Etienne Giraud

Evidence for Active Efflux as the Primary Mechanism of Resistance to Ciprofloxacin in Salmonella enterica Serovar Typhimurium

ABSTRACT The occurrence of active efflux and cell wall modifications were studied in Salmonella enterica serovar Typhimurium mutants that were selected with enrofloxacin and whose phenotypes of resistance to fluoroquinolones could not be explained only by mutations in the genes coding for gyrase or topoisomerase IV. Mutant BN18/21 exhibited a decreased susceptibility to ciprofloxacin (MIC = 0.125 μg/ml) but did not have a mutation in the gyrA gene. Mutants BN18/41 and BN18/71 had the same substitution, Gly81Cys in GyrA, but exhibited different levels of resistance to ciprofloxacin (MICs = 2 and 8 μg/ml, respectively). None of the mutants had mutations in the parC gene. Evidence for active efflux was provided by a classical fluorimetric method, which revealed a three- to fourfold decrease in ciprofloxacin accumulation in the three mutants compared to that in the parent strain, which was annuled by addition of the efflux pump inhibitor carbonyl cyanide m-chlorophenylhydrazone. In mutant BN18/71, a second fluorimetric method also showed a 50% reduction in the level of accumulation of ethidium bromide, a known efflux pump substrate. Immunoblotting and enzyme-linked immunosorbent assay experiments with an anti-AcrA antibody revealed that the resistance phenotype was strongly correlated with the expression level of the AcrAB efflux pump and suggested that decreased susceptibility to ciprofloxacin due to active efflux probably related to overproduction of this pump could occur before that due to gyrA mutations. Alterations were also found in the outer membrane protein and lipopolysaccharide profiles of the mutants, and these alterations were possibly responsible for the decrease in the permeability of the outer membrane that was observed in the mutants and that could act synergistically with active efflux to decrease the level of ciprofloxacin accumulation.

Complete sequence of the floR-carrying multiresistance plasmid pAB5S9 from freshwater Aeromonas bestiarum

OBJECTIVES A multiresistant Aeromonas bestiarum strain, shown to be persistent and spreading in a freshwater stream, was investigated for the presence, location and organization of antimicrobial resistance genes. METHODS The plasmid pAB5S9 was transferred by electroporation into Escherichia coli TG1. The resistance phenotype mediated by pAB5S9 was determined. Moreover, the plasmid was sequenced completely and analysed for its structure and organization of reading frames. RESULTS Plasmid pAB5S9 mediated resistances to phenicols, sulphonamides, streptomycin and tetracycline. The analysis of the 24.7 kb sequence revealed the presence of 20 predicted coding sequences (CDSs), which included the floR, sul2 and strA-strB resistance genes and a tetR-tet(Y) determinant. Approximately 7.5 kb of pAB5S9 showed 100% nucleotide sequence identity to three non-contiguous segments of the SXT element of Vibrio cholerae. Regions identical to SXT comprised the floR gene, flanked upstream by a complete and downstream by a truncated ISCR2 element, and the region of the sul2 and strA-strB genes. Other CDSs of pAB5S9 related to plasmid replication and partitioning, metabolic and gene regulation functions as well as conjugative transfer showed homology to sequences from diverse bacterial species, indicating a mosaic structure. CONCLUSIONS This study provides the first report of a floR-carrying plasmid in the genus Aeromonas and the first description of a tetR-tet(Y) determinant. The analysis of the multiresistant A. bestiarum strain indicates that strains of this species, some of which are opportunistic pathogens for fish, might also act as a resistance gene reservoir in the freshwater environment.

Characterization of high-level fluoroquinolone resistance in Escherichia coli O78:K80 isolated from turkeys

Fluoroquinolone resistance was characterized in Escherichia coli O78:K80 isolated from diseased turkeys. The level of resistance to fluoroquinolones of the isolates appeared closely correlated with substitutions in GyrA and ParC, but not with the production of the AcrAB efflux pump. Among isolates highly resistant to ciprofloxacin (MIC 8 mg/L) and harbouring identical substitutions (two in GyrA and one in ParC), two close but distinguishable ribotypes were identified. This indicated that at least two independent selection events may have occurred.

Binding of the RamR Repressor to Wild-Type and Mutated Promoters of the ramA Gene Involved in Efflux-Mediated Multidrug Resistance in Salmonella enterica Serovar Typhimurium

ABSTRACT The transcriptional activator RamA is involved in multidrug resistance (MDR) by increasing expression of the AcrAB-TolC RND-type efflux system in several pathogenic Enterobacteriaceae. In Salmonella enterica serovar Typhimurium (S. Typhimurium), ramA expression is negatively regulated at the local level by RamR, a transcriptional repressor of the TetR family. We here studied the DNA-binding activity of the RamR repressor with the ramA promoter (PramA). As determined by high-resolution footprinting, the 28-bp-long RamR binding site covers essential features of PramA, including the −10 conserved region, the transcriptional start site of ramA, and two 7-bp inverted repeats. Based on the RamR footprint and on electrophoretic mobility shift assays (EMSAs), we propose that RamR interacts with PramA as a dimer of dimers, in a fashion that is structurally similar to the QacR-DNA binding model. Surface plasmon resonance (SPR) measurements indicated that RamR has a 3-fold-lower affinity (KD [equilibrium dissociation constant] = 191 nM) for the 2-bp-deleted PramA of an MDR S. Typhimurium clinical isolate than for the wild-type PramA (KD = 66 nM). These results confirm the direct regulatory role of RamR in the repression of ramA transcription and precisely define how an alteration of its binding site can give rise to an MDR phenotype.

ramR mutations affecting fluoroquinolone susceptibility in epidemic multidrug-resistant Salmonella enterica serovar Kentucky ST198

A screening for non-target mutations affecting fluoroquinolone susceptibility was conducted in epidemic multidrug-resistant Salmonella enterica serovar Kentucky ST198. Among a panel of representative isolates (n = 27), covering the epidemic, only three showed distinct mutations in ramR resulting in enhanced expression of genes encoding the AcrAB-TolC efflux system and low increase in ciprofloxacin MIC. No mutations were detected in other regulatory regions of this efflux system. Ciprofloxacin resistance in serovar Kentucky ST198 is thus currently mainly due to multiple target gene mutations.

Antimicrobial resistance and virulence common mechanisms (ebook)

Multiple relationships exist between antimicrobial resistance and bacterial virulence, and the spread of clones combining multiple antibiotic resistance and a high virulence level is an increasing problem. It was previously described how mutation-driven or horizontally acquired resistance mechanisms can also have effects on virulence. It was also reported that mobile genetic elements often carry both resistance determinants and virulence-modulating genes, which favors the co-selection of both traits. In the present volume, we present a collection of articles which document additional aspects of the interactions between antimicrobial resistance and virulence in bacteria, and describe their potential therapeutic consequences.