- Volume 1, Issue 1A, 2019

Beta Lactamases is proven to be one of the leading cause of resistance to β-lactam antibiotics among gram-negative bacteria. Many up to date researches have shown increase in the incidence and prevalence of ESBL worldwide. This study aimed to determine the prevalence of ESBL strains of Klebsiella spp. and Escherichia coli species in urinary isolates from the patients admitted in Thumbay hospitals around United Arab Emirates. Furthermore, drug resistant genes (SHV and CTX-M) in the ESBL positive samples were detected. 237 urine samples were collected from November 2017 to January 2018. Based on the lactose utilization, colony morphology, and biochemical utilization of the gram negative bacilli were identified as E. coli (53), Klebsiella pneumoniae (10) and Citrobacter species (2). Antibiotic sensitivity test, double disc diffusion test and combination disc tests all confirmed that the 65 (27.4 %) out of 237 isolates were ESBL producing bacteria. There was high prevalence of bacteria in females than male and the number of E. coli strains is higher than Klebsiella spp. DNA isolation was performed on the 65 samples, out of which 50 samples were selected for PCR based on their concentration. The selected DNA samples were used to detect the presence of bla CTX-M and bla SHV genes. Only 24 DNA samples (48 %) contains blaCTX-M genes, bla SHV or both the genes. 14 samples had bla CTX-M gene, 2 bla SHV genes, and 8 with both bla SHV and bla CTX-M. At the rate at which ESBL is spreading, further research, close observation and cautious use of antibiotics is important.

The Enterococci are a resilient collection of species, found in the human intestine, river sediment and even certain cheeses. Human infection by this genus is dominated by E. faecalis and E. faecium. Vancomycin resistant enterococci (VRE) are associated with higher mortality rates over non-VRE strains. Enterococci can utilise the highly efficient pheromone responsive plasmid (PRP) system to transfer plasmid DNA between cells. Plasmid containing donor cells respond to small peptide pheromones (7–8 amino acids) and transfer plasmid DNA to pheromone-producing plasmid-free recipient cells. PRP can encode antibiotic resistance (including vancomycin) and virulence enhancing factors. Investigation into the PRP system between donor and recipient E. faecalis environmental isolates has indicated a 40 % decrease in PRP transfer in colder environments. Additionally, PRP efficiencies under other conditions, including in presence of synthetic pheromone peptides, have been calculated. Future assays will utilise pheromone imitative fluorescently labelled synthetic peptides to visualise the pheromone binding receptor (PrgZ) on the E. faecalis donor cell membrane. Later experiments will focus on varying the synthetic pheromone amino acid composition so to interfere with the PRP system machinery, with the aim of reducing PRP transfer efficiency or preventing PRP transfer completely.

Chronic wounds are a significant issue in healthcare, presenting a considerable economic burden to the NHS and a serious health risk to patients. The majority of non-healing wounds have been shown to contain a biofilm which prolongs the inflammatory stage of wound healing and significantly delays wound healing. This often causes a normal wound to progress and become chronic, presenting further problems for patients including increased risk of secondary infection, further deterioration of the wound and an increase in treatment intensity. This project aims to assess the efficacy of several compounds in modulating the formation of biofilms in a number of clinically relevant pathogens when used at sub-inhibitory concentrations. The organisms used in this project include Pseudomonas aeruginosa and Staphylococcus aureus. We aim to test the efficacy of three plant derived compounds including 4-hydroxy-2,5-dimethyl-3(2 h) furanone (HDMF), 2-methyltetrahydrofuran-3-one (MTHF) and l-ascorbic acid. Future work will characterise the efficacy of these compounds when delivered to a biofilm from a hydrogel based delivery system. At sub-inhibitory concentrations in pure solution, candidate molecules tested to date showed no ability to reduce biofilm formation. Indeed, treatment with HDMF resulted in greater production of biofilm in P. aeruginosa and treatment with all compounds showed no difference in biofilm formation by S. aureus. To characterise the impact of hydrogel based delivery on compound efficacy all candidate molecules were loaded into a hydrogel and shown to be effectively released from it. Experiments to characterise the modulatory potential of these compounds when released from a hydrogel are currently underway.

