Multiple antibiotic resistance in Streptococcus pneumoniae

A 40-year-old Libyan male was admitted to the intensive therapy unit of Zliten Central Hospital, Libya after a road traffic accident in which he had been the driver. On physical examination he was irritable, dyspnoeic, cyanotic, had contusions and abrasions on his chest and abdomen (mainly on the left side), a lacerated wound on the forehead, a large haematoma over the left thigh and tenderness over the left side of the chest and abdomen.     

Kinetic mechanism of metallo-beta-lactamase L1 from Stenotrophomonas maltophilia

The reaction of nitrocefin with metallo-beta-lactamase L1 from Stenotrophomonas maltophilia was studied using rapid-scan and stopped-flow ultraviolet-visible (UV-vis) studies in an effort to discern the kinetic mechanism used by L1 to hydrolyze penicillins and cephalosporins. Rapid-scan and stopped-flow UV-vis studies of nitrocefin hydrolysis by L1 identified three species: (1) the substrate (nitrocefin) displayed an absorbance peak at 390 nm (epsilon = 11 500 M(-1) cm(-1)) that decreased during the reaction with a rate constant of 170 +/- 30 s(-1); (2) the product (hydrolyzed nitrocefin) displayed an absorbance peak at 485 nm (epsilon = 17 420 M(-1) cm(-1)) that increased during the reaction with rate constant of 40 +/- 1 s(-1); and (3) an intermediate displayed an absorbance peak at 665 nm (epsilon = 32 000 M(-1) cm(-1)) that increased initially with a rate constant of 190 +/- 3 s(-1) and then decreased with a rate constant of 38 +/- 2 s(-1). Single-turnover experiments demonstrated that there were no pre-steady-state bursts in the reaction of L1 with nitrocefin; moreover, the progress curves could be fit to a kinetic mechanism that includes the formation of a transient intermediate by using KINSIM and the rate constants given above. Progress curves from experiments conducted at different reaction conditions or with a different substrate could also be fit to the proposed kinetic mechanism. The evidence for the presence of an intermediate along with kinetic simulations supports a hydrolytic mechanism for L1 that involves an intermediate whose breakdown is rate-determining.     

Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia

The gram-negative bacterium Stenotrophomonas maltophilia is increasingly recognized as an important cause of nosocomial infection. Infection occurs principally, but not exclusively, in debilitated and immunosuppressed individuals. Management of S. maltophilia-associated infection is problematic because many strains of the bacterium manifest resistance to multiple antibiotics. These difficulties are compounded by methodological problems in in vitro susceptibility testing for which there are, as yet, no formal guidelines. Despite its acknowledged importance as a nosocomial pathogen, little is known of the epidemiology of S. maltophilia, and although it is considered an environmental bacterium, its sources and reservoirs are often not readily apparent. Molecular typing systems may contribute to our knowledge of the epidemiology of S. maltophilia infection, thus allowing the development of strategies to interrupt the transmission of the bacterium in the hospital setting. Even less is known of pathogenic mechanisms and putative virulence factors involved in the natural history of S. maltophilia infection and this, coupled with difficulties in distinguishing colonization from true infection, has fostered the view that the bacterium is essentially nonpathogenic. This article aims to review the current taxonomic status of S. maltophilia, and it discusses the laboratory identification of the bacterium. The epidemiology of the organism is considered with particular reference to nosocomial outbreaks, several of which have been investigated by molecular typing techniques. Risk factors for acquisition of the bacterium are also reviewed, and the ever-expanding spectrum of clinical syndromes associated with S. maltophilia is surveyed. Antimicrobial resistance mechanisms, pitfalls in in vitro susceptibility testing, and therapy of S. maltophilia infections are also discussed.     

