binding properties of APH. Interestingly, in NMR experiments, the dynamics differ significantly in various APH complexes, although crystallographic studies indicate that no larger conformational changes occur upon ligand binding. Isothermal titration calorimetry also shows different thermodynamic contributions to ligand binding. Formation of aminoglycoside-APH complexes is enthalpically driven, while the enthalpic change upon aminoglycoside binding to the nucleotide-APH complex is much smaller. The differential effects of nucleotide binding and antibiotic binding to APH can be explained theoretically by single-residue fluctuations and correlated motions of the enzyme. The surprising destabilization of β-sheet residues upon nucleotide binding, as seen in hydrogen/deuterium exchange experiments, shows that the number of closest neighbors does not fully explain residue flexibility. Additionally, we must consider correlated motions of dynamic protein domains, which show that not only connectivity but also the overall protein architecture is important for protein dynamics.

NMR detected hydrogen-deuterium exchange reveals differential dynamics of antibiotic- and nucleotide-bound aminoglycoside phosphotransferase 3'-IIIa

In this work, hydrogen-deuterium exchange detected by NMR spectroscopy is used to determine the dynamic properties of the aminoglycoside phosphotransferase 3'-IIIa (APH), a protein of intense interest due to its involvement in conferring antibiotic resistance to both gram negative and gram positive microorganisms. This represents the first characterization of dynamic properties of an aminoglycoside-modifying enzyme. Herein we describe in vitro dynamics of apo, binary, and ternary complexes of APH with kanamycin A, neomycin B, and metal-nucleotide. Regions of APH in different complexes that are superimposable in crystal structures show remarkably different dynamic behavior. A complete exchange of backbone amides is observed within the first 15 h of exposure to D(2)O in the apo form of this 31 kDa protein. Binding of aminoglycosides to the enzyme induces significant protection against exchange, and approximately 30% of the amides remain unexchanged up to 95 h after exposure to D(2)O. Our data also indicate that neomycin creates greater solvent protection and overall enhanced structural stability to APH than kanamycin. Surprisingly, nucleotide binding to the enzyme-aminoglycoside complex increases solvent accessibility of a number of amides and is responsible for destabilization of a nearby beta-sheet, thus providing a rational explanation for previously observed global thermodynamic parameters. Our data also provide a molecular basis for broad substrate selectivity of APH.

Nosocomial bacterial infections in Intensive Care Units. I: Organisms and mechanisms of antibiotic resistance

Hospital-acquired infection is an increasing problem in intensive care units, where the patients are more susceptible and the organisms often more resistant than in other environments. This review discusses the reasons for these phenomena and describes the mechanisms underlying antibiotic resistance and the common intensive care unit-acquired organisms.

Enterococcus gastritis

Helicobacter pylori infection is the most common cause of gastritis with its associated sequelae. Gastritis secondary to other bacteria is rare. This report describes Enterococcus-associated gastritis in a 59-year-old diabetic man. Nine months after receiving treatment for H. pylori-associated gastritis, he underwent endoscopy to confirm H. pylori eradication and to evaluate the status of previously seen ulcers. Mucosal biopsy specimens revealed severe active but focal gastritis adjacent to gram-positive coccobacilli in short to long chains with no H. pylori. Culture grew an Enterococcus similar to E. hirae and E. durans. No treatment was given, and endoscopy done 2 months later showed complete resolution of the gastritis and absence of H. pylori or enterococci. Our patient's gastritis represents a previously undescribed manifestation of Enterococcus infection. It is possible that the presence of NSAID gastric mucosal injury and diabetes predisposed this individual to the development of transient Enterococcus gastritis.

Guidelines on antimicrobial chemotherapy for prevention and treatment of infections in the intensive care unit

Severe infections (SIs) in Intensive Care Units (ICUs) constitute difficult therapeutic problems confronting clinicians who deal with severely ill patients. Some SIs are opportunistic infections acquired either in the community or in hospitals, particularly in immunodepressed patients. The great majority of ICU infections are of nosocomial origin. Resistant organisms have led to changing antibiotic therapy in ICU infections. Before microbiology is available, empiric therapy is based on: (i) proper identification of bacterial risks in each infection site; (ii) local surveillance of frequent nosocomial organisms/susceptibility patterns in the ICU; (iii) identification of environmental risk factors and the patient's underlying condition. In documented infection, antibiotic therapy must take into account gram-positive vs gram-negative bacteria or mixed infections, pharmacokinetics/pharmacodynamic parameters of chosen antibiotic(s) and concentrations at the infection site, in order to prevent selection of resistant mutants and to provide the most efficient antibiotic therapy. With increasingly sophisticated intensive care measures, invasive exploratory procedures, and surgical procedures, evolving profiles of hospital infections require updated Guidelines for treatment of severe infections in ICUs. Preventive and therapeutic strategies include control of antibiotic use, and suitable antibacterial treatments which result in shortened hospital stay, improved outcome of hospital infections and significant cost savings.

