The effect of different C. difficile MLST strains on viability and activity of macrophages.

Objectives: Clostridioides difficile is the most common infectious agent of nosocomial diarrhea. C. difficile infection (CDI) pathogenesis and disease severity depend on its toxins (toxins A, B and binary) and on the host's immune response, especially the innate immune system. The current study examined the efficacy of macrophage activity, macrophages viability and cytokine secretion levelsin response to different sequence type (ST) strains of C. difficile. Methods: RAW 264.7 macrophages were exposed to six different strains of C. difficile as well as to both toxins A and B and macrophage viability was measured. The levels of four secreted cytokines were determined by RT-PCR and ELISA. Morphological changes to the macrophages were investigated by fluorescent microscopy. Results: Strains ST37 and ST42 affected macrophages' vitality the most. Toxins A and B led to a significant reduction in macrophages' vitality at most time points. In addition, starting at 30-min post-exposure to 5 ng/µl of both toxins led to significant differences in macrophage viability versus at lower concentrations. Furthermore, cytokine secretion levels, including IL-12, IL-6 and TNF-α, increased dramatically when macrophages were exposed to strains ST42 or ST104. Finally, gene expression surveys point to increases in IL-12 gene expression in response to both ST42 and ST104. Conclusions: C. difficile strains with higher toxins levels induced an increased activation of the innate immune system and may activate macrophages more profoundly resulting in secretion of higher levels of pro-inflammatory cytokines. However, higher toxin levels may also damage macrophages' normal skeletal structure, reducing macrophage viability.

Different bile acids have versatile effects on sporulation, toxin levels and biofilm formation of different Clostridioides difficile strains.

Clostridioides difficile infection develops following ingestion of virulent stains by a susceptible host. Once germinated, toxins TcdA and TcdB, and in some of the strains binary toxin, are secreted, eliciting disease. Bile acids play a significant role in the process of spore germination and outgrowth, with cholate and its derivative enhancing colony formation, while chenodeoxycholate inhibit germination and outgrowth. This work investigated bile acids' impact on spore germination, toxin levels and biofilm formation in various strain types (STs). Thirty C. difficile isolates (A+ B+ CDT-\+) of different STs were exposed to increasing concentrations of the bile acids, cholic acid (CA), taurocholic acid (TCA) and chenodeoxycholic acid (CDCA). Following treatments, spore germination was determined. Toxin concentrations were semi-quantified using the C. Diff Tox A/B II™ kit. Biofilm formation was detected by the microplate assay with crystal violet. SYTO® 9 and propidium iodide staining were used for live and dead cell detection, respectively, inside the biofilm. Toxins levels were increased by 1.5-28-fold in response to CA and by 1.5-20-fold in response to TCA, and decreased by 1-37-fold due to CDCA exposure. CA had a concentration-dependent effect on biofilm formation, with the low concentration (0.1%) inducing- and the higher concentrations inhibiting biofilm formation, while CDCA significantly reduced biofilm production at all concentrations. There were no differences in the bile acids effects on different STs. Further investigation might identify a specific bile acids' combination with inhibitory effects on C. difficile toxin and biofilm production, which could modulate toxin formation to reduce the likelihood of developing CDI.

Impact of Helicobacter pylori virulence markers on clinical outcomes in adult populations.

BACKGROUND: In recent years, associations between specific virulence markers of Helicobacter pylori (H. pylori) and gastrointestinal disorders have been suggested. AIM: To investigate the presence of virulence factors including vacuolating cytotoxin A genotypes (s1m1, s1m2, s2m1, and s2m2), cytotoxin-associated gene A (CagA), and urease activity in H. pylori strains isolated from Arab and Jewish populations in northern Israel and to assess associations between these factors and patients' demographics and clinical outcomes. METHODS: Patients (n = 108) who underwent gastroscopy at the Baruch Padeh Medical Center, Poriya due to symptomatic gastroduodenal pathologies as part of H. pylori diagnosis were enrolled in the study. Gastric biopsy specimens were collected from the antrum of the stomach. Clinical condition was assessed by clinical pathology tests. Bacteria were isolated on modified BD Helicobacter Agar (BD Diagnostics, Sparks, MD, United States). Bacterial DNA was extracted, and PCR was performed to detect CagA and vacuolating cytotoxin A genes. Urease activity was assessed using a rapid urease test. RESULTS: A significant correlation was found between disease severity and patient ethnicity (P = 0.002). A significant correlation was found between CagA presence and the s1m1 genotype (P = 0.02), which is considered the most virulent genotype. Further, a higher level of urease activity was associated with isolates originating from the Jewish population. Moreover, higher urease activity levels were measured among CagA-/s1m1 and CagA-/s2m2 isolates. CONCLUSION: Our study highlights the importance of incorporating molecular methods for detection of virulence markers of H. pylori in order to tailor optimal treatments for each patient. Further investigation should be performed regarding associations between H. pylori virulence factors and ethnicity.

