Changing epidemiology of extended-spectrum ß-lactamases in Argentina: emergence of CTX-M-15.

A multicenter survey, carried out in 2010 in Argentina, showed an increased prevalence of extended-spectrum ß-lactamase (ESBL)-producing enterobacteria, with some changes in the molecular epidemiology of circulating ESBLs. While enzymes of the CTX-M-2 group remain endemic, the emergence of CTX-M-15 and of enzymes of the CTX-M-8 and CTX-M-9 groups was observed. The CTX-M-15-positive isolates represented 40% of CTX-M producers and included representatives of Escherichia coli ST131 and Klebsiella pneumoniae ST11.

[Integrons: gene collectors]. / Integrones: los coleccionistas de genes.

Integrons gained great interest due to their participation in resistance gene recruitment and expression. Their basic structure includes a fragment that encodes an integrase (intI) followed by a recognition sequence (attI) into which they may incorporate gene cassettes (encoding resistance mechanisms). A promoter (Pc) embedded within the integrase gene controls the transcription of integrated resistance markers, as these genes do not have their own promoters. When in cassettes, resistance genes are flanked by specific sequences (attC), which are recognized by the integrase that, by site specific recombination, incorporates them after attI in proper orientation for their expression. In the past, integrons were classified according to their sequence homology; currently they are classified according to their location. In general, they are divided into "mobile" integrons (those associated with insertion sequences, transposons and/or plasmids, being most of them associated with resistance mechanisms), and chromosomally-located "super" integrons with large arrangements of cassette genes. "Mobile" class 1 integrons are the most abundant in clinical isolates and are generally associated with Tn21 subgroup transposons, followed by class 2, derived primarily from Tn7. These elements are not mobile themselves, but their association with mobile platforms that facilitate horizontal transfer, explains their wide distribution among bacteria. This review also attempts to describe the mobile integrons described so far in Argentina.

[Phenotypic and genotypic characterization of imipenem-resistant Pseudomonas aeruginosa isolated in a Buenos Aires hospital]. / Caracterización fenotípica y genotípica de la resistencia a imipenem en Pseudomonas aeruginosa aisladas en un hospital de Buenos Aires.

From 129 P. aeruginosa isolated at a health care centre located in Buenos Aires (Hospital "Eva Perón"), 14% produced IMP-13. Although 18 isolates were metallo-beta-lactamases (MBL) producers, only those isolates that displayed altered outer membrane protein profiles correlated with the resistant category according to CLSI or even Subcomisión de Antimicrobianos, SADEBAC, AAM. Phenotypic screening of metallo-beta-lactamases proved to be appropriate for detecting MBL producing isolates. IMP-13 producing isolates corresponded to at least five different clonal types, which not only suggests the dissemination of the resistant strain but also of the resistant marker.

Immunobiological role of llama heavy-chain antibodies against a bacterial beta-lactamase.

In 1993, a fraction of antibodies (Abs) devoid of L chain was found naturally occurring in the Camelidae. They were found to lack L chains, as well as the first constant heavy-chain domain (CH(1)) and therefore they were named "heavy-chain Abs" (HCAbs). Subsequent studies focused on the functional, structural and biochemical properties of recombinant variable fragments (rVHHs) of HCAbs. It was stated that rVHHs have an augmented capacity to interact with "partially hidden" epitopes, like enzymes active sites, and have an increased stability to thermal and chemical aggression. It has been suggested that these unconventional Abs could represent an evolutionary advantage, being more efficient than conventional Abs to inhibit microbial enzymes, and thus exerting a more protective immune response against pathogens. The present work focuses on the immunobiological role of HCAbs, in their capacity to inhibit microbial enzymes. Two animal models were selected, comprising a model for common vertebrates without HCAbs (rabbits), and a model for vertebrates with both conventional and unconventional Abs (Lama glama). A recombinant bacterial beta-lactamase (CTX-M-2) was selected as the microbial enzymatic antigen. After conventional immunization schedules, neither serum titers nor serum inhibitory capacity showed significant differences when rabbits and llamas were compared. These results indicate that the a priori assumption that the adaptive immune system of camelids could be better "prepared" to respond to bacterial enzymes because of the presence of HCAbs, is not always accurate. Furthermore, when the different llama antibody isotypes and subclasses were purified, it was demonstrated that the inhibitory capacity of total serum was due exclusively to IgG(1). HCAbs not only failed to inhibit CTX-M-2, but instead they activated its enzymatic activity. Altogether, these results indicate that the hypotheses extrapolated from the rVHHs properties need to be revised; the real role of HCAbs in vivo remains unknown, as well as their evolutionary cause.

