High and selective resistance to mecillinam in adenylate cyclase-deficient or cyclic adenosine 3'',5''-monophosphate receptor protein-deficient mutants of Escherichia coli.

Adenylate cyclase-deficient (cya) mutants of Escherichia coli K-12 were selectively and highly resistant to mecillinam (FL1060) among several beta-lactam antibiotics in the absence of cyclic adenosine 3',5'-monophosphate (cAMP). They became sensitive to the drug in the presence of cAMP. Also, cAMP receptor protein-negative (crp) mutants, with the exception of strain 5333, were highly resistant to mecillinam in the presence and in the absence of cAMP. Mecillinam exerted two distinct and sequential effects in both cya+ strains and cya strains supplemented with cAMP: (i) rounding of cells and (ii) cessation of cell division. The first effect was accompanied by a decrease in growth rate, whereas the second effect was accompanied by enlargement and lysis of the rounded cells. The second effect of mecillinam was dependent on inoculum size and cAMP. When the cell density was above about 10(6) cells per ml, the rounded cells stopped dividing but did not lyse. In the absence of cAMP, cya strains neither stopped dividing nor lysed; they were resistant to the second, lethal effect of mecillinam.     

10种中草药提取物体外抗铜绿假单胞菌作用研究

通过对粗糠柴等10种中草药采用80%乙醇室温下浸渍制备的提取物进行体外抗铜绿假单胞菌及其耐药菌活性研究,并采取药敏纸片法测定临床分离菌株的耐药性。结果表明:这10种中草药80%乙醇提取物中,粗糠柴的乙酸乙酯层对铜绿假单胞菌标准菌及其耐药菌的抑菌效果最好,其抑菌圈直径范围在10~17 mm之间,MIC范围在0.125~0.5 mg·mL~(-1)之间,MBC范围在0.5~1 mg·mL~(-1)之间;正丁醇层、水层的抑菌活性较乙酸乙酯层弱,石油醚层对铜绿假单胞菌没有效果。而小叶藤黄、滇南红厚壳、续随子的乙酸乙酯层,巴豆、罗汉松、肉桂醇提物对铜绿假单胞菌及其耐药菌株有较弱抗菌活性;滇南红厚壳的正丁醇层、续随子乙酸乙酯层以及大八角和郁金的醇提物对铜绿假单胞菌及其耐药菌株均无活性。从这些数据中可以得出,粗糠柴的乙酸乙酯层、正丁醇层和水层对铜绿假单胞菌及其耐药菌有较好的抑菌活性,尤以乙酸乙酯层活性最好,而粗糠柴的石油醚层没有活性。     

Inhibition of lateral wall elongation by mecillinam stimulates cell division in certain cell division conditional mutants of Escherichia coli.

The effect of mecillinam, a beta-lactam antibiotic that specifically binds penicillin-binding protein 2 of Escherichia coli, causes transition from rod to coccal shape, and inhibits cell division in sensitive cells, has been tested on three different E. coli temperature-sensitive cell division mutants. At the nonpermissive temperature, the antibiotic allows an increase in cell number for strains BUG6 and AX655 but not for AX621. In strain AX655, the cell division stimulation was observed only if the antibiotic was added immediately after shifting to the nonpermissive temperature, whereas in BUG6, the rise in cell number was observed also when mecillinam was added after 90 min of incubation at the nonpermissive temperature. In all cases, cell division began occurring 30 min after addition of the antibiotic. Mecillinam had no effect on division of dnaA, dnaB temperature-sensitive mutants or on division of BUG6 derivatives made resistant to this antibiotic. Other beta-lactam antibiotics such as penicillin, ampicillin, cephalexin, and piperacillin and non beta-lactam antibiotics such as fosfomycin, teichomycin, and vancomycin that inhibit cell wall synthesis did not show any effect on cell division for any of the mutants. The response of the three cell division mutants to mecillinam is interpreted in terms of a recently proposed model for shape regulation in bacteria.     

Comparative study of the antibacterial activity of a number of new antibiotics and their combinations in relation to Pseudomonas aeruginosa]

Tobramycin and sisomycin proved to have the highest antibacterial activity against 156 clinical strains of Ps. aeruginosa and were 4--8 times more effective than monomycin, kanamycin, neomycin and to a lesser extent gentamicin. The combination of mecillinam and sisomycin had a synergistic effect with respect to 26 out of 50 strains of Ps. aeruginosa and the combination of mecillinam and tobramycin had a synergistic effect on 18 strains. An antagonistic effect was observed with the use of the above combinations in 3 cases. The effect of the combinations depended on sensitivity of Ps. aeruginosa cultures to the aminoglycoside antibiotic included into the compositions.     