Diabetic foot infection is the main reason for diabetes-related hospitalisation and is a major cause of diabetes-related amputation. Recent figures published by Public Health England show that there are more than 163 diabetes related amputations in England every week. This study investigates the effect of antibiotic loaded calcium sulfate (Stimulan® Rapid Cure) beads on in-vitro bacterial growth from tissue taken from diabetic foot infections. Patients were recruited from the Macleod Diabetes and Endocrine Centre at the Royal Devon and Exeter Hospital. Inclusion in the study was based on clinical recognition of an infected foot ulcer requiring wound debridement. Debrided tissue was homogenised and 50 µl spread over the surface of Columbia blood agar and fastidious anaerobe agar. Three replicate calcium sulfate beads containing a combination of vancomycin and gentamicin were then placed on the surface of the agar. Each bead contained approximately 3.4 mg and 1.6 mg of vancomycin and gentamicin respectively. Plates were incubated aerobically or anaerobically as appropriate. Zones of inhibition were recorded at 1 and 4 days. Calcium sulfate beads containing vancomycin and gentamicin were able to inhibit bacterial growth in all tissue homogenates tested with zone diameters ranging from 16 to 40 mm. Local release of antibiotics could have the benefit of achieving high local concentrations within poorly vascularised tissue which may inhibit bacterial growth at the wound site. By improving treatment of diabetic foot infections, it may be possible to prevent amputation, maintain mobility and conserve quality of life.

Rapid and accurate identification of pathogens in CF could ensure prompt treatment with the most appropriate antibiotic; potentially improving outcomes and shortening hospital stays. As traditional culture methods for detecting bacteria are time-consuming there is a growing interest in SERS as a novel culture-free technique that produces a whole-organism spectroscopic fingerprint at high speed. Bacterial isolates including Pseudomonas aeruginosa (n=32), Staphylococcus aureus (n=5), Streptococcus pneumoniae (n=5) were incubated for 6 h at 37 °C/180 r.p.m., with a starting optical density (OD) of 0.15. After adjustment of the OD to 0.3, bacterial cells were harvested by centrifugation at 9000 rcf for 3 min and washed three times with dH2O. Bacterial pellets were mixed with citrate reduced silver colloid (CRSC) and dried. Spectra were recorded (4×10 s at 785 nm) and analysed within GRAMS/Al using Principal Component Analysis (PCA). Spectra of P. aeruginosa isolates (n=32) were separated into two distinct groups; the spectra of one group (n=12) was dominated by the pigment pyocyanin with vibrational brands present at 1350, 1492, 1598 and 1615 cm-1. The other group (n=20) had characteristic vibrational bands at 661, 735 and 800 cm-1 which correspond to guanine, adenine and uracil, respectively. S. aureus has a main characteristic band at 735 cm-1 and S. pneumoniae has a characteristic band present at 480 cm-1. Bacterial species clustered separately when analysed by PCA. Reproducible and distinguishable SERS spectra of bacterial isolates were obtained, and it was possible to differentiate between different bacterial species using PCA. These results suggest SERS has the potential to rapidly detect bacteria.

Antibiotic resistance is a serious threat to public health. The empiric use of the wrong antibiotic occurs due to urgency in treatment combined with slow, culture-based diagnostic techniques. Inappropriate antibiotic choice can promote the development of antibiotic resistance. We propose to use live/dead spectrometry as a rapid alternative to culture-based techniques through application of the LIVE/DEAD® BacLightTM Bacterial Viability Kit. We have developed a spectroscopic device (Optrode) to measure fluorescence from SYTO 9 and propidium iodide stained cells that can be used to enumerate the bacterial load. We propose a procedure using the Optrode that will take bacteria in a clinical sample, challenge with a panel of antibiotics, and measure live/dead ratios to determine the best bactericidal choice. Using calibration data we optimised the live/dead spectrometry protocol outlined in the kit instructions, improving upon media selection for growth and staining, and analytical parameters. We applied the optimised methodology to detect live and dead Escherichia coli in populations challenged with ampicillin. Killing was detected by the Optrode in near real-time when E. coli was treated with ampicillin and stained with SYTO 9 and/or PI. Following on from the promising results generated with ampicillin, live/dead spectrometry of ampicillin challenged cells was characterised in terms of antibiotic concentration, growth phase, and susceptibility to treatment for each treatment time. The generated data demonstrated that reliable detection of E. coli knockdown by ampicillin using live/dead spectrometry requires log phase cells challenged with a suitable concentration for a particular treatment time.

