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      Características patogénicas de cepas de Pseudomonas aeruginosa resistentes a carbapenémicos, asociadas con la formación de biopelículas Translated title: Pathogenic characteristics of Pseudomonas aeruginosa strains resistant to carbapenems associated with biofilm formation

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          Abstract

          Introducción. A escala mundial, se ha observado la aparición de cepas de Pseudomonas aeruginosa multirresistentes durante las últimas décadas. Este patógeno oportunista produce mecanismos de resistencia a diversos antibióticos. La resistencia a carbapenémicos en cepas de P. aeruginosa se ha asociado con la formación de biopelículas bacterianas, favorecidas por la presencia de exopolisacáridos (EPS) embebidos en una matriz extracelular y por la producción de los pili tipo IV (T4P). El objetivo de este trabajo fue evaluar la formación de biopelículas en cepas clínicas aisladas en el Hospital Infantil de México Federico Gómez de P. aeruginosa resistentes a carbapenémicos, a través de la cuantificación de los expolisacáridos totales-reductores y su asociación con la expresión fenotípica de los T4P. Métodos. Se realizaron ensayos de susceptibilidad antibiótica por el método de Kirby-Bauer en 92 cepas clínicas de P. aeruginosa. Asimismo, se determinó la concentración mínima inhibitoria (MIC) para imipenem (IMP) y meropenem (MEM) por el método de dilución seriada en placas con agar con un replicador de Steers. La producción de metalo-β-lactamasas fue determinada mediante la técnica de difusión en disco y de sinergismo. Las biopelículas fueron realizadas en cepas clínicas de P. aeruginosa resistentes a carbapenémicos, a través de la cuantificación de cristal violeta, azúcares totales (antrona) y azúcares reductores (DNS), además de la expresión fenotípica de los T4P por la actividad de twitching motility . La diversidad genética de las cepas formadoras de biopelículas y productoras de azúcares reductores fue evaluada mediante la técnica de electroforesis de campos pulsados (PFGE). Resultados. El 30.4% (28/92) de las cepas de P. aeruginosa de origen pediátrico fueron recuperadas de la sala de cirugía y el 50% (46/92) de muestras de orina. Los resultados por Kirby-bauer mostraron que más de 50% de la cepas de P. aeruginosa fueron resistentes a 12 diferentes antibióticos. La MIC a los carbapenémicos fue de 64 µg/ml, con 43.1% (25/58) para MEM y 56.8% (33/58) para IMP. Así mismo, la producción de metalo-β-lactamasas fue observada en 43% (25/58) para MEM, 2% (1/58) para IMP y 12% (7/58) para ambas. Los análisis mostraron que 82% (48/58) de las cepas de P. aeruginosa resistentes a carbapenémicos fueron altas formadoras de biopelículas. De éstas, 46.5% (27/58) mostraron concentraciones de EPS totales de 2000 a 6000 µg/ml y 27.5% (16/58) mostraron concentraciones de EPS reductores de 316 a 1108 µg/ml; además, 75% (44/58) de estas cepas mostraron actividad fenotípica de twitching motility . Conclusiones. La detección de azúcares totales, azúcares reductores y el fenómeno de twitching motility son factores que favorecen el desarrollo de las biopelículas en cepas clínicas de P. aeruginosa resistentes a carbapenémicos. Los datos sugieren que estos factores están involucrados en la formación de biopelículas que confieren a la bacteria la capacidad para sobrevivir, persistir y colonizar a su hospedero.

          Translated abstract

          Background. In recent years, the worldwide emergence of multidrug-resistant strains of Pseudomonas aeruginosa has been observed. This opportunistic pathogen produces mechanisms of resistance to several antibiotics. The resistance to carbapenems in P. aeruginosa strains has been associated with bacterial biofilm formation, favored by the presence of exopolysaccharides (EPS) embedded in an extracellular matrix and to the production of type IV pili (T4P). We undertook this study to assess biofilm formation in clinical strains of P. aeruginosa resistant to carbapenems isolated at the Hospital Infantil de Mexico Federico Gomez (HIMFG) through quantification of total-reducing EPS and its association with the phenotypic expression of T4P. Methods. Antibiotic susceptibility tests were performed using the Kirby-Bauer method in 92 clinical isolates of P. aeruginosa ; likewise, the minimum inhibitory concentration (MIC) was determined for imipenem (IMP) and meropenem (MEM) by the serial dilution method in agar plates with a Steers replicator. Production of metallo-β-lactamase (MBL) was determined by the disk diffusion method and synergism. Biofilm formation was performed in clinical isolates of P. aeruginosa resistant to carbapenems through the quantification of crystal violet, total sugar (anthrone), and reducing sugar (DNS), in addition to the phenotypic expression of T4P activity of twitching motility. The genetic diversity of strains forming biofilm and producing reducing sugars was evaluated by pulsed-field gel electrophoresis (PFGE). Results. There were 30.4% (28/92) of P. aeruginosa strains of pediatric origin and 50% (46/92) of urine samples that were recovered from the operating room. The results using the Kirby-Bauer method showed that >50% of P. aeruginosa strains were resistant to 12 different antibiotics. The MIC to carbapenems was 64 µg/ml, with 43.1% (25/58) for MEM and 56.8% (33/58) for IMP. Likewise, MBL production was observed in 43% (25/58) for MEM, 2% (1/58) for IMP, and 12% (7/58) for both. Qualitative and quantitative analysis showed that 82% (48/58) of P. aeruginosa strains resistant to carbapenems were high biofilm formers using the crystal violet method. Of the high biofilm forming strains, 46.5% (27/58) showed concentrations of total EPS between 2000 and 6000 µg/ml and 27.5% (16/58) showed concentrations of reducing EPS between 316 and 1108 µg/ml. In addition, 75% (44/58) of these strains showed phenotypic activity of twitching motility. Conclusions. Detection of total sugars, reducing sugars, and the phenomenon of twitching motility are factors that promote the development of biofilms in clinical strains of P. aeruginosa resistant to MBL producers to carbapenems. Our data suggest that these factors are involved in biofilm formation, which confer bacterium with the ability to survive, persist, and colonize its host.

