Antibiotic resistance in Staphylococcus aureus and its relevance in therapy

Synthesis and antibacterial activity of 3-(arylazo)indoles and related azoheterocycles

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospitalizations and mortality from bacterial infections and is considered a national priority for disease control. In this work we synthesized and evaluated twenty novel C-3 arylazo-coupled indoles and one 4-arylazo-benzo[d]imidazole. The substituents on the C3-aromatic moiety included alkyl, halogen, amino, alkoxy, alkylsulfonyl at positions ortho, meta and para. The indoles utilized were 4-bromo, 5,6-methylenedioxy, 7-aza. In this effort, several azo-indoles showed promising anti-MRSA activities with MIC values as low as 3 μM. Another important finding of this work that sets that stage for a further larger investigation is that 4-arylazo-benzo[d]imidazole is a previously unexplored scaffold with potent anti-MRSA activity.

In vitro untargeted polar metabolomics data from B. cenocepacia and S. aureus biofilm supernatants

Here, we offer a metabolomics dataset generated via high-performance liquid chromatography and high-resolution mass spectrometry analysis of in vitro biofilm supernatant harvested from the human pathogens Burkholderia cenocepacia and Staphylococcus aureus. A total of 618 polar metabolites were identified across all experimental groups.

Listeria monocytogenes, Salmonella spp., and Staphylococcus aureus: Threats to the Food Industry and Public Health

Foodborne pathogens have always been of public health concern and represent safety issues for food processors. These pathogens develop new ways to overcome antibiotics, survive in different environmental conditions, and the ability to reproduce in many hostile environments configure them as serious health hazards. Considering the huge number of microorganisms, three bacterial representatives were selected to provide a better knowledge about the question of which one is the worst enemy for humans, from the food industry point of view, taking into consideration their multiplication specificity, virulence, and resistance. As we constantly are exposed to these pathogens in our nutritional habits, this overview aims to summarize the most relevant characteristics associated with the pathogenicity, clinical symptoms and most importantly, how deadly Listeria monocytogenes, Salmonella spp., and Staphylococcus aureus can be in the hospital and the food industry, by comparing among them. Overall, the microbiological knowledge clearly suggests that while all three pathogens are dangerous, L. monocytogenes presents the highest risk of death due to their ability to cause severe complications in vulnerable populations as it presents a range of virulence factors that facilitate evasion of the immune system and cytological effects. Additionally, it shows great resistance to standard food processing and preservation techniques, making it one of the most difficult pathogens to control. Understanding the risks and characteristics of these foodborne pathogens is essential for implementing effective control measures to prevent their occurrence in food products and to promote public health.

A Comparative Analysis of MRSA: Epidemiology and Antibiotic Resistance in Greece and Romania

This study provides a comparative analysis of 243 Methicillin-resistant Staphylococcus aureus (MRSA) isolated strains from Greece and Romania, focusing on their epidemiology and antibiotic resistance patterns. Laboratory procedures included phenotypic and automated identification methods, susceptibility testing, DNA isolation, and PCR for detecting antibiotic resistance genes (MecA, SCCmec). Our study results show significant regional differences. In both regions, males have higher MRSA infection rates than females, but the percentages vary. Greece has a higher incidence of MRSA in younger age groups compared to Romania. The majority of MRSA infections occur in inpatient settings in both countries, highlighting the necessity for enhanced infection control measures. Antibiotic resistance profiles reveal higher resistance to several antibiotics in Greece compared to Romania. A molecular analysis shows a widespread distribution of antibiotic resistance genes among MRSA isolates in Greece. These results highlight the necessity for accomplished preventive strategies and optimized treatment protocols.

Nanosecond pulsed electric fields increase antibiotic susceptibility in methicillin-resistant Staphylococcus aureus

IMPORTANCE

We have found that treatment with short electric pulses potentiates the effects of multiple antibiotics against methicillin-resistant Staphylococcus aureus. By reducing the dose of antibiotic necessary to be effective, co-treatment with electric pulses could amplify the effects of standard antibiotic dosing to treat S. aureus infections such as skin and soft-tissue infections (SSTIs). SSTIs are accessible to physical intervention and are good candidates for electric pulse co-treatment, which could be adopted as a step-in wound and abscess debridement.