Multi-resistance to antimicrobial agents for the ten most frequently isolated bacterial pathogens

Cross-resistance and multi-resistance to selected antibiotics was determined for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Amikacin-resistant Enterobacteriaceae often showed cross-resistance to ss-lactam antibiotics. Only 1% of the Escherichia coli isolates showed resistance to more than four antibiotics from a set of seven. This rate was higher for other Enterobacteriaceae and there were high levels of cross-resistance for P. aeruginosa. The cross-resistance of oxacillin with other antibiotics is well known in staphylococci. Penicillin-resistant pneumococcal isolates were cross-resistant to macrolides. Cross-resistance was only a minor problem in H. influenzae and M. catarrhalis. Cross- and multi-resistance are important problems for Gram-negative and Gram-positive bacteria but not for fastidious bacteria with the exception of penicillin-resistant S. pneumoniae.

A DNA vaccine encoding a peptide mimic of Streptococcus pneumoniae serotype 4 capsular polysaccharide induces specific anti-carbohydrate antibodies in Balb/c mice

Streptococcus pneumoniae is a leading cause of morbidity and mortality in both the developing and developed world. The T-independent nature of the current polysaccharide vaccine renders it ineffective in elderly adults and children <2 years of age. Although the recently licensed conjugate vaccines are capable of producing T-cell-dependent immunity, they also have their limitations, namely a lack of response in certain populations. Our laboratory has focused on a different approach, DNA vaccination. We have defined a peptide sequence (pep4) that mimics the S. pneumoniae serotype 4 capsular polysaccharide (PPS4) using a monoclonal antibody to PPS4 (mAb4) and phage display library. Pep4 was synthesized, complexed to proteosomes and used to immunize mice. We have shown by ELISA that this peptide mimic is capable of eliciting an anti-PPS4 immune response significantly higher than in negative control mice (P<0.05). A PPS4-DNA vaccine was made by cloning an oligodeoxynucleotide encoding pep4 into the HBcAg vector. Following epidermal immunization with the PPS4-DNA vaccine, mice produced an anti-PPS4 antibody response significantly higher than in mice immunized with an impertinent DNA vector (P<0.05). Our results demonstrate the feasibility of peptide mimicry in DNA vaccine development.

Antimicrobial resistance in staphylococci and enterococci in 10 Portuguese hospitals in 1996 and 1997. POSGAR. Portuguese Study Group of Antimicrobial Resistance

During a 2-year period, 10 Portuguese hospitals located throughout the country studied antimicrobial susceptibilities of clinically relevant staphylococci and enterococci. Of more than 12,000 Staphylococcus aureus isolates tested, two main patterns were found, methicillin-sensitive organisms most of them resistant only to penicillin but a few to other antimicrobials and methicillin-resistant S. aureus (MRSA) strains (prevalence 48.2%) resistant to most of the antimicrobials tested and uniformly susceptible to vancomycin. Among coagulase-negative staphylococci (CNS), 71% of S. epidermidis (approximately 5,000 isolates tested) and 84% S. haemolyticus (approximately 1,000 isolates tested) were also resistant to methicillin as well as most other antimicrobials except vancomycin. Most of the 5,000 Enterococcus faecalis isolates tested were susceptible to ampicillin and vancomycin, in contrast to 650 E. faecium isolates, 70% of which were resistant to ampicillin and 20% to vancomycin and all other antibiotics. A high prevalence of aminoglycoside resistance occurred in both Enterococcus species. This survey showed that resistance profiles of staphylococci and enterococci hospital isolates have not changed in the last 5 years in Portugal, with the exception of the rise in vancomycin resistance in E. faecium. The high prevalence of methicillin resistance in S. aureus and in the CNS remains an issue of medical concern.

Antimicrobial susceptibility and frequency of occurrence of clinical blood isolates in Europe from the SENTRY antimicrobial surveillance program, 1997 and 1998

As part of the European arm of the SENTRY Antimicrobial Surveillance Program, 25 European university hospitals referred 9613 blood isolates for in vitro testing against >20 antimicrobial agents. Escherichia coli, Staphylococcus aureus, coagulase-negative Staphylococcus, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the 5 most frequent isolates and accounted for two-thirds of all referrals, with minor regional variation. Of these, approximately 0.36% of E. coli and 16.7% of K. pneumoniae isolates proved to be potential extended-spectrum beta-lactamase producers, and their incidence clearly varied regionally. Quinolone resistance was detected among gram-negative species; in particular, P. aeruginosa and Acinetobacter species. Considerable regional variation was observed in the incidences of methicillin resistance in S. aureus and penicillin resistance in Streptococcus pneumoniae. The incidence of vancomycin resistance in enterococci was relatively low overall and primarily associated with Enterococcus faecium. However, extrapolation of these data to smaller and nonteaching hospitals should be undertaken with caution, since resistance rates may be lower in these facilities.