Molecular heterogeneity of the L-1 metallo-beta-lactamase family from Stenotrophomonas maltophilia

We have determined the nucleotide sequence of the blaS gene encoding the carbapenem-hydrolyzing L-1 beta-lactamase from Stenotrophomonas maltophilia GN12873. Analysis of the DNA and deduced amino acid sequences identified a product of 290 amino acids. Comparisons of the L-1 amino acid sequence with those of other zinc beta-lactamases showed 88.6% identity with the L-1 enzyme from S. maltophilia IID1275 and less than 20% identity with other class B metalloenzymes.     

Subcutaneous lesions and bacteraemia due to Stenotrophomonas maltophilia in three leukaemic patients with neutropenia

Subcutaneous lesions were seen in three of 13 neutropenia patients who had Stenotrophomonas (Xanthomonas) maltophilia bacteraemia. The characteristic clinical presentation resembled leukaemic infiltrates, and were different from deep ulcers or subcutaneous nodules caused by Pseudomonas aeruginosa. The three patients had acute leukaemia and were treated with intensive combination chemotherapy. All had previously been treated with broad-spectrum antibiotics, and each patient recovered after proper combination antibiotic treatment given according to sensitivity testing.     

The crystal structure of the L1 metallo-beta-lactamase from Stenotrophomonas maltophilia at 1.7 A resolution

The emission spectrum of TaO, excited in a tantalum hollow cathode lamp, has been observed at high resolution using a Fourier transform spectrometer. In addition to previously known transitions, a number of new bands have been identified and assigned as belonging to two new electronic transitions: H2Pi1/2-X2Delta3/2 and K2Phi5/2-X2Delta3/2. A rotational analysis ofthe 0-0 and 0-1 bands of the H2Pi1/2-X2Delta3/2 transition and of the 0-1, 1-2, 0-0, 1-0, and 2-1 bands of theK2Phi5/2-X2Delta3/2 transition has been carried out, providing the following equilibrium constants for the ground X2Delta3/2 state:omegae = 1028.9060(15) cm-1, omegaexe = 3.58928(66) cm-1, Be = 0.40289737(139) cm-1, alphae = 0.00185445(83) cm-1, andre = 1.6873430(29) ?. The principal molecular constants for the H2Pi1/2 state are T00 = 20 634.32758 (40) cm-1,B0 = 0.3766867(31) cm-1, and r0 = 1.7450604(72) ?, while the equilibrium constants for the K2Phi5/2 state areomegae = 905.4549(15) cm-1, omegaexe = 3.67601(64) cm-1, Be = 0.37965102(36) cm-1, alphae = 0.00189370(21) cm-1, andre = 1.7382343(8) ?. Although the H2Pi1/2 and K2Phi5/2 states have been observed previously in matrix isolation experiments, our work on these states is the first in the gas phase. Copyright 1998 Academic Press.     

Degradation of hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX) by Stenotrophomonas maltophilia PB1

A mixed microbial culture capable of metabolizing the explosive RDX (hexahydro-1,3,5-trinitro-1,3,5-triazine) was obtained from soil enrichments under aerobic and nitrogen-limiting conditions. A bacterium, Stenotrophomonas maltophilia PB1, isolated from the culture used RDX as a sole source of nitrogen for growth. Three moles of nitrogen was used per mole of RDX, yielding a metabolite identified by mass spectroscopy and 1H nuclear magnetic resonance analysis as methylene-N-(hydroxymethyl)-hydroxylamine-N'-(hydroxymethyl)nitroamin e. The bacterium also used s-triazine as a sole source of nitrogen but not the structurally similar compounds octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine, cyanuric acid, and melamine. An inducible RDX-degrading activity was present in crude cell extracts.     