Ligand-Based Drug Design of Novel Antimicrobials against Staphylococcus aureus by Targeting Bacterial Transcription

Staphylococcus aureus is a common human commensal pathogen that causes a wide range of infectious diseases. Due to the generation of antimicrobial resistance, the pathogen becomes resistant to more and more antibiotics, resulting in methicillin-resistant S. aureus (MRSA) and even multidrug-resistant S. aureus (MDRSA), namely 'superbugs'. This situation highlights the urgent need for novel antimicrobials. Bacterial transcription, which is responsible for bacterial RNA synthesis, is a valid but underutilized target for developing antimicrobials. Previously, we reported a novel class of antimicrobials, coined nusbiarylins, that inhibited bacterial transcription by interrupting the protein-protein interaction (PPI) between two transcription factors NusB and NusE. In this work, we developed a ligand-based workflow based on the chemical structures of nusbiarylins and their activity against S. aureus. The ligand-based models-including the pharmacophore model, 3D QSAR, AutoQSAR, and ADME/T calculation-were integrated and used in the following virtual screening of the ChemDiv PPI database. As a result, four compounds, including J098-0498, 1067-0401, M013-0558, and F186-026, were identified as potential antimicrobials against S. aureus, with predicted pMIC values ranging from 3.8 to 4.2. The docking study showed that these molecules bound to NusB tightly with the binding free energy ranging from -58 to -66 kcal/mol.

Chemical Biology of Sortase A Inhibition: A Gateway to Anti-infective Therapeutic Agents

Staphylococcus aureus is the leading cause of hospital-acquired infections. The enzyme sortase A, present on the cell surface of S. aureus, plays a key role in bacterial virulence without affecting the bacterial viability. Inhibition of sortase A activity offers a powerful but clinically less explored therapeutic strategy, as it offers the possibility of not inducing any selective pressure on the bacteria to evolve drug-resistant strains. In this Perspective, we offer a chemical space narrative for the design of sortase A inhibitors, as delineated into three broad domains: peptidomimetics, natural products, and synthetic small molecules. This provides immense opportunities for medicinal chemists to alleviate the ever-growing crisis of antibiotic resistance.

Detection and Colonization of Multidrug Resistant Organisms in a Regional Teaching Hospital of Taiwan

This study evaluated the prevalence of clinical multidrug-resistant organisms (MDROs) and analyzed correlations between MDROs and patient characteristics in a regional teaching hospital of Taiwan. A retrospective comparative case-control study was conducted from January 2016 to August 2018 by collecting data from 486 hospitalized and non-hospitalized patients (M = 286, F = 200), including patient gender and age, microbial species, and antibiotic susceptibility. The results indicated that at least one MDRO was isolated from 5.3–6.3% of patients (p < 0.05), with an average age of 61.08 years. Of the MDROs strains, vancomycin-resistant enterococcus and carbapenem-resistant acinetobacter baumannii increased annually (p < 0.002 and p < 0.012, respectively). Three factors of age (over 60 years), treatment in an intensive care unit (ICU), and specimen category were statistically significant (p < 0.039, p < 0.001 and p < 0.001, respectively) and indicated that elderly patients in an ICU have a higher risk of being infected by MDROs. The outpatients infected by methicillin-resistant staphylococcus aureus (MRSA) were more frequent than inpatients, implying the existence of community-acquired MRSA strains. The results of this study could provide valuable information for the detection and colonization of multidrug-resistant organisms in hospital infection control systems.

Antibiotics in the aquatic environments: A review of lakes, China

The potential threat of antibiotics to the environment and human health has raised significant concerns in recent years. The consumption and production of antibiotics in China are the highest in the world due to its rapid economic development and huge population, possibly resulting in the high detection frequencies and concentrations of antibiotics in aquatic environments of China. As a water resource, lakes in China play an important role in sustainable economic and social development. Understanding the current state of antibiotics in lakes in China is important. Closed and semi-closed lakes provide an ideal medium for the accumulation of antibiotics and antibiotic resistance genes (ARGs). This review summarizes the current levels of antibiotic exposure in relevant environmental compartments in lakes. The ecological and health risks of antibiotics are also evaluated. This review concludes that 39 antibiotics have been detected in the aquatic environments of lakes in China. The levels of antibiotic contamination in lakes in China is relatively high on the global scale. Antibiotic contamination is higher in sediment than water and aquatic organisms. Quinolone antibiotics (QNs) pose the greatest risks. The contents of antibiotics in aquatic organisms are far lower than their maximum residual limits (MRLs), with the exception of the organisms in Honghu Lake. The lakes experience high levels of ARG contamination. A greater assessment of ARG presence and antibiotic exposure are urgent.

