Emergence of Pseudomonas aeruginosa with class 1 integron carrying blaVIM-2 and blaVIM-4 in the University Clinical Hospital of Bialystok (northeastern Poland).

The effectiveness of carbapenems, considered as last-resort antimicrobials in severe infections, becomes compromised by bacterial resistance. The production of metallo-ß-lactamases (MBLs) is the most significant threat to carbapenems activity among Pseudomonas aeruginosa. The aim of this study was to assess the presence and type of MBLs genes in carbapenem-resistant P. aeruginosa clinical strains, to identify the location of MBLs genes and to determine genetic relatedness between MBL-producers using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The first identified MBL-positive (with blaVIM genes) P. aeruginosa strains were isolated from patients hospitalized in the University Clinical Hospital of Bialystok in the period from September 2012 to December 2013. Variants of MBLs genes and variable integron regions were characterized by PCR and sequencing. PFGE was performed after digesting of bacterial genomes by XbaI enzyme. By MLST seven housekeeping genes were analyzed for the determination of sequence type (ST). Three strains carried the blaVIM-2 gene and one harbored the blaVIM-4 gene. The blaVIM genes resided within class 1 integrons. PCR mapping of integrons revealed the presence of four different cassette arrays. Genetic relatedness analysis by PFGE classified VIM-positive strains into four unrelated pulsotypes (A-D). MLST demonstrated the presence of four (ST 111, ST27, and ST17) different sequence type including one previously undescribed new type of ST 2342. Antimicrobial susceptibility testing showed that VIM-positive strains were resistant to carbapenems, cephalosporins, aminoglycosides, and quinolones, intermediate to aztreonam, and susceptible only to colistin. Integrons mapping, PFGE, and MLST results may point to different origin of these strains and independent introduction into hospitalized patients.

Prevalence of resistance to aminoglycosides and fluoroquinolones among Pseudomonas aeruginosa strains in a University Hospital in Northeastern Poland

The present study was conducted to investigate the prevalence of genes encoding resistance to aminoglycosides and fluoroquinolones among twenty-five Pseudomonas aeruginosa isolated between 2002 and 2009. In PCR, following genes were detected: ant(2")-Ia in 9 (36.0%), aac(6')-Ib in 7 (28.0%), qnrB in 5 (20.0%), aph(3")-Ib in 2 (8.0%) of isolates.

Influence of unmodified and ß-glycerophosphate cross-linked chitosan on anti-Candida activity of clotrimazole in semi-solid delivery systems.

The combination of an antifungal agent and drug carrier with adjunctive antimicrobial properties represents novel strategy of complex therapy in pharmaceutical technology. The goal of this study was to investigate the unmodified and ion cross-linked chitosan's influence on anti-Candida activity of clotrimazole used as a model drug in hydrogels. It was particularly crucial to explore whether the chitosans' structure modification by ß-glycerophosphate altered its antifungal properties. Antifungal studies (performed by plate diffusion method according to CLSI reference protocol) revealed that hydrogels obtained with chitosan/ß-glycerophosphate displayed lower anti-Candida effect, probably as a result of weakened polycationic properties of chitosan in the presence of ion cross-linker. Designed chitosan hydrogels with clotrimazole were found to be more efficient against tested Candida strains and showed more favorable drug release profile compared to commercially available product. These observations indicate that novel chitosan formulations may be considered as promising semi-solid delivery system of clotrimazole.

Emergence of OXA-48 carbapenemase-producing Enterobacter cloacae ST89 infection in Poland.

BACKGROUND: The utility of carbapenems, which are considered 'last-line' agents, is being diminished by the growing incidence of various resistance mechanisms in bacteria. We aimed to investigate the molecular mechanism of carbapenem resistance in Enterobacter cloacae recovered from a 76-year-old patient who had undergone coronary artery bypass grafting and repair of the mitral and tricuspid valves. Interestingly, the patient had no prior history of hospital admission abroad. METHODS: The Carba-NP test II and synergy testing were performed to confirm carbapenemase activity. PCR was used to detect carbapenemase-encoding genes. Nucleotide and amino acid sequence analysis was performed to identify OXA-48 variants. Moreover, we performed multilocus sequence typing (MLST) of multidrug-resistant (MDR) E. cloacae. RESULTS: We detected no significant increase in zone diameter around disks with inhibitors. However, the Carba-NP test II revealed carbapenemase activity in all isolates. All isolates showed the presence of the exact OXA-48 carbapenemase variant. Furthermore, MLST analysis revealed that the MDR E. cloacae isolates belonged to ST89. CONCLUSIONS: We report a case of infection caused by a unique carbapenem-resistant E. cloacae ST89 producing OXA-48 carbapenemase. Interestingly, these pathogens developed resistance to other 'last-resort' agents, namely colistin and tigecycline. There is a crucial need for surveillance programs aimed at screening for carbapenemase-producing Gram-negative bacteria, especially in patients transferred from high-incidence areas.