The National Collection of Type Cultures (NCTC) is a bacterial culture collection which is taxonomically and biologically diverse. NCTC holds approximately 6000 different strains from over 900 different species; among them strains originally isolated in the 19th century, strains for use as controls as stipulated EUCAST and ISO guidelines, type strains on which the description of bacterial species are based and other strains from a variety of backgrounds. The remit of NCTC is to provide authentic bacterial cultures of medical and veterinary interest to the scientific community, to support and enhance the reproducibility of scientific research and to improve global public health. To fulfil this remit, remain scientifically relevant and to preserve the legacy of contemporary medical bacteriology for future scientists, NCTC accessions strains of clinical significance: such as recently circulating and outbreak strains, diagnostic escape mutants and strains with novel antimicrobial resistance profiles. In 2018, 166 bacterial strains were accessioned into the NCTC and made available to the scientific community. These include NCTC 14052: a reference strain for emergent hyper-virulent K. pneumoniae, 4 type strains of newly described bacterial species, 82 strains accessioned from the Murray Collection of pre-antibiotic era Enterobacteriaceae and 8 strains with antimicrobial resistance mechanisms previously unrepresented in the collection, including NCTC 14208: a N. gonorrhoeae isolated from an instance of combined ceftriaxone and azithromycin treatment failure. Through literature review we have highlighted their value to the scientific community, both in their own right and in the context of bacterial strains already held by the NCTC.

The incidences of Candida albicans infections and their changing drug resistance patterns have drastically increased in recent years. Therefore, new drugs and alternative treatment strategies are promptly required. Combination therapy and the use of natural products have been extensively studied as alternative treatment. In this study, we synthesized Eugenol Tosylate Congeners (ETCs 1–6) and evaluated their antifungal activity profile alone and in combination with fluconazole (FLC) against four FLC susceptible and three FLC resistant clinical isolates of Candida albicans isolates according to CLSI guidelines. For insight mechanism of antifungal action of ETCs, activity of plasma membrane H+-ATPase pump of these C. albicans isolates was determined by monitoring the pH of the external medium. ETC 1 and ETC 4 were the most active congeners against the resistant isolates with the MIC ranging from 125 to 250 µg ml−1. The MFC of ETCs ranged from 1000 µg ml−1 to 2000 µg ml−1. Results interpreted from fractional inhibitory concentration index (FICI) and isobolograms showed 36 % of synergy, 29 % of additive, 33 % of indifferent and 2 % of antagonistic interactions. These compounds also inhibit H+efflux activity of H+-ATPase pump at varying degrees. Our results suggest that these ETCs may be directly binding to this pump and thereby inhibiting H+-efflux in Candida cells. These results advocate the potential of these compounds in developing new antifungal drugs; however, further studies are required to understand the other mechanisms involved and in vivo efficacy and toxicity of these compounds.

Pseudomonas aeruginosa is a significant nosocomial pathogen responsible for severe and life threatening infections particularly in immunocompromised patients. This organism is ubiquitous in healthcare environments particularly water systems which act as a reservoir of infection. Recognition of a potential outbreak and having the ability to quickly identify and mitigate sources of exposure is critical for effective infection control. Historically analysis of P. aeruginosa antibiogram profiles represents a convenient and frequently used ‘first line’ indicator of strain relatedness. Reported here is a comparison of P. aeruginosa antibiogram profiles with those obtained using rapid Variable Number Tandem Repeat (VNTR) for patient and environmental isolates in in three separate local nosocomial outbreaks. The results demonstrate that antibiogram profiles from P. aeruginosa should not be employed as presumptive indicators of relatedness, doing so can falsely re-assure clinicians. Use of rapid molecular typing method VNTR allows genotypically identical strains to be unambiguously identified within 48 h.

