Efflux-Related Carbapenem Resistance in Acinetobacter baumannii Is Associated with Two-Component Regulatory Efflux Systems' Alteration and Insertion of ΔAbaR25-Type Island Fragment.

The efflux pumps, beside the class D carbapenem-hydrolysing enzymes (CHLDs), are being increasingly investigated as a mechanism of carbapenem resistance in Acinetobacter baumannii. This study investigates the contribution of efflux mechanism to carbapenem resistance in 61 acquired blaCHDL-genes-carrying A. baumannii clinical strains isolated in Warsaw, Poland. Studies were conducted using phenotypic (susceptibility testing to carbapenems ± efflux pump inhibitors (EPIs)) and molecular (determining expression levels of efflux operon with regulatory-gene and whole genome sequencing (WGS)) methods. EPIs reduced carbapenem resistance of 14/61 isolates. Upregulation (5-67-fold) of adeB was observed together with mutations in the sequences of AdeRS local and of BaeS global regulators in all 15 selected isolates. Long-read WGS of isolate no. AB96 revealed the presence of AbaR25 resistance island and its two disrupted elements: the first contained a duplicate ISAba1-blaOXA-23, and the second was located between adeR and adeA in the efflux operon. This insert was flanked by two copies of ISAba1, and one of them provides a strong promoter for adeABC, elevating the adeB expression levels. Our study for the first time reports the involvement of the insertion of the ΔAbaR25-type resistance island fragment with ISAba1 element upstream the efflux operon in the carbapenem resistance of A. baumannii.

Cocrystallizing and Codelivering Complementary Drugs to MultidrugResistant Tuberculosis Bacteria in Perfecting Multidrug Therapy.

Bacteria cells exhibit multidrug resistance in one of two ways: by raising the genetic expression of multidrug efflux pumps or by accumulating several drug-resistant components in many genes. Multidrug-resistive tuberculosis bacteria are treated by multidrug therapy, where a few certain antibacterial drugs are administered together to kill a bacterium jointly. A major drawback of conventional multidrug therapy is that the administration never ensures the reaching of different drug molecules to a particular bacterium cell at the same time, which promotes growing drug resistivity step-wise. As a result, it enhances the treatment time. With additional tabletability and plasticity, the formation of a cocrystal of multidrug can ensure administrating the multidrug chemically together to a target bacterium cell. With properly maintaining the basic philosophy of multidrug therapy here, the synergistic effects of drug molecules can ensure killing the bacteria, even before getting the option to raise the drug resistance against them. This can minimize the treatment span, expenditure and drug resistance. A potential threat of epidemic from tuberculosis has appeared after the Covid-19 outbreak. An unwanted loop of finding molecules with the potential to kill tuberculosis, getting their corresponding drug approvals, and abandoning the drug after facing drug resistance can be suppressed here. This perspective aims to develop the universal drug regimen by postulating the principles of drug molecule selection, cocrystallization, and subsequent harmonisation within a short period to address multidrug-resistant bacteria.

Cryo-EM Structures of the Klebsiella pneumoniae AcrB Multidrug Efflux Pump.

The continued challenges of the COVID-19 pandemic combined with the growing problem of antimicrobial-resistant bacterial infections has severely impacted global health. Specifically, the Gram-negative pathogen Klebsiella pneumoniae is one of the most prevalent causes of secondary bacterial infection in COVID-19 patients, with approximately an 83% mortality rate observed among COVID-19 patients with these bacterial coinfections. K. pneumoniae belongs to the ESKAPE group of pathogens, a group that commonly gives rise to severe infections that are often life-threatening. Recently, K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae has drawn wide public attention, as the mortality rate for this infection can be as high as 71%. The most predominant and clinically important multidrug efflux system in K. pneumoniae is the acriflavine resistance B (AcrB) multidrug efflux pump. This pump mediates resistance to different classes of structurally diverse antimicrobial agents, including quinolones, ß-lactams, tetracyclines, macrolides, aminoglycosides, and chloramphenicol. We here report single-particle cryo-electron microscopy (cryo-EM) structures of K. pneumoniae AcrB, in both the absence and the presence of the antibiotic erythromycin. These structures allow us to elucidate specific pump-drug interactions and pinpoint exactly how this pump recognizes antibiotics. IMPORTANCE Klebsiella pneumoniae has emerged as one of the most problematic and highly antibiotic-resistant pathogens worldwide. It is the second most common causative agent involved in secondary bacterial infection in COVID-19 patients. K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae is a major concern in global public health because of the high mortality rate of this infection. Its drug resistance is due, in a significant part, to active efflux of these bactericides, a major mechanism that K. pneumoniae uses to resist to the action of multiple classes of antibiotics. Here, we report cryo-electron microscopy (cryo-EM) structures of the prevalent and clinically important K. pneumoniae AcrB multidrug efflux pump, in both the absence and the presence of the erythromycin antibiotic. These structures allow us to understand the action mechanism for drug recognition in this pump. Our studies will ultimately inform an era in structure-guided drug design to combat multidrug resistance in these Gram-negative pathogens.