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          Most cited references43

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          Flagellar and twitching motility are necessary for Pseudomonas aeruginosa biofilm development.

          The formation of complex bacterial communities known as biofilms begins with the interaction of planktonic cells with a surface in response to appropriate environmental signals. We report the isolation and characterization of mutants of Pseudomonas aeruginosa PA14 defective in the initiation of biofilm formation on an abiotic surface, polyvinylchloride (PVC) plastic. These mutants are designated surface attachment defective (sad ). Two classes of sad mutants were analysed: (i) mutants defective in flagellar-mediated motility and (ii) mutants defective in biogenesis of the polar-localized type IV pili. We followed the development of the biofilm formed by the wild type over 8 h using phase-contrast microscopy. The wild-type strain first formed a monolayer of cells on the abiotic surface, followed by the appearance of microcolonies that were dispersed throughout the monolayer of cells. Using time-lapse microscopy, we present evidence that microcolonies form by aggregation of cells present in the monolayer. As observed with the wild type, strains with mutations in genes required for the synthesis of type IV pili formed a monolayer of cells on the PVC plastic. However, in contrast to the wild-type strain, the type IV pili mutants did not develop microcolonies over the course of the experiments, suggesting that these structures play an important role in microcolony formation. Very few cells of a non-motile strain (carrying a mutation in flgK) attached to PVC even after 8 h of incubation, suggesting a role for flagella and/or motility in the initial cell-to-surface interactions. The phenotype of these mutants thus allows us to initiate the dissection of the developmental pathway leading to biofilm formation.
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            Pseudomonas aeruginosa: all roads lead to resistance.

            Pseudomonas aeruginosa is often resistant to multiple antibiotics and consequently has joined the ranks of 'superbugs' due to its enormous capacity to engender resistance. It demonstrates decreased susceptibility to most antibiotics due to low outer membrane permeability coupled to adaptive mechanisms and can readily achieve clinical resistance. Newer research, using mutant library screens, microarray technologies and mutation frequency analysis, has identified very large collections of genes (the resistome) that when mutated lead to resistance as well as new forms of adaptive resistance that can be triggered by antibiotics themselves, in in vivo growth conditions or complex adaptations such as biofilm growth or swarming motility. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Complete genome sequence of Pseudomonas aeruginosa PAO1, an opportunistic pathogen.

              Pseudomonas aeruginosa is a ubiquitous environmental bacterium that is one of the top three causes of opportunistic human infections. A major factor in its prominence as a pathogen is its intrinsic resistance to antibiotics and disinfectants. Here we report the complete sequence of P. aeruginosa strain PAO1. At 6.3 million base pairs, this is the largest bacterial genome sequenced, and the sequence provides insights into the basis of the versatility and intrinsic drug resistance of P. aeruginosa. Consistent with its larger genome size and environmental adaptability, P. aeruginosa contains the highest proportion of regulatory genes observed for a bacterial genome and a large number of genes involved in the catabolism, transport and efflux of organic compounds as well as four potential chemotaxis systems. We propose that the size and complexity of the P. aeruginosa genome reflect an evolutionary adaptation permitting it to thrive in diverse environments and resist the effects of a variety of antimicrobial substances.
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                Author and article information

                Journal
                bmim
                Boletín médico del Hospital Infantil de México
                Bol. Med. Hosp. Infant. Mex.
                Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez (México, DF, Mexico )
                1665-1146
                April 2013
                : 70
                : 2
                : 136-150
                Affiliations
                [01] orgnameHospital Infantil de México Federico Gómez orgdiv1Laboratorio de Bacteriología Intestinal
                [02] orgnameHospital Infantil de México Federico Gómez orgdiv1Laboratorio Clínico Central
                [04] orgnameUniversidad Nacional Autónoma de México orgdiv1Facultad de Medicina orgdiv2Departamento de Salud Pública
                [05] orgnameHospital General ''Dr. Manuel Gea González'' orgdiv1Departamento de Ecología de Agentes Patógenos
                [03] orgnameInstituto Politécnico Nacional orgdiv1Departamento de Microbiología orgdiv2Laboratorio de Bacteriología Médica
                Article
                S1665-11462013000200010 S1665-1146(13)07000200010
                f76de8e4-5012-49cb-b70b-ea75300e4464

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 05 March 2013
                : 05 February 2013
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 44, Pages: 15
                Product

                SciELO Mexico

                Categories
                Artículos de investigación

                Pseudomonas aeruginosa,cepas clínicas,resistencia a antibióticos,biopelículas,pili,clinical isolates,antibiotic resistance,biofilms

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