During bacteremic pneumonia, the prevailing dogma is that bacteria seed from the lungs into the blood. Recently, we have shown that experimental murine sepsis is preceded by intracellular replication within splenic macrophages (Ercoli Nat Microbiol 2018), which shed into the bloodstream initiating invasive disease. Here we aimed to investigate a role for the spleen in the pathogenesis of bacteraemia following pneumonia. We analysed by confocal microscopy the fate of pneumococci during ex vivo human spleen perfusions (REC reference: 18/EM/0057), in spleens during pneumonia in non-human primates (Reyes PLOS one 2016) and mice. During ex vivohumanspleenperfusion, clusters of pneumococci were observed within macrophages and the size of bacterial clusters increased over time. To associate these infectious foci to invasive pneumococcal disease during pneumonia, we analysed spleens in a baboon pneumonia model, and detected pneumococcal clusters in splenic macrophages. To test the functional relevance of these data, we treated intranasally-challenged mice with a single, non-therapeutic sub-MIC dose of azithromycin, known to concentrate inside macrophages. Data showed that bacterial lung-counts were identical in treated and untreated mice. Untreated mice showed signs of disease, had high blood and spleen-counts, whereas mice treated with the non-therapeutic dose showed no signs of disease, had low spleen-counts and no bacteraemia. Thus, the number of pneumococci in the spleen, not the lung, correlates to blood-counts during bacterial pneumonia. We hypothesise that after initial control of invasive infection by the spleen, bacteraemia associated with pneumonia arises from a sub-set of splenic macrophages that are permissive for bacterial replication.

On the C. difficile cell surface is a proteinaceous paracrystalline array, known as the S-layer. The S-layer of C. difficile is composed of two proteins: the high molecular weight (HMW) and the low molecular weight (LMW) S-layer proteins, derived from the pre-protein SlpA. PS-II, an anionic polymer found in all C. difficile strains examined to date, has been identified as the ligand responsible for the attachment of S-layer and associated cell wall proteins. Early efforts to knock out slpA proved unsuccessful and the genes thought to encode the PS-II synthesis pathway were also thought to be essential. However, by using bacteriocins that specifically target the S-layer, we recently isolated a mutant which had no evident S-layer due to a mutation in the slpA gene. As the S-layer was previously thought to be essential, it now brings into question whether PS-II is also essential. In the strain lacking an S-layer, we have now created a deletion mutant in the putative PS-II polymerase and we are attempting to generate additional mutations in the polysaccharide synthesis pathway. Analysis of these mutants will provide insights into the mechanism of PS-II synthesis and shed light on its function in cell morphogenesis.

Salmonella enterica is a human and veterinary pathogen of global importance. Cattle are a key reservoir of S. enterica serotypes that cause non-typhoidal salmonellosis in humans and infections are often acquired via consumption of contaminated food. Salmonella can survive within the bovine lymphatic system and contaminated peripheral lymph nodes often enter the food chain via ground beef production because they are small and deeply embedded in fat, making it impossible to remove them during food production. S. enterica serotypes can also cause acute enteritis and systemic typhoid-like disease in cattle, thereby exerting a significant burden on bovine welfare and productivity. Existing vaccines confer limited serotype-specific protection and a need exists to better understand the host and bacterial factors involved in pathogenesis and protection to inform the design of new vaccines and other intervention strategies. Most of our knowledge about salmonellosis comes from the mouse typhoid model. Here, we sought to understand the effects of infection by Salmonella Dublin, which causes typhoid-like disease in cattle, in its natural host. By infecting cattle with S. Dublin expressing green fluorescent protein and using flow cytometry we have been able to isolate and characterise the bovine cells infected by S. Dublin, study changes in their cell surface marker expression post-infection and compare tropism in the intestine and draining lymph nodes. We have also studied the survival of S. Dublin in the main infected host cell type in vitro using primary cells to determine the consequences of infection on the pathogen itself.