Whole-cell protein profiles are useful for distinguishing enterococcal species recovered from clinical specimens.

Whole-cell protein analysis was performed for differentiating 150 enterococcal isolates to the species level, which had previously been identified by extended phenotypic conventional tests. Whole-cell protein profile (WCPP) showed a high degree of similarity within species and comparison between species revealed important differences in band profiles. All Enterococcus faecalis and Enterococcus faecium isolates were properly located into their corresponding species, regardless of their clinical source and susceptibility pattern. Moreover, WCPP allowed relocation of some isolates that had erroneously been identified by the usual conventional scheme (i.e. two atypical arginine-negative E. faecalis isolates). WCPP proved to be a simple method to ascertain the various enterococcal species, especially those other than E. faecalis, and may be a suitable tool for high-complexity or reference clinical laboratories.

[Community-acquired methicillin-resistant Staphylococcus aureus infections in a hospital for acute diseases]. / Infecciones adquiridas en la comunidad por Staphylococcus aureus resistente a meticilina en un hospital de agudos.

Community-acquired methicillin-resistant Staphylococcus aureus infections in a hospital for acute diseases. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent pathogens associated with nosocomial infections. However, most recently, MRSA has arisen as an emerging community pathogen, causing serious infections, mainly among young patients. We herein describe 33 cases of infections caused by community-acquired MRSA (C-MRSA), diagnosed between May 2005 and June 2006, at "Eva Perón" Hospital. The isolations were retrospectively studied. Methicillin resistance was confirmed by means of the detection of the mecA gene, and the genes for two virulence factors (Panton-Valentine Leucocidin -PVL- and gamma-haemolysin) as well as the cassette mec type were screened by PCR. All the patients were previously healthy. Four patients under 12, presented bacteremia, one had serious pneumonia, and the three remaining patients had osteoarticular infections; all the patients over 12, had skin and soft tissue infections without systemic damage. The C-MRSA strains harboured cassette mec type IV, and the PVL and gamma-haemolysin genes. They were methicillin-resistant, with no other associated resistances. It is important to consider the presence of these community- acquired strains in order to develop strategies for their correct treatment.

[Genetic environment of CTX-M-2 in Klebsiella pneumoniae isolates from hospitalized patients in Uruguay]. / Entorno genético de CTX-M-2 en aislamientos de Klebsiella pneumoniae provenientes de pacientes hospitalizados en Uruguay.

We studied two CTX-M-2-producing Klebsiella pneumoniae clinical strains, K96005 and K13, isolated from hospitalized patients in Uruguay, during 1996 and 2003, respectively. The genomic surroundings of bla(CTX-M-2) were characterized by PCR-mapping and DNA sequencing. Our results show that blaCTX-M-2 is included in a complex class-1 integron (InK13), associated with an orf513 in both isolates. The genetic array of the integron, aac(6')-lb, bla(OxA,2), orfD (gene cassette region), associated with an orf513-bla(CTX-M-2), seems to be widely disseminated over the Rio de la Plata region.

[Prevalence of metallo-beta-lactamase in carbapenem resistant Pseudomonas aeruginosa at a university hospital of Buenos Aires City]. / Prevalencia de metalo-beta-lactamasas en pseudomonas aeruginosa resistentes a carbapenemes en un hospital universitario de Buenos Aires.

The present study was conducted to estimate the prevalence of metallo-beta-lactamases in 91 consecutive carbapenem resistant Pseudomonas aeruginosa isolates, recovered from inpatients at Hospital de Clínicas in Buenos Aires. Both, phenotypic and genotypic methods detected the presence of carbapenemases in 10 (11%) isolates, corresponding to VIM-11 in 7/10 and VIM-2 in the others. Codifying genes were all included in class 1 integrons, upstream genes coding for aminoglycoside modifying enzymes. One hundred percent sensitivity and specificity was achieved by the metallo-beta-lactamases phenotypic screening method using EDTA (1 micromol) disks in the Pseudomonas aeruginosa isolates included in this study. Sensitivity to aztreonam in carbapenem resistant isolates was suspicious of the presence of these enzymes.

[Comparison of different methods in order to identify Proteus spp]. / Comparación de diferentes métodos para identificar las especies del género Proteus.