In vitro activity of rifampicin alone and in combination with imipenem against multidrug-resistant Acinetobacter baumannii harboring the blaOXA-72 resistance gene.

BACKGROUND: The growing incidence of multidrug resistance (MDR) in bacteria is an emerging challenge in the treatment of infections. Acinetobacter baumannii is an opportunistic pathogen prone to exhibit MDR that contributes significantly to nosocomial infections, particularly in severely ill patients. Thus, we performed research on rifampicin activity against selected MDR OXA-72 carbapenemase-producing A. baumannii strains. Since it is widely accepted that rifampicin should not be used as monotherapy in order to avoid the rapid development of rifampicin resistance, we evaluated the efficacy of combination therapy with imipenem. METHODS: Minimal inhibitory concentrations (MICs) of both rifampicin and imipenem were determined by use of the broth microdilution method. Evaluations of the interactions between rifampicin and imipenem were performed by analysis of the fractional inhibitory concentration index (∑FIC), determined using the checkerboard titration method. RESULTS: All tested isolates showed full susceptibility to rifampicin. The checkerboard method revealed synergism in 5 isolates (29%) and an additive effect in another 5 isolates (29%); no difference was reported in the remaining 7 isolates (41%). Strains moderately resistant to imipenem (MIC ≤ 64 mg/l) tended to show synergy or additive interaction. CONCLUSIONS: We conclude that in vitro synergism or an additive interaction between rifampicin and imipenem most likely occurs in A. baumannii strains showing moderate resistance to imipenem (MIC ≤ 64 mg/l). Moreover, utilizing this combination in the therapy of infections caused by strains exhibiting higher levels of resistance (MIC > 64 mg/l) is not recommended since in this setting imipenem could not prevent the development of rifampicin resistance.

Prevalence of resistance to aminoglycosides and fluoroquinolones among Pseudomonas aeruginosa strains in a University Hospital in Northeastern Poland.

The present study was conducted to investigate the prevalence of genes encoding resistance to aminoglycosides and fluoroquinolones among twenty-five Pseudomonas aeruginosa isolated between 2002 and 2009. In PCR, following genes were detected: ant(2″)-Ia in 9 (36.0%), aac(6')-Ib in 7 (28.0%), qnrB in 5 (20.0%), aph(3″)-Ib in 2 (8.0%) of isolates.

Carbapenem-resistant strains from the family Enterobacteriaceae isolated in the period 2006-2011 from clinical specimens of patients treated at the university hospital in northeastern Poland.

INTRODUCTION: In recent years an alarming increase of carbapenem-resistant Enterobacteriaceae has been noticed, which creates frequent therapeutic problems, especially for patients residing in intensive care units (ICU). The aim of this study was to evaluate the prevalence of carbapenem-resistant strains of Enterobacteriaceae isolated in the years 2006-2011 at the University Hospital in Bialystok (UHB). METHODS: Based on microbiological analysis reports we conducted a retrospective study of strains resistant to carbapenems. We assigned strains to three carbapenem-resistance phenotypes, and analyzed susceptibility to antibiotics and prevalence of these strains in hospital wards and in clinical specimens collected from hospitalized patients. During a six-year period, 216 strains resistant to carbapenems were tested, which represents 0.96% of all Enterobacteriaceae (n = 22.391) isolated during this period. RESULTS: The greatest number of carbapenem-resistant strains was identified in 2011 (96 strains, 44.44%). Antibiotics that showed the highest activity against strains occurring most frequently (Klebsiella pneumoniae [n = 103] and Enterobacter cloacae [n = 85]) were tigecycline (102 [99.03%] of K. pneumoniae tested strains and 61 [100%] of E. cloacae strains were susceptible), colistin (33 [86.84%] of K. pneumoniae tested strains and 84 [100%] of E. cloacae were susceptible), and amikacin (86 [83.49%] of K. pneumoniae tested strains and 26 [30.58%] of E. cloacae strains were susceptible). CONCLUSIONS: Carbapenem resistance among Enterobacteriaceae isolates showed a trend to increase during the six-year period of study. Because infections caused by carbapenem-resistant strains are frequently life-threatening, the effective strategies to control the spreading of antibiotic resistance are necessary.

The effect of PAMAM dendrimers on the antibacterial activity of antibiotics with different water solubility.