Roles of pyruvate dehydrogenase and branched-chain α-keto acid dehydrogenase in branched-chain membrane fatty acid levels and associated functions in Staphylococcus aureus

PURPOSE

Membrane fluidity to a large extent is governed by the presence of branched-chain fatty acids (BCFAs). Branched-chain α-keto acid dehydrogenase (BKD) is the key enzyme in BCFA synthesis. A Staphylococcus aureus BKD-deficient strain still produced substantial levels of BCFAs. Pyruvate dehydrogenase (PDH) with structural similarity to BKD has been speculated to contribute to BCFAs in S. aureus.

METHODOLOGY

This study was carried out using BKD-, PDH- and BKD : PDH-deficient derivatives of methicillin-resistant S. aureus strain JE2. Differences in growth kinetics were evaluated spectrophotometrically, membrane BCFAs using gas chromatography and membrane fluidity by fluorescence polarization. Carotenoid levels were estimated by measuring A465 of methanol extracts from 48 h cultures. MIC values were determined by broth microdilution.Results/Key findings. BCFAs made up 50 % of membrane fatty acids in wild-type but only 31 % in the BKD-deficient mutant. BCFA level was ~80 % in the PDH-deficient strain and 38 % in the BKD : PDH-deficient strain. BKD-deficient mutant showed decreased membrane fluidity, the PDH-deficient mutant showed increased membrane fluidity. The BKD- and PDH-deficient strains grew slower and the BKD : PDH-deficient strain grew slowest at 37 °C. However at 20 °C, the BKD- and BKD : PDH-deficient strains grew only a little followed by autolysis of these cells. The BKD-deficient strain produced higher levels of staphyloxanthin. The PDH-deficient and BKD : PDH-deficient strains produced very little staphyloxanthin. The BKD-deficient strain showed increased susceptibility to daptomycin.

CONCLUSION

The BCFA composition of the cell membrane in S. aureus seems to significantly impact cell growth, membrane fluidity and resistance to daptomycin.

Melatonin-enhanced biosynthesis of antimicrobial AgNPs by improving the phytochemical reducing potential of a callus culture of Ocimum basilicum L. var. thyrsiflora

We describe the synthesis of AgNPs using Ocimum basilicum L. var. thyrsiflora leaf derived callus extracts formed in response to thidiazuron alone and a combination of TDZ melatonin which act both as reducing and stabilizing agents.

New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections

Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, "a return to the pre-antibiotic era", is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic.

Control of Methicillin-Resistant Staphylococcus aureus Pneumonia Utilizing TLR2 Agonist Pam3CSK4

The spread of methicillin-resistant Staphylococcus aureus (MRSA) is a critical health issue that has drawn greater attention to the potential use of immunotherapy. Toll-like receptor 2 (TLR2), a pattern recognition receptor, is an essential component in host innate defense system against S. aureus infection. However, little is known about the innate immune response, specifically TLR2 activation, against MRSA infection. Here, we evaluate the protective effect and the mechanism of MRSA murine pneumonia after pretreatment with Pam3CSK4, a TLR2 agonist. We found that the MRSA-pneumonia mouse model, pretreated with Pam3CSK4, had reduced bacteria and mortality in comparison to control mice. As well, lower protein and mRNA levels of TNF-α, IL-1β and IL-6 were observed in lungs and bronchus of the Pam3CSK4 pretreatment group. Conversely, expression of anti-inflammatory cytokine IL-10, but not TGF-β, increased in Pam3CSK4-pretreated mice. Our additional studies showed that CXCL-2 and CXCL1, which are necessary for neutrophil recruitment, were less evident in the Pam3CSK4-pretreated group compared to control group, whereas the expression of Fcγ receptors (FcγⅠ/Ⅲ) and complement receptors (CR1/3) increased in murine lungs. Furthermore, we found that increased survival and improved bacterial clearance were not a result of higher levels of neutrophil infiltration, but rather a result of enhanced phagocytosis and bactericidal activity of neutrophils in vitro and in vivo as well as increased robust oxidative activity and release of lactoferrin. Our cumulative findings suggest that Pam3CSK4 could be a novel immunotherapeutic candidate against MRSA pneumonia.