Overexpression, purification, and characterization of the cloned metallo-beta-lactamase L1 from Stenotrophomonas maltophilia

OBJECTIVES: The purpose of this study was to assess whether the presence or absence of myocardial viability during dobutamine echocardiography (DE) predicts survival in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction. BACKGROUND: In patients with CAD, the presence of myocardial viability during DE identifies viable myocardium and predicts recovery of LV systolic function after revascularization. However, there is little data on the relation between myocardial viability and clinical outcome in patients with CAD and severe LV dysfunction. METHODS: We studied 318 patients with CAD and a LV ejection fraction (EF) < or =35% who underwent DE and were followed for 18+/-10 months. Patients were classified into four groups. Group I (n=85) consisted of patients who had evidence of myocardial viability and subsequently underwent revascularization. Group II (n=119) consisted of patients with myocardial viability who did not undergo revascularization. Group III (n=30) consisted of patients who did not have myocardial viability and underwent revascularization. Finally, group IV (n=84) patients lacked myocardial viability and did not undergo revascularization. RESULTS: The four groups had similar baseline characteristics and rest LVEF. During follow-up there were 51 deaths (16%). The mortality rate was 6% in group I, 20% in group II, 17% in group III and 20% in group TV (p=0.01, group I vs. other groups). CONCLUSIONS: In patients with CAD and severe LV dysfunction who demonstrated myocardial viability during DE, revascularization improved survival compared with medical therapy.     

Molecular epidemiology of Stenotrophomonas maltophilia isolated from clinical specimens from patients with cystic fibrosis and associated environmental samples

Stenotrophomonas maltophilia was isolated from the respiratory tracts of 41 (25%) of 163 children attending our pediatric cystic fibrosis unit between September 1993 and December 1995. The extents of S. maltophilia contamination of environmental sites frequented by these patients were investigated with a selective medium incorporating vancomycin, imipenem, and amphotericin B. Eighty-two isolates of S. maltophilia were cultured from 67 different environmental sites sampled between January and July 1996. The organism was widespread in the home environment, with 20 (36%) and 25 (42%) of sampled sites positive in the homes of colonized and noncolonized patients, respectively. In the nosocomial setting, it was isolated from 18 (32%) sites in the hospital ward and from 4 (17%) sites in the outpatient clinic area. The most common sites of contamination were sink drains, faucets, and other items frequently in contact with water. All environmental and clinical isolates were genotyped with enterobacterial repetitive intergenic consensus sequences as primers. A total of 33 of the 41 patients were colonized with unique strains, and four pairs of patients shared strains. Further characterization by pulsed-field gel electrophoresis after digestion with XbaI found that there was no evidence of patient-to-patient transmission; however, there was some evidence that a small number of patients may have acquired the organism from the hospital environment. Resampling of environmental sites in the hospital ward in January 1997 revealed evidence of genetic drift, complicating the accurate determination of environmental sources for clinical strains. The source of the majority of S. maltophilia strains colonizing the respiratory tracts of these patients with cystic fibrosis remained uncertain but may have represented multiple, independent acquisitions from a variety of environmental sites both within and outside the hospital.     

Glycopeptide antibiotic resistance genes in glycopeptide-producing organisms

The mechanism of high-level resistance to vancomycin in enterococci consists of the synthesis of peptidoglycan terminating in D-alanyl-D-lactate instead of the usual D-alanyl-D-alanine. This alternate cell wall biosynthesis pathway is ensured by the collective actions of three enzymes: VanH, VanA, and VanX. The origin of this resistance mechanism is unknown. We have cloned three genes encoding homologs of VanH, VanA, and VanX from two organisms which produce glycopeptide antibiotics: the A47934 producer Streptomyces toyocaensis NRRL 15009 and the vancomycin producer Amycolatopsis orientalis C329.2. The predicted amino acid sequences are highly similar to those found in VRE: 54 to 61% identity for VanH, 59 to 63% identity for VanA, and 61 to 64% identity for VanX. Furthermore, the orientations of the genes, vanH, vanA, and vanX, are identical to the orientations found in vancomycin-resistant enterococci. Southern analysis of total DNA from other glycopeptide-producing organisms, A. orientalis 18098 (chloro-eremomycin producer), A. orientalis subsp. lurida (ristocetin producer), and Amycolatopsis coloradensis subsp. labeda (teicoplanin and avoparcin producer), with a probe derived from the vanH, vanA, and vanX cluster from A. orientalis C329.2 revealed cross-hybridizing DNA in all strains. In addition, the vanH, vanA, vanX cluster was amplified from all glycopeptide-producing organisms by PCR with degenerate primers complementary to conserved regions in VanH and VanX. Thus, this gene sequence is common to all glycopeptide producers tested. These results suggest that glycopeptide-producing organisms may have been the source of resistance genes in vancomycin-resistant enterococci.     

