Molecular typing and resistance mechanisms of carbapenem resistant Pseudomonas aeruginosa isolated from a Chinese surgical intensive care unit.

BACKGROUND: Carbapenems are an important class of drugs for the treatment of Pseudomonas aeruginosa (P. aeruginosa) infections. However, carbapenem resistance has been commonly observed in nonfermenter species of bacteria. The purpose of this study was to investigate the molecular epidemiology and carbapenem resistant mechanisms of P. aeruginosa isolated from a surgical intensive care unit (SICU) in China. METHODS: The molecular typing was analyzed by REP-PCR. Enzyme activity was measured with a 260 nm wavelength spectrophotometer. The levels of outer membrane proteins OprD and OprN were measured by Western blotting. The levels of mexA gene transcriptional expression were measured by quantitative real-time PCR. The metallo-beta-lactamase genes IMP, VIM, SPM, GES, and GIM were amplified by PCR. DNA fragments were sequenced by an automated ABI PRISM 3700. RESULTS: Forty-two strains resistant to carbapenems isolated from a SICU were analyzed. REP-PCR revealed 34 belonging to type A, a predominant strain in this SICU. But we did not find metallo-beta-lactamases IMP, VIM, SPM, GES, or GIM genes by PCR. With a three-dimensional extract test, we found 34 strains producing high levels of AmpC enzymes. We also observed the activity of beta-lactamases enzymes in the imipenem resistant group, which was statistically different from the sensitive group. Western blotting revealed that 23 strains showed loss of OprD, 18 strains had decreased OprD expression, and 14 strains expressed OprN. We discovered 27 strains that overexpressed mexA by quantitative real-time PCR, and the resistance rate to meropenem was statistically different between the overexpressing group and the low-expressing group. Nucleotide sequences and deduced amino acid sequence analysis revealed that eight strains carried mutations in the mexR gene operon down regulating MexAB-OprM. The nucleotide sequences of mexR genes from PA36, PA41 and PA48 were submitted to the Genebank with accession numbers of AY899299, AY899300, and AY899301. CONCLUSIONS: There was a predominant strain in the SICU of our hospital. Imipenem resistance is mainly mediated by OprD deficiency or loss, and high activity AmpC enzymes. Overexpression of MexAB-OprM is one of the mechanisms of meropenem resistance, which are partly upregulated by mutations in the mexR gene. The expression of MexEF-OprN also plays an important role in the carbapenem resistance.

The maximum tolerated dose of gamma radiation to the optic nerve during γ knife radiosurgery in an animal study.

BACKGROUND: The safety of gamma knife radiosurgery should be considered when treating pituitary adenomas. OBJECTIVES: To determine the maximum tolerated dose of radiation delivered by gamma knife radiosurgery to optic nerves. METHODS: An animal model designed to establish prolonged balloon compression of the optic chiasm and parasellar region was developed to mimic the optic nerve compression caused by pituitary adenomas. Twenty cats underwent surgery to place a balloon for compression effect and 20 cats in a sham operation group received microsurgery without any treatment. The effects of gamma knife irradiation at 10-13 Gy on normal (sham operation group) and compressed (optic nerve compression group) optic nerves were investigated by pattern visual evoked potential examination and histopathology. RESULTS: Gamma knife radiosurgery at 10 Gy had almost no effect. At 11 Gy, P100 latency was significantly prolonged and P100 amplitude was significantly decreased in compressed optic nerves, but there was little change in the normal optic nerves. Doses of 11 Gy and higher induced significant electrophysiological variations and degeneration of the myelin sheath and axons in both normal and compressed optic nerves. CONCLUSIONS: Compressed optic nerves are more sensitive to gamma knife radiosurgery than normal optic nerves. The minimum dose of gamma knife radiosurgery that causes radiation injury in normal optic nerves is 12 Gy; however, the minimum dose is 11 Gy in compressed optic nerves.

Relationship between genomic types of Escherichia coli and clinical diseases.