椒样薄荷、薄荷和苏格兰留兰香精油与抗生素的协同抑菌功能

以开花期的椒样薄荷(Mentha × piperita)、薄荷(M. haplocalyx)和苏格兰留兰香(M. × gentilis)叶片部位提取的精油为研究对象, 通过GC-MS分析, 并采用纸片扩散法研究了3种精油单独使用及与抗生素联合使用时对金黄色葡萄球菌、蜡状芽孢杆菌、大肠杆菌、绿脓杆菌和肺炎克雷伯氏菌的抑制情况。结果表明, (1) 椒样薄荷与薄荷精油中含量最高的成分为薄荷醇、薄荷酮和异薄荷酮, 苏格兰留兰香精油的主要成分为香芹酮和柠檬烯。薄荷和苏格兰留兰香精油符合欧洲药典与ISO标准, 椒样薄荷需要继续改良以提高其精油品质与抑菌功能。(2) 精油单独使用时, Pseudomonas aeruginosa ATCC 15442对椒样薄荷精油和薄荷精油敏感; P. aeruginosa ATCC 27853对薄荷精油和苏格兰留兰香精油敏感。精油与抗生素联合使用时抑菌范围和强度均有所改变: 绿脓杆菌的2个菌株对精油与抗生素的组合最为敏感, 其中, 椒样薄荷精油与头孢他啶的组合对P. aeruginosa ATCC 15442显示出最强的增效作用, 薄荷精油与头孢他啶混合之后对P. aeruginosa ATCC 27853出现拮抗作用。Staphylococcus aureus ATCC 25923对所有精油以及精油与抗生素混合物均有抗性。(3) 椒样薄荷、薄荷和苏格兰留兰香精油的不同成分及其含量差异不仅对精油品质有影响, 而且影响精油对测试菌种的抑制作用, 可考虑将其作为薄荷属植物品质育种的参考指标。     

Transferable amikacin and cefamandole resistance: Pseudomonas maltophilia and Acinetobacter strains as possible reservoirs of R plasmids

Three strains belonging to gramnegative non-fermenting rods, i.e. a Pseudomonas maltophilia strain and two strains of Acinetobacter, were tested, as representatives of different types of nosocomial strains, for transferability of their multiple drug resistance. As all of them posed difficulties in demonstrating the transferability of their resistance by conventional methods, a three-step procedure was developed that includes a transfer to rifampicin-resistant P. aeruginosa recipients, then to susceptible P. aeruginosa intermediate strains, and, finally, from these strains to rifampicin-resistant Enterobacteriaceae. In three strains studied three genetically different types of R plasmids have been demonstrated. P. maltophilia transferred Amikacin resistance, as well as resistance to other antibiotics, to P. aeruginosa and then to Enterobacteria. In contrast, an Amikacin-resistant Acinetobacter with quite identical multiple drug resistance spectrum transferred its resistance to P. aeruginosa only, but not to Enterobacteria. Finally, another Acinetobacter strain, resistant to Gentamicin but susceptible to Amikacin transferred this resistance directly to Enterobacteria (and, separately, to P. aeruginosa, too). All three strains transferred Cefamandole resistance together with other resistances. Non-fermenting rods, thus, might be a source of transmissible resistance to reserve antibiotics as Amikacin, and advanced-type Cephalosporins.     

In vitro interactions of tobramycin with various nonantibiotics against Pseudomonas aeruginosa and Burkholderia cenocepacia

Pseudomonas aeruginosa and Burkholderia cepacia are the major pathogens that colonize the airway surface and cause progressive respiratory failure and high mortality, especially in cystic fibrosis (CF) patients. Tobramycin is the treatment of choice, but persistent usage enables the infectious organisms to activate defence mechanisms, making eradication rarely successful. Combinations of antibiotic and nonantibiotic compounds have been tested in vitro against P. aeruginosa and B. cepacia , but with mixed results. Sodium ions interfere with the bacterial tobramycin uptake system, but amiloride partially reverses this antagonism. In this pilot study, we extend previous findings of the effectiveness of tobramycin in combination with amiloride and other nonantibiotics against a P. aeruginosa type strain, and against four P. aeruginosa strains and one Burkholderia cenocepacia strain isolated from CF patients. Significantly, the four clinical P. aeruginosa strains were tobramycin resistant. We also find that Na⁺ and K⁺, but not Cl⁻, are the chief antagonists of tobramycin efficacy. These results suggest that chemotherapy for CF patients might not only be compromised by antibiotic-resistant pathogens alone, but by a lack of penetration of antibiotics caused either by bacterial biofilms or the high sodium flux in the CF lung, or by antagonistic effects of some drug combinations, any of which could allow the persistence of drug-susceptible bacteria.     