Epidemiology of bloodstream infections caused by methicillin-resistant Staphylococcus aureus at a tertiary care hospital in New York

BACKGROUND

In the United States, bloodstream infections (BSIs) are predominated by Staphylococcus aureus. The proportion of community-acquired methicillin-resistant S aureus (MRSA) BSI is on the rise. The goal of this study is to explore the epidemiology of BSI caused by S aureus within Staten Island, New York.

METHODS

This is a case-case-control study from April 2012-October 2014. Cases were comprised of patients with BSI secondary to MRSA and methicillin-sensitive S aureus (MSSA). The control group contained patients who were hospitalized during the same time period as cases but did not develop infections during their stay. Two multivariable models compared each group of cases with the uninfected controls.

RESULTS

A total of 354 patients were analyzed. Infections were community acquired in 76% of cases. The major source of BSI was skin-related infections (n = 76). The first multivariable model showed that recent central venous catheter placement was an independent infection risk factor (odds ratio [OR] = 80.7; 95% confidence interval [CI], 2.2-3,014.1). In the second model, prior hospital stay >3 days (OR = 4.1; 95% CI, 1.5-5.7) and chronic kidney disease (OR = 3.0; 95% CI, 1.01-9.2) were uniquely associated with MSSA. Persistent bacteremia, recurrence, and other hospital-acquired infections were more likely with MRSA BSI than MSSA BSI.

CONCLUSION

Most infections were community acquired. The presence of a central venous catheter constituted a robust independent risk factor for MRSA BSI. Patients with MRSA BSI suffered worse outcomes than those with MSSA BSI.

Isolation and Genome Characterization of the Virulent Staphylococcus aureus Bacteriophage SA97

A novel bacteriophage that infects S. aureus, SA97, was isolated and characterized. The phage SA97 belongs to the Siphoviridae family, and the cell wall teichoic acid (WTA) was found to be a host receptor of the phage SA97. Genome analysis revealed that SA97 contains 40,592 bp of DNA encoding 54 predicted open reading frames (ORFs), and none of these genes were related to virulence or drug resistance. Although a few genes associated with lysogen formation were detected in the phage SA97 genome, the phage SA97 produced neither lysogen nor transductant in S. aureus. These results suggest that the phage SA97 may be a promising candidate for controlling S. aureus.

Salivary peptidomic as a tool to disclose new potential antimicrobial peptides

Antimicrobial peptides (AMPs) and peptidomimetics are among the new generation of antibiotics due to their broad spectrum of activity towards pathogenic agents. Considering the fact that the oral cavity is a relevant entryway for pathogenic microorganisms, it must be armed with several defenses in order to maintain homeostasis. Thus, we aimed at disclosing potential AMPs in saliva from humans, pigs and mice. We enriched salivary peptides by filtration and then separated and identified multiple peptides by nanoHPLC-MALDI-TOF/TOF. Using this approach, we identified 45 different peptides from mice's saliva and 94 from pig's saliva. Almost all peptides from pig and mice saliva were new assignments, encouraging the application of this technique to other mammals' saliva. The potential antimicrobial activity was then calculated in silico with an available CAMP's algorithm. Eight peptides from pig's basic proline-rich protein, as well as 6 peptides resulting from human's P-B peptide, 1 from P-C peptide fragmentation and 1 from statherin were found to have potential antimicrobial activity. Therefore, the peptides GPPPQGGRPQG and RFGYGYGPYQPVPEQPLYPQ were synthetically obtained and their antimicrobial properties evaluated in vitro for different bacterial strains. These showed to exert an antibacterial effect in Staphylococcus aureus. This report validates the prospection of mammal's saliva to find new alternatives to antibiotics.

BIOLOGICAL SIGNIFICANCE

With the growing problem of antibiotic resistance, the identification of new routes in antibiotic therapy is on the scientific agenda worldwide. Antimicrobial peptides (AMPs) and peptidomimetics are among the new generation of antibiotics due to their broad spectrum of activity towards pathogenic agents and owing to a less probable microbial resistance that can arise from their use. Thus, we explored the saliva from humans, pigs and mice to identify potential AMPs using a peptidomic approach. At the end, eight peptides from pig's basic proline-rich protein, six peptides resulting from human's P-B peptide, one from P-C peptide fragmentation and one from statherin were found to have potential antimicrobial activity. From this, the peptides GPPPQGGRPQG and RFGYGYGPYQPVPEQPLYPQ were tested showing to have antibacterial effect in S. aureus which highlights the potential of mammal's saliva to find new alternatives to antibiotics.