Comparison of different methods in order to identify Proteus spp. The objectives were: (a) to identify Proteus strains to species level, following Farmer's and O'Hara's conventional biochemical reactions; b) to evaluate the sensitivity and specificity of both the API 20E method and a schema of reduced reactions (TSI and MIO agar: motility, indole and ornithine) comparing them with conventional methodology, and c) to evaluate the utility of SDS-PAGE (total proteins) in order to identify Proteus strains to species level. Two hundred and five Proteus spp. clinical isolates, were collected between January 1998 and September 2004, from inpatients and outpatients at Hospital de Clinicas. Strains were identified by means of conventional methodology, the API 20E method, and a schema of reduced reactions. SDS-PAGE (total proteins) was used in 48 out of the 205 strains. The API 20E method identified 79 out of 87 (90.8%) strains of P. mirabilis, 103 out of 103 P. vulgaris complex, and 15 out of 15 P. penneri. Eight strains of P. mirabilis were identified as Proteus spp., the acid production from maltose being necessary to identify them to species level. The schema of reduced reactions identified 205 out of 205 (100%) strains, that is, this schema of reduced reactions identified all the strains to species level without any additional tests, in marked contrast to the API 20E method. The SDS-PAGE (total proteins) identified the three species of the genus, even if the strains of P. mirabilis showed different biochemical reactions.

Phenotypic and genotypic characterization of macrolide resistant Streptococcus pneumoniae recovered from adult patients with community-acquired pneumonia in an Argentinian teaching hospital.

Streptococcus pneumoniae isolates (n = 262) were recovered from adult patients with community-acquired pneumonia. Erythromycin-resistance levels increased from 9% (1997-1998) to 16% (2000-2002). Sampling for resistance mechanisms prevalent within 19 erythromycin-resistant S. pneumoniae showed mef(E) in 13/19 isolates while 4/19 carried the erm(B) gene (3/19 cMLS(B) and 1/19 iMLS(B) phenotype). MIC ranges for erythromycin and clindamycin were 0.5-16 mg/l and <0.008-0.063 mg/l for the M phenotype, 128-512 mg/l and 128-256 mg/l for the cMLS(B) phenotype, and 4 and <0.008 mg/l for the iMLS(B) phenotype. This is the first report studying the prevalence of macrolide resistance determinants in S. pneumoniae in our country.

[Phenotypic and genotypic characterization of resistance to third-generation cephalosporins in Enterobacter spp]. / Caracterización fenotípica y genotípica de la resistencia enzimática a las cefalosporinas de tercera generación en Enterobacter spp.

Enterobacter spp. are becoming increasingly frequent nosocomial pathogens with multiple resistance mechanism to beta-lactam antibiotics. We carried out the phenotypic and genotypic characterization of beta-lactamases in 27 Enterobacter spp. (25 Enterobacter cloacae y 2 Enterobacter aerogenes), as well as the ability of different extended spectrum-lactamase (ESBL) screening methods. Resistance to third generation cephalosporins was observed in 15/27 (63%) isolates. Twelve resistant isolates produced high level chromosomal encoded AmpC beta-lactamase; 6 of them were also producers of PER-2. Resistance to third generation cephalosporins in the remaining 3 isolates was due to the presence of ESBLs, PER-2 in 2 cases, and CTX-M-2 in the other. Only CTX-M-2 production was detected with all tested cephalosporins using difusion synergy tests, while cefepime improved ESBLs detection in 7/8 PER-2 producers, 4/8 in the inhibitor approximation test and 7/8 with double disk test using cefepime containing disk with and without clavulanic acid. Dilution method, including cephalosporins with and without the inhibitor detected 1/9 ESBLs producers.

Methicillin-resistant Staphylococcus aureus strains in Buenos Aires teaching hospitals: replacement of the multidrug resistant South American clone by another susceptible to rifampin, minocycline and trimethoprim-sulfamethoxazole.

The aim of this study was to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from different infectious sites of hospitalized patients at two university hospitals. Fourteen isolates were analyzed by repetitive sequence based PCR (Rep-PCR), randomly amplified polymorphic DNA assay (RAPD-PCR), and pulsed-field gel electrophoresis (PFGE). We found that a prevalent clone of MRSA, susceptible to rifampin, minocycline, and trimethoprim/sulfamethoxazole (RIF(s), MIN(s), TMS(s)) was present in both hospitals in replacement of the multiresistant MRSA South American clone, previously described in these hospitals. The staphylococcal chromosomal cassette (SCCmec) type I element was detected in this new clone.

[Consensus for antimicrobial susceptibility testing for Enterobacteriaceae. Subcommittee on Antimicrobials, SADEBAC (Argentinian Society of Clinical Bacteriology), Argentinian Association of Microbiology]. / Consenso sobre las pruebas de sensibilidad a los antimicrobianos en Enterobacteriaceae.