Current guidelines for the treatment and prevention of nosocomial infections

Nosocomial infections (NIs) are among the most difficult problems confronting clinicians who deal with severely ill patients. The incidence of these hospital-acquired infections varies with the size of hospitals, with specialities of wards, and with many other factors such as length of hospital stay, local trends in antibiotic usage, nursing and hygiene conditions, hospital design and geographical distribution of patients at risk. An average incidence of NI can be estimated at 5 to 10%, with higher rates in large university hospitals, reaching up to 28% in the intensive care unit (ICU). Changing epidemiology of NI and emerging resistance problems have resulted in evolving strategies of antibiotic usage in patients at risk. Several recent antibiotic resistance problems have been identified, for instance in Gram-positive organisms, and have been surveyed, in addition to those previously well known in Gram-negative bacilli. The choice of empiric antibiotic therapy for the treatment of any NI before microbiology is available has become a difficult challenge, requiring: (i) surveillance data on a regular basis of predominant organisms in units at risk; (ii) surveillance of the current resistance patterns of these organisms; (iii) identification of outbreaks involving the prevalent organisms, using modern molecular techniques for typing the strain and assess cross-contamination. In documented infection, monotherapy vs combination therapy has been often discussed in the treatment of serious Gram-negative hospital infections, but these concepts vary with the site of infection, the nature of organism involved and its pattern of resistance, the kind of antibiotic which may more or less quickly select resistant mutants. Antibiotic therapy concepts vary significantly between countries, and combinations either empirical or based on laboratory data are often preferred in European countries than in the US. Frequent collaborative studies and an increasing communication between experts of different countries, make guidelines and consensus conferences, established in a particular country, useful elsewhere and may contribute to improvement in the management of NI. Guidelines for the prevention and the control of NI are well established in many developed countries and they may have resulted in the improvement of the prevention and the treatment of NI. However, there is still potential progress that should be made, including individual preventive practices, improvement in nursing practices, control of antibiotic use, trend to shorten the hospital stay and early discharge from hospital, which results in significant cost savings.

The use of neamine as a molecular template: inactivation of bacterial antibiotic resistance enzyme aminoglycoside 3'-phosphotransferase type IIa

Aminoglycoside 3'-phosphotransferase type IIa [APH(3')-IIa] is a member of the family of bacterial aminoglycoside-modifying enzymes. Bacteria that harbor these enzymes are resistant to aminoglycoside antibiotics. Four aminoglycoside-based affinity inactivators were synthesized and were shown to be both substrates and inactivators for APH(3')-IIa. These affinity inactivators are N-bromoacetylated derivatives of neamine, an aminoglycoside antibiotic, where the bromoacetyl moiety in each was introduced regiospecifically at a different amine of the parent compound.

Mechanism of aminoglycoside 3'-phosphotransferase type IIIa: His188 is not a phosphate-accepting residue

BACKGROUND

The enzyme aminoglycoside 3'-phosphotransferase Type IIIa (APH(3')-IIIa), confers resistance to many aminoglycoside antibiotics by regiospecific phosphorylation of their hydroxyl groups. The chemical mechanism of phosphoryl transfer is unknown. Based on sequence homology, it has been suggested that a conserved His residue, His188, could be phosphorylated by ATP, and this phospho-His would transfer the phosphate to the incoming aminoglycoside. We have used chemical modification, site-directed mutagenesis and positional isotope exchange methods to probe the mechanism of phosphoryl transfer by APH(3')-IIIa.

RESULTS

Chemical modification by diethylpyrocarbonate implicated His in aminoglycoside phosphorylation by APH(3')-IIIa. We prepared His --> Ala mutants of all four His residues in APH(3')-IIIa and found minimal effects of the mutations on the steady-state phosphorylation of several aminoglycosides. One of these mutants, His188Ala, was largely insoluble when compared to the wild-type enzyme. Positional isotope exchange experiments using gamma-[18O]-ATP did not support a double-displacement mechanism.

CONCLUSIONS

His residues are not required for aminoglycoside phosphorylation by APH(3')-IIIa. The conserved His 188 is thus not a phosphate accepting residue but does seem to be important for proper enzyme folding. Positional isotope exchange experiments are consistent with direct attack of the aminoglycoside hydroxyl group on the gamma-phosphate of ATP.