EsxA might as a virulence factor induce antibodies in patients with Staphylococcus aureus infection

Staphylococcus aureus (S. aureus) is an important human pathogen, which commonly causes the acquired infectious diseases in the hospital and community. Effective and simple antibiotic treatment against S. aureus-related disease becomes increasingly difficult. Developing a safe and effective vaccine against S. aureus has become one of the world’s hot spots once again. The key issue of developing the vaccine of S. aureus is how to find an ideal key pathogenic gene of S. aureus. It was previously suggested that EsxA might be a very important factor in S. aureus abscess formation in mice, but clinical experimental evidence was lacking. We therefore expressed EsxA protein through prokaryotic expression system and purified EsxA protein by Ni-affinity chromatography. ELISA was used to detect the anti-EsxA antibodies in sera of 78 patients with S. aureus infection and results showed that the anti-EsxA antibodies were positive in the sera of 19 patients. We further analyzed the EsxA positive antibodies related strains by antimicrobial susceptibility assay and found that all of the corresponding strains were multi-drug resistant. Among those multi-drug resistant strains, 73.7% were resistant to MRSA. The results indicated EsxA is very important in the pathogenesis of S. aureus. We suggested that the EsxA is very valuable as vaccine candidate target antigens for prevention and control of S. aureus infection.

Meticillin-resistant Staphylococcus aureus pneumonia

Meticillin-resistant Staphylococcus aureus causes an evolving clinical presentation of pneumonia. Health-care-acquired infection differs from community-associated disease, with important implications for treatment. Current antibiotics are less than ideal, and broader management strategies are crucial to prevent complacency.

Puerperal mastitis requiring hospitalization during a nine-year period

OBJECTIVES

To review the clinical and microbiologic features of isolates among patients with puerperal mastitis requiring hospitalization.

STUDY DESIGN

Between January 2000 and December 2008, postpartum patients who were hospitalized for mastitis were enrolled. The clinical characteristics, microbiologic results, management, and outcomes were reviewed.

RESULTS

One hundred twenty-seven cases were enrolled. Seventy-six patients (59.9%) underwent incision and drainage for abscess drainage, all of whom discontinued breastfeeding. Staphylococcus aureus and coagulase-negative staphylococci were the most common isolates. Among 81 isolates of S aureus, 52 (64.2%) were resistant to oxacillin. Patients undergoing incision and drainage were more likely to discontinue breastfeeding, had a longer duration of symptoms, a longer hospitalization, a higher platelet count and higher rates of infection caused by S aureus and oxacillin-resistant S aureus.

CONCLUSION

Oxacillin-resistant S aureus has emerged in patients with puerperal mastitis during the past decade, and often necessitates incision and drainage, which results in discontinuation of breastfeeding.

The potential economic value of a Staphylococcus aureus vaccine for neonates

The continuing morbidity and mortality associated with Staphylococcus aureus (S. aureus) infections, especially methicillin-resistant S. aureus (MRSA) infections, have motivated calls to make S. aureus vaccine development a research priority. We developed a decision analytic computer simulation model to determine the potential economic impact of a S. aureus vaccine for neonates. Our results suggest that a S. aureus vaccine for the neonatal population would be strongly cost-effective (and in many situations dominant) over a wide range of vaccine efficacies (down to 10%) for vaccine costs (or=1%).

Staphylococcus aureus vaccine for orthopedic patients: an economic model and analysis

To evaluate the potential economic value of a Staphylococcus aureus vaccine for pre-operative orthopedic surgery patients, we developed an economic computer simulation model. At MRSA colonization rates as low as 1%, a $50 vaccine was cost-effective [<or=$50,000 per quality-adjusted life year (QALY) saved] at vaccine efficacy >or=30%, and a $100 vaccine at vaccine efficacy >or=70%. High MRSA prevalence (>or=25%) could justify a vaccine price as high as $1000. Our results suggest that a S. aureus vaccine for the pre-operative orthopedic population would be very cost-effective over a wide range of MRSA prevalence and vaccine efficacies and costs.

Trimethoprim-sulfamethoxazole for methicillin-resistant Staphylococcus aureus: a forgotten alternative?