Erythromycin (EM) and tobramycin (TOB) are well-known and widely used antibiotics, belonging to different therapeutic groups: macrolide and aminoglycoside, respectively. Moreover, they possess different solubility: EM is slightly soluble and TOB is freely soluble in water. It was previously demonstrated that PAMAM dendrimers enhanced the pharmacological activity of antifungal drugs by increasing their solubility. Therefore, it appears interesting to investigate the effect of PAMAM-NH2 and PAMAM-OH dendrimers generation 2 (G2) and generation 3 (G3) on the antibacterial activity of antibiotics with different water solubility. In this study it was shown that the aqueous solubility of EM was significantly increased by PAMAM dendrimers (PAMAM-NH2 and PAMAM-OH caused about 8- and 7- fold solubility increases, respectively). However, it was indicated that despite the increase in the solubility, there was only slight influence on the antibacterial activity of EM (2- and 4-fold decreases in the MBC values of EM in the presence of PAMAM-OH G3 and PAMAM-NH2 G2 or G3 for strains of Staphylococcus aureus were noted, respectively). It was also found that there was no influence of PAMAM on the antibacterial activity of hydrophilic TOB.

Hydrogel of ketoconazole and PAMAM dendrimers: formulation and antifungal activity.

Ketoconazole (KET), an imidazole derivative with well-known antifungal properties, is lipophilic and practically insoluble in water, therefore its clinical use has some practical disadvantages. The aim of the present study was to investigate the influence of PAMAM-NH(2) and PAMAM-OH dendrimers generation 2 and generation 3 on the solubility and antifungal activity of KET and to design and evaluate KET hydrogel with PAMAM dendrimers. It was shown that the surface charge of PAMAM dendrimers strongly affects their influence on the improvement of solubility and antifungal activity of KET. The MIC and MFC values obtained by broth dilution method indicate that PAMAM-NH(2) dendrimers significantly (up to 16-fold) increased the antifungal activity of KET against Candida strains (e.g., in culture Candida albicans 1103059/11 MIC value was 0.008 µg/mL and 0.064 µg/mL, and MFC was 2 µg/mL and 32 µg/mL for KET in 10 mg/mL solution of PAMAM-NH(2) G2 and pure KET, respectively). Antifungal activity of designed KET hydrogel with PAMAM-NH(2) dendrimers measured by the plate diffusion method was definitely higher than pure KET hydrogel and than commercial available product. It was shown that the improvement of solubility and in the consequence the higher KET release from hydrogels seems to be a very significant factor affecting antifungal activity of KET in hydrogels containing PAMAM dendrimers.

Poly(amidoamine) dendrimers increase antifungal activity of clotrimazole.

Clotrimazole (CLO) is a local imidazolic antifungal agent. A major problem associated with the successful formulation of effective dosage forms containing CLO is its poor aqueous solubility, which presents a hindrance for the local availability of CLO and limits the effective antifungal therapy. In the present study, the effects of various concentrations of poly(amidoamine) (PAMAM) dendrimers generation 2 (G2) and generation 3 (G3) with amine (PAMAM-NH(2)) or hydroxyl surface groups (PAMAM-OH) on aqueous solubility and antifungal activity of CLO were studied. The obtained results showed that all tested PAMAM dendrimers improved the solubility of CLO and the more potent were PAMAM-NH(2) dendrimers. The increase in solubility of CLO was highest at dendrimer concentration of 10 mg/ml. Microbiology studies indicated that only PAMAM-NH(2) dendrimers significantly increased the antifungal activity of CLO (a 4-32-fold increase in the antifungal activity compared to pure CLO) and the most potent was dendrimer PAMAM-NH(2) G2. These observations indicate that PAMAM dendrimers might be considered as potential carriers of CLO and provide further impetus to evaluate these polymers for use in basic drug delivery studies and to design semisolid dosage forms based on dendrimers with antimicrobial drugs, like CLO.

[Sanfetrinem, the member of trinems--in vitro activity against Klebsiella pneumoniae producing ESBL]. / Sanfetrinem, przedstawiciel trinemów--aktywnosc in vitro wobec szczepów Klebsiella pneumoniae wytwarzajacych ESBL.

Sanfetrinem is the first member of tricyclic beta-lactams (trinems) which can be administered orally as a hexatil ester. His chemical structure is related to carbapenems. High stability to many beta-lactamases and human renal dehydropeptydase were described. The investigation was performed on 43 strains of Klebsiella pneumoniae producing ESBL isolated from hospitalized patients. The MICs of sanfetrinem and imipenem were determined by E-test. Additionaly, susceptibility to antibiotics was tested by disc diffusion method. Klebsiella pneumoniae ATCC 700603, Escherichia coli ATCC 25922 and Escherichia coli ATCC 35218 were used as a control strains. MIC50 and MIC90 of sanfetrinem and imipenem amounted respectively 0,38/3 mg/1 and 0,19/0,25 mg/l. Range of MIC value was from 0,064 mg/l to 4 mg/l for sanfetrinem, and from 0,094 mg/l to 0,38 mg/l for imipenem. Additionaly, geometric and aritmetic means were calculated to both antibiotics. All results of study were compared using correlation factor and "Student" t-test. None of these 43 Klebsiella pneumoniae strains was resistant to imipenem and cefepime. Majority of isolates demonstrated susceptibility to ciprofloxacin and cefoxitin--90,7% and 74,4% respectively All strains were resistant to gentamicin, amikacin and trimethoprim/sulfamethoxazole.