Neisseria meningitidisis a cause of meningitis and severe sepsis. A moonlighting protein is a protein with the ability to perform additional task(s) alongside its recognised function. These proteins have been identified in both prokaryotic and eukaryotic cells and they represent a highly conserved subset of proteins that typically are either metabolic pathway-associated enzymes or act as molecular chaperones. To explore the role of GlnA in the pathogenesis of meningococcal disease, the encoding gene designated NMB0359, was amplified from the wild-type meningococcal strain MC58 and cloned into the pQE-30 expression vector. Recombinant glutamine synthetase (rGlnA) was expressed in E. coli and purified by immobilised metal affinity chromatograph. Rabbit antisera was raised against purified rGlnA (RαGlnA) and used to investigate the localisation of GlnA at the cell surface. Attempts were also made to generate glnA knockout and complemented strains of wild-type N. meningitidis. rGlnA was successfully purified from E. coli cell lysates under native conditions. A highly immuno-reactive band of the expected size (52 kDa) was observed when rGlnA immunoblot was probed with RαGlnA. GlnA could be detected on the surface of wild-type encapsulated N. meningitidis MC58 using whole-cell enzyme linked immunosorbent assay (ELISA). Surface localisation of GlnA indicates that it may be a moonlighting protein carrying out function(s) at the cell surface. Future work will investigate possible moonlighting functions which may include adhesion to host cells and proteins, regulation of the host immune response, and contribution to bacterial virulence.

Autotransporter proteins are major secreted virulence factors of Gram-negative bacteria. They are translocated across the inner membrane via the Sec machinery and the outer membrane via the Bam complex and a series of periplasmic chaperones, respectively. The passenger domain may then be proteolytically cleaved and released into the external milieu. The meningococcal autotransporters Adhesion and penetration protein (App) and Meningococcal serine protease A (MspA) are secreted S6-peptidase family autotransporters. Our previous work has shown that FITC-labelled recombinant App or MspA can be taken up by host cells and translocated into the nucleus. App and MspA can also bind to, and cleave recombinant host histones. We furthered investigate the ability of App and MspA (and their inactive derivatives) to cleave recombinant and host-derived histones. Our data demonstrate proteolytic activity of App and MspA on recombinant H3 and Hep-2 cell-derived H3 (which may undergo post-translational modifications that are not applied to the recombinant protein); no cleavage was observed when the histone proteins were treated with proteolytically inactive mutants of the autotransporter proteins. We have also further investigated the nuclear localisation of App and MspA by deleting areas of interest within the meningococcal autotransporters and assessing the impact on nuclear localisation in order to identify the autotransporter motifs required to direct App and MspA to the nuclear compartment. In summary, our results confirm that App and MspA can reach the nuclear compartment of the host cell and clip host-derived histone H3.

The opportunistic pathogen Pseudomonas aeruginosa utilizes a wide range of virulence factors to adapt to the host environment. With the antimicrobial pipeline drying up, understanding and targeting virulence factors for therapeutic development is an exciting alternative for the discovery of novel disease inhibitors. An integrated genome-wide transposon mutagenesis screening approach was performed in P. aeruginosa using multiple in vivo disease models with the aim to identify new virulence factors required for infection. A mutant attenuated in the production of multiple virulence determinants using in vitro assays was identified. This mutant also showed severe attenuation using in vivo models with up to an 80 % increased survival in murine chronic and acute lung infection models. The predicted protein coded by the mutated gene showed homology to nitrite and sulphite reductases. Using a methyl viologen reduction assay, we have shown that this gene encondes a nitrite reductase, operating in a siroheme and 4Fe-4S dependant manner. The preference for nitrite and the requirement of siroheme revealed that product of this gene is an assimilatory nitrite reductase and hence we propose it to be named as NirA. Work is now on-going to understand how NirA contributes to virulence and determine the crystal structure of this protein with a view to screen for novel inhibitors of this enzyme using a drug discovery platform available in our laboratories.