椒样薄荷、薄荷和苏格兰留兰香精油与抗生素的协同抑菌功能

以开花期的椒样薄荷（Mentha×piperita）、薄荷（M.haplocalyx）和苏格兰留兰香（M.×gentilis）叶片部位提取的精油为研究对象,通过GC-MS分析,并采用纸片扩散法研究了3种精油单独使用及与抗生素联合使用时对金黄色葡萄球菌、蜡状芽孢杆菌、大肠杆菌、绿脓杆菌和肺炎克雷伯氏菌的抑制情况。结果表明,（1）椒样薄荷与薄荷精油中含量最高的成分为薄荷醇、薄荷酮和异薄荷酮,苏格兰留兰香精油的主要成分为香芹酮和柠檬烯。薄荷和苏格兰留兰香精油符合欧洲药典与ISO标准,椒样薄荷需要继续改良以提高其精油品质与抑菌功能。（2）精油单独使用时,Pseudomonas aeruginosa ATCC15442对椒样薄荷精油和薄荷精油敏感;P.aeruginosa ATCC27853对薄荷精油和苏格兰留兰香精油敏感。精油与抗生素联合使用时抑菌范围和强度均有所改变：绿脓杆菌的2个菌株对精油与抗生素的组合最为敏感,其中,椒样薄荷精油与头孢他啶的组合对P.aeruginosa ATCC15442显示出最强的增效作用,薄荷精油与头孢他啶混合之后对P.aeruginosa ATCC27853出现拮抗作用。Staphylococcus aureus ATCC25923对所有精油以及精油与抗生素混合物均有抗性。（3）椒样薄荷、薄荷和苏格兰留兰香精油的不同成分及其含量差异不仅对精油品质有影响,而且影响精油对测试菌种的抑制作用,可考虑将其作为薄荷属植物品质育种的参考指标。     

Macrolides decrease the minimal inhibitory concentrations of anti-pseudomonal agents against Pseudomonas aeruginosa from cystic fibrosis patients in biofilm

ABSTRACT: BACKGROUND: Biofilm production is an important mechanism for bacterial survival and its association with antimicrobial resistance represents a challenge for the patient treatment. In this study we evaluated the in vitro action of macrolides in combination with anti-pseudomonal agents on biofilm-grown Pseudomonas aeruginosa recovered from cystic fibrosis (CF) patient. RESULTS: A total of 64 isolates were analysed. The (BIC) results were consistently higher than those minimal inhibitory concentration (MIC) for most anti-pseudomonal agents tested (ceftazidime: P = 0.001, ciprofloxacin: P = 0.234, tobramycin: P = 0.001, imipenem: P < 0.001, meropenem: P = 0.005). When macrolides were associated with the anti-pseudomonal agents, the BIC values were reduced significantly for ceftazidime (P < 0.001) and tobramycin (P < 0.001), regardless the concentration of macrolides. Strong (IQ) was observed when azithromycin at 8 mg/L was associated with all anti-pseudomonal agents tested in biofilm conditions. CONCLUSIONS: P. aeruginosa from CF patients within biofilms are highly resistant to antibiotics but macrolides proved to augment the in vitro activity of anti-pseudomonal agents.     

Interpretation of Diffusion Susceptibility Data Obtained with 50-μg Carbenicillin Discs Against Gram-Negative Organisms

A total of 284 clinical isolates of various species of Enterobacteriaceae, Pseudomonas aeruginosa, P. maltophilia, and Acinetobacter anitratum were tested for susceptibility to carbenicillin by the standardized Bauer-Kirby disc diffusion technique and a microtiter broth dilution method. The data obtained led to the following proposed criteria for the interpretation of the results of disc susceptibility tests. Enterobacteriaceae that yield zones of inhibition equal to or greater than 20 mm in diameter around 50-mug discs of carbenicillin are designated as sensitive to the drug; isolates that yield zones measuring from 18 to 19 mm in diameter are reported as of equivocal (intermediate) susceptibility to the drug, whereas those enterobacterial isolates that are characterized by zones of inhibition of 17 mm or less in diameter are interpreted as resistant to carbenicillin. Isolates of P. aeruginosa, P. maltophilia, and A. anitratum yielding zones of 14 mm or more in diameter around 50-mug discs of carbenicillin are reported as sensitive, whereas those isolates that are characterized by zones of 13 mm or less in diameter are reported as resistant to this drug.     