Methicillin-resistant Staphylococcus aureus (MRSA) is a growing infectious concern, mainly in the context of its rapid adaptation to novel antibiotic options for its treatment and the growing morbidity, mortality, and healthcare costs associated with its emergence. the authors sought to investigate whether an older antibiotic, such as trimethoprim-sulfamethoxazole (SXT), may have a role in treating MRSA-related infections, according to the available literature on the subject. The authors reviewed literature data on: resistance of MRSA to SXT worldwide in recent years, efficacy of SXT for MRSA decolonization or prophylaxis from MRSA infections, and clinical therapeutic efficacy of SXT in treating mild or severe community-acquired or hospital-acquired MRSA infections. Resistance varies worldwide, in general being low in the industrialized world and higher in developing countries. SXT is one of the numerous understudied options for MRSA decolonization and is growingly recognized as potentially effective in preventing MRSA infections in certain settings. Limited data on its therapeutic efficacy are encouraging, at least for mild, community-acquired infections. SXT may represent a cost-effective alternative weapon against MRSA. Its utility against this increasingly threatening pathogen need clarification through further clinical trials.

Structural and biochemical characterization of MepR, a multidrug binding transcription regulator of the Staphylococcus aureus multidrug efflux pump MepA

MepR is a multidrug binding transcription regulator that represses expression of the Staphylococcus aureus multidrug efflux pump gene, mepA, as well as its own gene. MepR is induced by multiple cationic toxins, which are also substrates of MepA. In order to understand the gene regulatory and drug-binding mechanisms of MepR, we carried out biochemical, in vivo and structural studies. The 2.40 A resolution structure of drug-free MepR reveals the most open MarR family protein conformation to date, which will require a huge conformational change to bind cognate DNA. DNA-binding data show that MepR uses a dual regulatory binding mode as the repressor binds the mepA operator as a dimer of dimers, but binds the mepR operator as a single dimer. Alignment of the six half sites reveals the consensus MepR binding site, 5'-GTTAGAT-3'. 'Drug' binding studies show that MepR binds to ethidium and DAPI with comparable affinities (K(d) = 2.6 and 4.5 microM, respectively), but with significantly lower affinity to the larger rhodamine 6G (K(d) = 62.6 microM). Mapping clinically relevant or in vitro selected MepR mutants onto the MepR structure suggests that their defective repressor phenotypes are due to structural and allosteric defects.

The epidemiology of antibiotic resistance

Antibiotic resistance has reached crisis point in many hospitals around the world. The majority are swamped with meticillin-resistant Staphylococcus aureus (MRSA), and many with multidrug-resistant (MDR) Gram-negatives. Whilst there are good treatment alternatives available for serious infections due to MRSA, mortality rates remain high. For MDR Gram-negatives the situation is more complex and worrying. There are few, if any, new agents in development that can be expected to benefit the situation in the next decade. Moreover, extreme (or extensive) drug-resistant and even pandrug-resistant Gram-negative infections are increasingly being described. Although definitions are confused in this area, reports suggest that patients in some intensive care units are dying from lack of availability of any antibiotic active against certain strains of Pseudomonas aeruginosa and Acinetobacter baumannii. A better understanding of the molecular basis of resistance is urgently needed if it is to be successfully overcome. Moreover, we urgently need better global early warning systems to detect new resistances and put mechanisms in place for their control.

Role for dnaK locus in tolerance of multiple stresses in Staphylococcus aureus

Heat-shock proteins are essential for stress tolerance and allowing organisms to survive conditions that cause protein unfolding. The role of the Staphylococcus aureus DnaK system in tolerance of various stresses was studied by disruption of dnaK by partial deletion and insertion of a kanamycin gene cassette. Deletion of dnaK in S. aureus strain COL resulted in poor growth at temperatures of 37 degrees C and above, and reduced carotenoid production. The mutant strain also exhibited increased susceptibility to oxidative and cell-wall-active antibiotic stress conditions. In addition, the mutant strain had slower rates of autolysis, suggesting a correlation between DnaK and functional expression of staphylococcal autolysins. Deletion of dnaK also resulted in a decrease in the ability of the organism to survive in a mouse host during a systemic infection. In summary, the DnaK system in S. aureus plays a significant role in the survival of S. aureus under various stress conditions.

Antibacterial natural products in medicinal chemistry--exodus or revival?