[The role of aminoglycoside--modifying enzymes in resistance of Gram-negative rods]. / Prawdopodobny udzial enzymów paleczek Gram-ujemnych w profilu opornosci na antybiotyki aminoglikozydowe.

The aim of the study was to evaluate the aminoglycoside resistance of Gram-negative bacilli isolated from patients. To the examination 35 strains of Enterobacteriaceae and 18 of non-fermentative bacteria were included. Resistance to aminoglycosides (gentamicin (G), netilmicin (Nt), tobramycin (T), amikacin (A), kanamycin (K), neomycin (N)) was established by disk diffusion method. Interpretation of enzymatic mechanisms was performed by Livermore. The most common enzymes AAC(6')I were found in Enterobacteriaceae group (mostly in E. cloaceae and P. mirabilis) and AAC(3') and in non-fermentative bacteria: AAC(6')I in P. aeruginosa and APH(3')VI and AAC(3')I in A. baumanii. The most frequent phenotype was resistance to six antibiotics (G, Nt, T, A, K, N) Resistance rates were high for gentamicin (>70 %) in both groups and amikacin (88,89 %) in non-fermentatives.

[Susceptibility of Branhamella catarrhalis to antibiotics]. / Wrazliwosc Branhamella catarrhalis na antybiotyki.

A total of 98 isolates of Branhamella catarrhalis were examined for their susceptibility to antibiotics using serial dilution method. Nitrocefin test was employed for detection of beta-lactamase activity. It was found that most of the isolates (71%) were resistant to ampicillin. Resistance to this antibiotic was accompanied by ability to beta-lactamase production. On the other hand, all isolates were susceptible to amoxicillin + clavulanic acid combination. Almost all isolates were susceptible to cefaclor (99%), cefuroxime (94%), cefotaxime (100%), ciprofloxacin (100%), tetracycline (91%), cotrimoxazole (93%) and erythromycin (93%).

[Antibiotic susceptibility and occurrence of ESBL in Pseudomonas aeruginosa strains isolated from different clinical specimens]. / Ocena wrazliwosci na antybiotyki i czestosc wystepowania beta-laktamaz o rozszerzonym spektrum substratowym (ESBL) wsród szczepów Pseudomonas aeruginosa izolowanych z próbek materialu klinicznego.

The aim of this study was to evaluate the drug susceptibility of 132 P. aeruginosa strains isolated from patients hospitalized in SPSK University Hospital in Bialystok. The isolates were obtained from clinical specimens over an 11-month period in 2001 and 2002. All the strains were identified in automatic ATB system using API 20 NE strips, and their susceptibility to antibiotics was tested by standard disc-diffusion method and agar dilution method. The minimal inhibitory concentration (MIC) was determined for five antibiotics: piperacillin, amikacin, ceftazidime, imipenem and ciprofloxacin. The majority of strains were susceptible to ceftazidime (91.7%), piperacillin combined with tazobactam (85.6%), amikacin (80.3%), meropenem and imipenem (81.8%). Many of our strains were resistant to cefotaxime (73.5%), ticarcillin (53%) and ciprofloxacin (48.5%). Also, the trial was undertaken to detect strains producing extended-spectrum beta-lactamases (ESBL) and inducible beta-lactamases (IBL) among P. aeruginosa rods isolated from different specimens. ESBL-producing strains were detected with double disc test (DDST) and combination double disc (CD) test. Clavulanate was applied as the inhibitor of these beta-lactamases. Strains producing ESBL were not found. On the other hand, as many as 127 P. aeruginosa strains (96.2%) produced inducible beta-lactamases (IBL).

[Adaptation of immunoenzymatic method for detection of antibody coated bacteria in urine]. / Adaptacja metody immunoenzymatycznej do wykrywania bakterii oplaszczonych przeciwcialami w moczu.

The modified immunoenzymatic method for detection of antibody coated bacteria (IP ACB) was compared with immunofluorescence technique (IF ACB) in the diagnosis of urinary tract infection. For the study 100 patients were employed with significant and insignificant bacteriuria. It was found that 81% of the results obtained by IP ACB and IF ACB were identical, however the immunoenzymatic method was more sensitive than immunofluorescence. Moreover, the IP ACB technique is simpler, less time consuming and may be performed by using the ordinary optic microscope.