In vitro activity of cefamandole, cefoxitin, cefuroxime, and carbenicillin, alone and in combination with aminoglycosides against Serratia marcescens.

Synergistic antibiotic studies were undertaken to compare the effectiveness of two new beta-lactamase resistant cephalosporins, cefamandole, and carbenicillin, with four aminoglycosides against clinical strains of Serratia marcescens. The strains demonstrated various combinations of resistance and/or susceptibility to the antibiotics tested. Tobramycin was the most effective aminoglycoside when used in combination with beta-lactam antibiotics. Carbenicillin and cefamandole demonstrated similar activity with aminoglycosides in synergy experiments. Tobramycin-carbenicillin was found to be the superior pairs as indicated by the total number of strains inhibited. This combination was the only one effective against certain high drug resistant strains and the strain resistant to all four aminoglycosides. Carbenicillin or cefamandole with tobramycin exhibited comparable activity against multiple drug resistant organisms. However, mutants significantly more resistant to cefamandole developed during susceptibility testing. The findings of this study have clinical relevance for treating infections by this formidable pathogen.     

Tartrazine-containing drugs

Tobramycin, an aminoglycoside antibiotic, was used to treat 52 infections due to gram-negative organisms in 51 patients. Complicated urinary tract infections, bacteremia and pyelonephritis accounted for 80% of the infections. The rate of immediate satisfactory response was 79%. During therapy with tobramycin, resistant organisms emerged in four patients--two Pseudomonas aeruginosa and two Escherichia coli strains. There were four superinfections with tobramycin-resistant Providencia sp. In four seriously ill patients the serum creatinine concentration increased 1 mg/dL or more; in three the increase was transient. No auditory toxicity was noted in the 19 patients in whom serial audiograms were made. In vitro testing of isolates from these patients showed that tobramycin and gentamicin had equal activity against Enterobacteriaceae. Tobramycin was two to four times more active against susceptible P. aeruginosa.     

Mecillinam: a new antibiotic for enteric fever.

Mecillinam is a new antibiotic related to the penicillins but more active than ampicillin against salmonellae, including Salmonella typhi. Mecillinam must be administered parenterally, but the ester, pivmecillinam, is absorbed from the gut. Eight patients suffering from typhoid fever and one suffering from paratyphoid fever were treated with the antibiotic, and seven responded satisfactorily. One patient could not tolerate pivmecillinam because of vomiting but there were no other adverse reactions. Serum and bile levels of mecillinam were many times the minimum inhibitory concentrations for most salmonellae. The antibiotic is a promising addition to the agents available for treating typhoid.     

Potentiation of antimalarial drug action by chlorpheniramine against multidrug-resistant Plasmodium falciparum in vitro

Chlorpheniramine, a histamine H1 receptor antagonist, was assayed for in vitro antimalarial activity against multidrug-resistant Plasmodium falciparum K1 strain and chloroquine-resistant P. falciparum T9/94 clone, by measuring the 3H-hypoxanthine incorporation. Chlorphenirame inhibited P. falciparum K1 and T9/94 growth with IC50 values of 136.0+/-40.2 microM and 102.0+/-22.6 microM respectively. A combination of antimalarial drug and chlorpheniramine was tested against resistant P. falciparum in vitro. Isobologram analysis showed that chlorpheniramine exerts marked synergistic action on chloroquine against P. falciparum K1 and T9/94. Chlorpheniramine also potentiated antimalarial action of mefloquine, quinine or pyronaridine against both of the resistant strains of P. falciparum. However, chlorpheniramine antagonism with artesunate was obtained in both P. falciparum K1 and T9/94. The results in this study indicate that antihistaminic drugs may be promising candidates for potentiating antimalarial drug action against drug resistant malarial parasites.     

Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included. A propensity score for empiric carbapenem therapy was derived and an adjusted multivariate analysis of mortality was conducted. A total of 394 patients had ESBL-Escherichia.coli and ESBL-Klebsiella pneumoniae bacteraemia of which 23.1% were community acquired cases. One hundred and fifty-one received initial active monotherapy comprising piperacillin-tazobactam (n = 94) or a carbapenem (n = 57). Patients who received carbapenems were less likely to have health-care associated risk factors and have an unknown source of bacteraemia, but were more likely to have a urinary source. Thirty-day mortality was comparable between those who received empiric piperacillin-tazobactam and a carbapenem (29 [30.9%] vs. 17 [29.8%]), P = 0.89). Those who received empiric piperacillin-tazobactam had a lower 30-day acquisition of multi-drug resistant and fungal infections (7 [7.4%] vs. 14 [24.6%]), P<0.01). After adjusting for confounders, use of empiric piperacillin-tazobactam was not associated with increased 30-day mortality (OR 1.00, 95% CI; 0.45–2.17). Empiric piperacillin-tazobactam was not associated with increased 30-day mortality and may result in fewer multi-drug resistant and fungal infections when compared with a carbapenem.     

Complete genome sequences of three Pseudomonas aeruginosa isolates with phenotypes of polymyxin B adaptation and inducible resistance

Clinical "superbug" isolates of Pseudomonas aeruginosa were previously observed to be resistant to several antibiotics, including polymyxin B, and/or to have a distinct, reproducible adaptive polymyxin resistance phenotype, identified by observing "skipped" wells (appearance of extra turbid wells) during broth microdilution testing. Here we report the complete assembled draft genome sequences of three such polymyxin resistant P. aeruginosa strains (9BR, 19BR, and 213BR).     

In vitro interaction between ceftazidime and vancomycin/teicoplanin in the presence of azithromycin againstPseudomonas aeruginosa

Pseudomonas aeruginosa is an opportunistic pathogen, intrinsically resistant to many antibiotics and prone to acquire resistance against many drugs. It is assumed that agents that disorganise the structure of the outer membrane might allow the passage of other drugs into cell. To verify this hypothesis, ceftazidime (CAZ) has been tested in association with glycopeptides (GLYs) and azithromycin (AZI). Time-kill experiments were performed on a representative strain. CAZ in combination with GLYs showed 99, 90 and 10% of CFU/ml reduction in 33.9,52.5 and 13.6% of the cases, respectively; the addition of AZI increased the incidence of 99% CFU/ml reduction to 42% of the cases. Indifference was the most common finding, and additive/synergism in the other cases. Present findings demonstrated that CAZ favourably reacted with GLYs in the presence of AZI.     

Atypical multidrug resistance may be associated with catalytically active mutants of human DNA topoisomerase II alpha

In human cells, atypical drug resistance was previously identified with reduced catalytic activity or nuclear localization efficiency of DNA topoisomerase II alpha (TOP2 alpha). We have shown two etoposide resistant hTOP2 alpha mutants, K798L and K798P confer resistance to etoposide. In this work, we showed these mutants are also resistant against doxorubicin and mAMSA in vivo in the yeast strain ISE2, rad52, top2-4 at the non-permissive temperature. We purified these mutants to characterize the drug resistant mechanism. Purified recombinant proteins were 8- to 12-fold more resistant to etoposide and doxorubicin than wild type TOP2 alpha, and 2-fold more resistant to amsacrine, as measured by accumulation of cleavable DNA. These data show that K798L and K798P may be intrinsically resistant against these drugs in vitro and that this character may confer atypical multidrug resistant phenotype in vivo in yeast.     

Novel S-benzylisothiourea compound that induces spherical cells in Escherichia coli probably by acting on a rod-shape-determining protein(s) other than penicillin-binding protein 2

Random screening for inhibitors of chromosome partitioning in Escherichia coli was done by the anucleate cell blue assay. A novel S-benzylisothiourea derivative, S-(3,4-dichlorobenzyl)isothiourea, tentatively named A22, was found to induce spherical cells and spherical anucleate cells in E. coli. Mecillinam, a specific inhibitor of penicillin-binding protein 2, which induces spherical cells in E. coli, also caused anucleate cell production. Spherical cells induced by treatment with either A22 or mecillinam varied in size, and anucleate cells seemed to be more frequent among the smaller cells. These results suggest that loss of the rod shape in E. coli leads to asymmetric cell division that results in production of anucleate cells. No competition was observed even in the presence of a 10-fold excess A22 in an in vitro assay of 14C-penicillin G binding, but mecillinam specifically inhibited binding of 14C-penicillin G to penicillin-binding protein 2. Simultaneous treatment with mecillinam and cephalexin, a specific inhibitor of penicillin-binding protein 3, induced lysis of E. coli cells, but a combination of A22 and cephalexin did not. These results suggest that the target molecule(s) of A22 was not penicillin-binding protein 2. A22 may act on a rod-shape-determining protein(s) other than penicillin-binding protein 2, such as RodA or MreB.