To create a drug, nature's blueprints often have to be improved through semisynthesis or total synthesis (chemical postevolution). Selected contributions from industrial and academic groups highlight the arduous but rewarding path from natural products to drugs. Principle modification types for natural products are discussed herein, such as decoration, substitution, and degradation. The biological, chemical, and socioeconomic environments of antibacterial research are dealt with in context. Natural products, many from soil organisms, have provided the majority of lead structures for marketed anti-infectives. Surprisingly, numerous "old" classes of antibacterial natural products have never been intensively explored by medicinal chemists. Nevertheless, research on antibacterial natural products is flagging. Apparently, the "old fashioned" natural products no longer fit into modern drug discovery. The handling of natural products is cumbersome, requiring nonstandardized workflows and extended timelines. Revisiting natural products with modern chemistry and target-finding tools from biology (reversed genomics) is one option for their revival.

Crystal structure of StaL, a glycopeptide antibiotic sulfotransferase from Streptomyces toyocaensis

Over the past decade, antimicrobial resistance has emerged as a major public health crisis. Glycopeptide antibiotics such as vancomycin and teicoplanin are clinically important for the treatment of Gram-positive bacterial infections. StaL is a 3'-phosphoadenosine 5'-phosphosulfate-dependent sulfotransferase capable of sulfating the cross-linked heptapeptide substrate both in vivo and in vitro, yielding the product A47934, a unique teicoplanin-class glycopeptide antibiotic. The sulfonation reaction catalyzed by StaL constitutes the final step in A47934 biosynthesis. Here we report the crystal structure of StaL and its complex with the cofactor product 3'-phosphoadenosine 5'-phosphate. This is only the second prokaryotic sulfotransferase to be structurally characterized. StaL belongs to the large sulfotransferase family and shows higher similarity to cytosolic sulfotransferases (ST) than to the bacterial ST (Stf0). StaL has a novel dimerization motif, different from any other STs that have been structurally characterized. We have also applied molecular modeling to investigate the binding mode of the unique substrate, desulfo-A47934. Based on the structural analysis and modeling results, a series of residues was mutated and kinetically characterized. In addition to the conserved residues (Lys(12), His(67), and Ser(98)), molecular modeling, fluorescence quenching experiments, and mutagenesis studies identified several other residues essential for substrate binding and/or activity, including Trp(34), His(43), Phe(77), Trp(132), and Glu(205).

Enhanced membrane disruption and antibiotic action against pathogenic bacteria by designed histidine-rich peptides at acidic pH

The histidine-rich amphipathic cationic peptide LAH4 has antibiotic and DNA delivery capabilities. Here, we explore the interaction of peptides from this family with model membranes as monitored by solid-state (2)H nuclear magnetic resonance and their antibiotic activities against a range of bacteria. At neutral pH, the membrane disruption is weak, but at acidic pH, the peptides strongly disturb the anionic lipid component of bacterial membranes and cause bacterial lysis. The peptides are effective antibiotics at both pH 7.2 and pH 5.5, although the antibacterial activity is strongly affected by the change in pH. At neutral pH, the LAH peptides were active against both methicillin-resistant and -sensitive Staphylococcus aureus strains but ineffective against Pseudomonas aeruginosa. In contrast, the LAH peptides were highly active against P. aeruginosa in an acidic environment, as is found in the epithelial-lining fluid of cystic fibrosis patients. Our results show that modest antibiotic activity of histidine-rich peptides can be dramatically enhanced by inducing membrane disruption, in this case by lowering the pH, and that histidine-rich peptides have potential as future antibiotic agents.

[Staphylococcus aureus infections: new challenges from an old pathogen]

Staphylococcus aureus is a versatile organism with several virulent characteristics and resistance mechanisms at its disposal. It is also a significant cause of a wide range of infectious diseases in humans. S. aureus often causes life-threatening deep seated infections like bacteremia, endocarditis and pneumonia. While traditionally confined mostly to the hospital setting, methicillin-resistant S. aureus (MRSA) is now rapidly becoming rampant in the community. Community-acquired MRSA is particularly significant because of its potential for unchecked spread within households and its propensity for causing serious skin and pulmonary infections. Because of the unfavorable outcome of many MRSA infections with the standard glycopeptide therapy, new antimicrobial agents belonging to various classes have been introduced and have been evaluated in clinical trials for their efficacy in treating resistant staphylococcal infections. A number of preventive strategies have also been suggested to contain the spread of such infections. In this review, we address the recent changes in the epidemiology of S. aureus and their impact on the clinical manifestations and management of serious infections. We also discuss new treatment modalities for MRSA infections and emphasize the importance of preventive approaches.