Direct visualization of single-cell non-repetitive genes by in situ activation of collateral activity of CRISPR/Cas12a inside cells

The spread of drug-resistance bacteria is a serious issue of environment. Tools allowing to image single-cell genes can provide key information about the spatial pattern and heterogeneity of cell population. Herein, we explored the possibility of in situ activation of collateral trans-cleavage activity of CRISPR/Cas12a inside cells, to achieve a direct detection of single-cell non-repetitive genes. CRISPR/Cas12a allows to recognize target genes without the need for denaturation or digestion process. Particularly, the target gene-activated trans-cleavage by CRISPR/ Cas12a inside cells outputs an amplified signal for the gene recognition, allowing to visualize non-repetitive genes. The signal-to-background ratio for imaging drug-resistance gene, oqxB in the Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) was further improved by combining multiple binding of Cas12a, enabled imaging of drug-resistance S. Typhimurium isolated from poultry farm and in the intestinal tract sec-tions. Single-cell investigation of S. Typhimurium under salt stress indicated that drug-sensitive strain owned a survival advantage over drug-resistance strain at high-content salt environment. This gene imaging methods holds potential for detecting the spread of drug resistance in the environment and serves as a means to inves-tigate the relationship between genotype and phenotype at single-cell level.

Mechanisms of Microbial Disinfectant Resistance

Disinfectants can effectively inhibit or kill microorganisms on the surface of objects and transmission media, which are widely used in food, hygiene, health, pandemic prevention and other fields. During the COVID-19 pandemic, the global use of disinfectants increased sharply, which played an important role in effectively preventing and controlling the spread of the virus and preventing the spread of the pandemic. However, improper use of disinfectants will reduce its effectiveness and even induce microbial resistance, which may increase the risk of infectious disease transmission. The disinfectant resistance gene of microorganism will also aggravate its pollution and transmission risk through vertical reproduction or horizontal transfer between the same or different species, which seriously threatens public health safety. At present, the wide emergence of antibiotic resistance gene (ARG) has attracted global attention to public health, but the understanding of disinfectant resistance is very limited. This paper reviews the research on microbial resistance to disinfectants in recent years, focusing on the mechanism of microbial resistance by forming biofilm, reducing cell membrane permeability, over expressing efflux pump, producing specific enzymes to eliminate or attenuate disinfectants, and changing action targets. The formation of strong biofilm can effectively prevent disinfectants from approaching microorganisms, reduce microbial sensitivity and improve resistance;the reduction of cell membrane permeability depends on the changes of membrane protein, phospholipid and lipopolysaccharide, which can reduce the entry of disinfectants into microbial cells;the overexpression of efflux pump system is conducive to microorganisms to discharge harmful substances in cells;the action of specific enzymes can degrade the effective components of disinfectants or improve microbial immunity;the change of target can reduce the combination of disinfectant and action site, so as to reduce the disinfection effect. In addition, aiming at the acquisition and transmission of microbial disinfectant resistance, the chromosome and plasmid mediated resistance genes as well as the relationship between microbial disinfectant resistance and antibiotic resistance in the environment were discussed. Disinfectant resistance genes can be transferred and transmitted by transformation, transduction or conjugation through mobile genetic elements such as plasmids and phages, which puts forward new requirements for scientific disinfection.

Efflux Pump Mediated Antimicrobial Resistance by Staphylococci in Health-Related Environments: Challenges and the Quest for Inhibition.

The increasing emergence of antimicrobial resistance in staphylococcal bacteria is a major health threat worldwide due to significant morbidity and mortality resulting from their associated hospital- or community-acquired infections. Dramatic decrease in the discovery of new antibiotics from the pharmaceutical industry coupled with increased use of sanitisers and disinfectants due to the ongoing COVID-19 pandemic can further aggravate the problem of antimicrobial resistance. Staphylococci utilise multiple mechanisms to circumvent the effects of antimicrobials. One of these resistance mechanisms is the export of antimicrobial agents through the activity of membrane-embedded multidrug efflux pump proteins. The use of efflux pump inhibitors in combination with currently approved antimicrobials is a promising strategy to potentiate their clinical efficacy against resistant strains of staphylococci, and simultaneously reduce the selection of resistant mutants. This review presents an overview of the current knowledge of staphylococcal efflux pumps, discusses their clinical impact, and summarises compounds found in the last decade from plant and synthetic origin that have the potential to be used as adjuvants to antibiotic therapy against multidrug resistant staphylococci. Critically, future high-resolution structures of staphylococcal efflux pumps could aid in design and development of safer, more target-specific and highly potent efflux pump inhibitors to progress into clinical use.