In this study, by analysis of genome structures of E. coli, the relationships between the genomic types of E. coli and the associated diseases were investigated. Samples of sputum, urine and other excretions from patients with different infective diseases were collected. And 62 E. coli strains were isolated from these samples. Intact bacterial genomic DNA was cleaved with I-CeuI, separated by pulsed field gel electrophoresis and then typed on the basis of cleavage map. The results showed that 7 I-CeuI sites were found in all the genome structures of the 62 E. coli, indicating that there were 7 rrn operons in the genomes. The size of genome ranged from 4,500 kb to 5,000 kb. According to the genome structures, 62 E. coli strains were divided into 30 genome types. It was concluded that genome structures of E. coli isolated from the patients with different infective diseases varied to some extent, suggesting that some genome types of E. coli were closely related to some infective diseases.

Relationship between Genomic Types of Escherichia coli and Clinical Diseases / 华中科技大学学报（医学）（英德文版）

In this study, by analysis of genome structures of E. coli, the relationships Between the genomic types of E. coli and the associated diseases were investigated. Samples of sputum, urine and other excretions from patients with different infective diseases were collected. And 62 E. coli strains were isolated from these samples. Intact bacterial genomic DNA was cleaved with I-CeuI, separated by pulsed field gel electrophoresis and then typed on the basis of cleavage map. The results showed that 7 I-CeuI sites were found in all the genome structures of the 62 E. coli, indicating that there were 7 rrn operons in the genomes. The size of genome ranged from 4500 kb to 5000 kb. According to thegenome structures, 62 E. coli strains were divided into 30 genome types. It was concluded that genome structures of E. coli isolated from the patients with different infective diseases varied to some extent, suggesting that some genome types of E. coli were closely related to some infective diseases.

[The roles of active efflux system overexpression and outer membrane protein OprD deficiency or loss in carbapenem resistance of Pseudomonas aeruginosa].

OBJECTIVE: To investigate the mechanisms of carbapenem resistance in Pseudomonas aeruginosa (PA). METHODS: Forty-nine strains of PA were isolated from surgical intensive care unit during a period of 3 years. The levels of outer membrane protein OprD and OprN were measured by Western blotting. RT-PCR was used to measure the transcription levels of mexA gene. The metallo-beta-lactamase genes IMP and VIM and the negative regulator gene mexR for mexAB-OprM operon were amplified. The DNA fragments were sequenced by automated ABI PRISM 3700 sequencer. RESULTS: 42 of the 49 strains were resistant to carbapenem. 23 of the 42 strains showed loss of OprD and were all resistant to imipenem, but only one strain was resistant to meropenem. 18 of the 42 strains had a decreased OprD expression, 17 of which were resistant to Imipenem, and 3 were resistant to meropenem as well. 7 strains expressed OprD, all of which were sensitive to carbapenem. 27 strains overexpressed the mexAB-OprM. The resistant rate to imipenem of the mexAB-OprM overexpression group was 86.4%, not significantly different from that of the mexAB-OprM low expression group (81.5%, chi(2) = 0.005, P = 0.943). But the resistant rate to meropenem of the mexAB-OprM overexpression group was 44.4%, statistically higher than that of mexAB-OprM low expression group (13.6%, chi(2) = 5.417, P = 0.020). Nucleotide sequences and deduced amino acid sequences analysis revealed that eight strains overexpressed mexAB-OprM carried mutations in mexR gene, 7 of which had amino acid substitutions in MexR protein, and one of which had terminal code at the position of amino acid 32. 14 strains were found expressing OprN. Neither IMP gene nor VIM gene was found in the isolates. CONCLUSION: In the clinical strains from SICU, the imipenem resistance is mainly mediated by OprD deficiency or loss. Overexpression of MexAB-OprM is the primary mechanism of meropenem resistance, which is upregulated by mutations in mexR gene. Metallo-beta-lactamases IMP and VIM are rarely seen.