Taking into account previous recommendations from the National Committee for Clinical Laboratory Standards (NCCLS), the Antimicrobial Committee, Sociedad Argentina de Bacteriología Clínica (SADEBAC), Asociación Argentina de Microbiología (AAM), and the experience from its members and some invited microbiologists, a consensus was obtained for antimicrobial susceptibility testing and interpretation in most frequent enterobacterial species isolated from clinical samples in our region. This document describes the natural antimicrobial resistance of some Enterobacteriaceae family members, including the resistance profiles due to their own chromosomal encoded beta-lactamases. A list of the antimicrobial agents that should be tested, their position on the agar plates, in order to detect the most frequent antimicrobial resistance mechanisms, and considerations on which antimicrobial agents should be reported regarding to the infection site and patient characteristics are included. Also, a description on appropriate phenotypic screening and confirmatory test for detection of prevalent extended spectrum beta-lactamases in our region are presented. Finally, a summary on frequent antimicrobial susceptibility profiles and their probably associated resistance mechanisms, and some infrequent antimicrobial resistance profiles that deserve confirmation are outlined.

Penicillin-binding proteins in Listeria monocytogenes.

The Penicillin-Binding Proteins (PBP) of Listeria monocytogenes 29-CCM-A: 454 (ATCC 15313) are described by the use of 125I-Penicillin X as radiotracer. The membranes of this tolerant bacilli contained at least five proteins with different affinities for the radiotracer or Dicloxacillin. The molecular weights of these proteins were estimated as 76, 74, 67, 66 and 47 KDa. Dicloxacillin induced the formation of straight filaments when present at sub-inhibitory concentrations, while Penicillin G did not induce any visible alteration in the morphology of this microorganism.

Chromogenic detection of aminoglycoside phosphotransferases.

Acquired resistance to aminoglycosides is most frequently due to the presence of the so-called aminoglycoside modifying enzymes (AGME) (1) able to catalyze one or more of three general reactions: N-acetylation, O-nucleotidylation and O-phosphorylation (2). Although resistance phenotype (to different (substrate or not for enzymatic modification) may serve as an approach for identifying actual enzymes present in a given isolate (3), results can be obscured or confusing, particularly when several different enzymes (4) (even, isoenzymes with different affinities) are superimposing their action in a single microorganism with potential "permeability" or target alterations. Thus, identification of the AGME content of a given strain also requires screening at the DNA level using probes specific to all the known AGME (5). However, the complete set of probes is available only to a few laboratories around the world, making surveillance for the appearance of novel enzymes, or the unlikely evolution of those already known, a relatively nonfeasible goal, as search for new enzymes may begin only after failing to hybridize to all known probes.

Antimicrobial activity of Argentine plants used in the treatment of infectious diseases. Isolation of active compounds from Sebastiania brasiliensis.

Different extracts of Sebastiania brasiliensis, Sebastiania klotszchiana, Polygonum punctatum, Lithraea molleoides and Myrcianthes cisplatensis, all plants growing in Entre Ríos Province and traditionally used as antiseptics, were tested against a set of Gram positive and Gram negative bacteria and fungi. All the species, with the exception of M. cisplatensis, presented activity against some of the microorganisms tested. A 50% hydroalcoholic extract of S. brasiliensis was selected for bioguided fractionation. Two antimicrobial compounds identified as methylgallate (MIC 128 microg/ml) and protocatechuic acid (MIC 128 microg/ml) were isolated apart from quercetin, kaempferol, quercitrin and gallic acid.

Antimicrobial activity of 5,6-dihydrobenzo-[a]-carbazoles.

A new series of 5,6-dihydrobenzo[a]carbazoles was synthesized, some showing good antibacterial activity. The presence of a dialkylamino ethyl chain on the 2-, 3- or 4-O-substituent seems to be critical for such activity.

Antimicrobial activity of 5,6-dihydrobenzo-[a]-carbazoles. Part II.

A new series of twenty-two 5,6-dihydrobenzo[a]carbazoles was synthesized, some showing good antibacterial activity. The presence and position of substituents seems to be critical for such activity.

[Obtaining dicloxacillin-resistant mutants in Listeria monocytogenes]. / Obtención de mutantes dicloxacilina resistentes en Listeria monocytogenes.

We obtained ten Dicloxacillin resistant mutants from Listeria monocytogenes ATCC: 15313 (29-CCM-A: 454). None of the mutants could be differentiated from the parental strain (except for their increased resistance) neither using conventional biochemical assays nor by analysis of the electrophoretic pattern of their detergent-soluble proteins (Figure 1). The wild type strain and some of these mutants were tolerant for Dicloxacillin and/or Penicillin G, but no rigorous correlation with each decrease in their susceptibility was observed (Table 1). Morphological studies showed that some of the resistant strains (growing at subinhibitory concentrations of Dicloxacillin) presented differences, including the formation of helical structures (Figures 2-5).