抗生素的耐药性与抗生素的应用

细菌对抗生素产生耐药性是一种自然生物现象,抗生素的广泛应用与滥用加速了耐药性过程.现就抗生素的耐药机理进行讨论,期望有助于进一步合理应用抗生素.     

Therapeutic antibiotics in animal feeds and antibiotic resistance

Recent statutory changes involving animal drugs are expected to facilitate the therapeutic use of antibiotics in animal feeds in the United States of America. The use of antibiotics in animal feeds is controversial due to the potential development of resistant bacterial pathogens in food-producing animals which are exposed to the antibiotics and the resultant public health risk. Zoonotic micro-organisms can be transmitted to humans through contact with animal populations, either directly or through the consumption of contaminated food. Recommendations to address the public health concerns include the strengthening of professional education in the areas of infectious diseases and the appropriate selection and use of antimicrobial agents, the development of a comprehensive food safety education programme for food-animal veterinarians and animal producers, and the development of surveillance programmes to monitor antimicrobial resistance among zoonotic pathogens. Early identification of emerging resistance can facilitate a timely and appropriate public health response.     

Prevalence of multiple antibiotic resistance in Neisseria gonorrhoeae

The susceptibility of 100 strains of Neisseria gonorrhoeae to five antimicrobial agents (penicillin, streptomycin, oxytetracycline, sulphamethoxazole, and gentamicin) was examined. Three strains were resistant to each antimicrobial, fourteen exhibited resistance to three or four of the five compounds tested, and 49 were resistant to a single agent, or to pairs of the selected agents. 34 strains were found to be fully sensitive to all of the compounds tested. It is suggested that resistance to gentamicin and sulphamethoxazole may be determined by a multiple resistance gene. The overall frequency of penicillin resistance was found to be 26-5 per cent (MIC greater than 0-06 mug/ml.), suggesting a significant decrease in resistance since 1968.     

Stenotrophomonas (Xanthomonas) maltophilia: in vitro susceptibility to selected antimicrobial drugs, single and combined, with and without defibrinated human blood

Sixteen selected isolates of Stenotrophomonas maltophilia varied in susceptibility to the combined phagocytic/serum bactericidal activity of fresh defibrinated human blood (65 vol%). Four representative isolates (X1, X11, X25, and X50), which differed in susceptibility to cefepime, ceftazidime, rifampin, and timentin, were subjected to checkerboard microtiter broth dilution tests involving combinations of cefepime plus timentin, ceftazidime plus ofloxacin, cotrimoxazole plus timentin, rifampin plus polymyxin B, and rifampin plus polymyxin B nonapeptide; all combinations yielded additive or synergistic effects against all four strains. Unexpectedly, the combination of cefepime plus timentin was bactericidally active against the two cefepime-resistant isolates. This finding was substantiated by blood/broth plus combined antimicrobial drug assays. Cefepime plus timentin effectively killed all four test strains. Ofloxacin combined with ceftazidime was bactericidally active against the test strains, including two isolates (X11, X50) with intermediate ofloxacin sensitivity. Cotrimoxazole plus timentin in blood, but not in broth, was bactericidal for the timentin-resistant isolate X25. As expected, various triple combinations of chemotherapeutic agents in blood and broth revealed polymyxin B plus rifampin, regardless of the third combination partner, to exert bactericidal activity against all test strains. Similarly, rifampin combined with ofloxacin and ceftazidime was bactericidally active in blood and broth. The observation that timentin combined with cefepime was effective against cefepime-resistant strains of S. maltophilia might prove of clinical relevance with regard to chemotherapy of nosocomial infections due to multiple-antibiotic resistant strains of this opportunistic pathogen.