Comparison of FT-IR with whole-genome sequencing for identification of maternal-to­neonate transmission of antibiotic-resistant bacteria.

Following a previous study in which we evaluated the carriage rates of extended spectrum ß-lactamase (ESBL) -producing Enterobacterales (ESBL+ E), carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and their neonates, in the current study we used, for the first time, Fourier transform infrared spectrometry (FT-IR) in order to determine whether antibiotic-resistant bacteria colonization in neonates has resulted from a vertical transmission from the mothers. To this end, 28 pairs of maternal and neonatal isolates of antibiotic-resistant bacteria, including ESBL-producing E. coli (ESBL+E.coli), ESBL-producing K. pneumoniae (ESBL+K. pneumoniae) and MRSA isolates, were subjected to a FT-IR analysis to assess the similarity between maternal and new-born isolates. We compared the FT-IR analysis results with whole genome sequencing of the isolates, in order to define whether FT-IR spectroscopy can be applied for bio-typing of bacteria and for assessment of mother-to­neonate transmission. The FT-IR analysis showed that all neonatal isolates were similar to their corresponding maternal isolates and belonged to the same cluster. Alignments of the DNA sequences of the maternal and neonatal isolates pairs revealed above 99% identity, thus confirming the FT-IR results. In conclusion, FT-IR spectroscopy can be applied to monitor bacterial transmission and specifically maternal-to­neonate transmission.

Incidence of biofilm formation among MRSA and MSSA clinical isolates from hospitalized patients in Israel.

AIM: To assess the biofilm-producing capacities of Staphylococcus aureus strains isolated from hospitalized patients in Israel. METHODS AND RESULTS: A total of 16 S. aureus (80 MRSA and 83 MSSA) from screening (nasal swab) and clinical samples (blood and wounds) were characterized. Biofilm-producing capacities were determined using two different biofilm detection assays: Congo Red agar (CRA) and microtiter plate (MtP). In addition, a real-time PCR analysis was performed to detect the presence of biofilm-associated genes (icaA and icaD) and mecA gene. The two assays showed similar biofilm production pattern (28.2% agreement). MRSA strains tended to be greater biofilm-producers than MSSA strains. The presence of mecA was associated with biofilm production (p = 0.030). Additionally, bacteria isolated from blood samples produced less biofilm compared to those from other sources. Finally, no association was found between icaA and icaD presence and biofilm production. CONCLUSION: This study supports earlier assumptions that biofilm formation depends strongly on environmental conditions. SIGNIFICANCE AND IMPACT OF STUDY: This study significantly improved our knowledge on the biofilm production capacity of S. aureus strains in Israel. Moreover, it revealed an association between the mecA gene and biofilm production. Finally, this study underscores the importance of further research to evaluate risk factors for biofilm production.

Characterization of reduced susceptibility to chlorhexidine among Gram-negative bacteria.

Chlorhexidine gluconate (CHG) is one of the most commonly used antiseptic, acting against Gram-negative, Gram-positive bacteria, yeast and fungi. However, over use may lead to reduced susceptibility of different bacteria to CHG. This study aimed to characterize the CHG susceptibility among Gram-negative strains in Israel, to evaluate factors that may affect this susceptibility, and to compare CHG susceptibility between ESBLs bacteria to strains without these enzymes. Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella spp, Escherichia coli, and Acinetobacter baumannii were isolated from clinical samples of 193 patients hospitalized at Padeh-Poriya Medical Center. Phenotypic CHG susceptibility was assessed by determining minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The highest CHG MIC was found among P. mirabilis. The differences between the CHG MIC values among the different strains were statistically significant (p < 0.001). ESBL-positive strains had higher MIC values as compared to ESBL-negative strains (p = 0.030). A significant association was found between CHG susceptibility and sample source (p = 0.015). In conclusion, the information gathered here significantly improves our knowledge on the reduced susceptibility to CHG among Gram-negative bacteria in Israel. Moreover, ESBL-positive bacteria are less susceptible to CHG and finally, bacteria in sputum, wounds, and body fluids are less CHG-susceptible.

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study.

We evaluated carriage rates of extended spectrum ß-lactam-producing Enterobacterales (ESBL-E), Carbapeneme-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and determined the maternal-to-neonate transmission rates of these antibiotic-resistant bacteria (ARB). Pregnant women provided rectal and vaginal samples, proximal to delivery. Stool samples were collected from newborns within 48 h of birth. All samples were cultured on selective media for ARB identification. Clinical and demographic data were collected from the participants' medical files. We performed molecular and phenotypic characterization of the different resistance mechanisms, and determined the isolates' antibiotic susceptibility and biofilm-forming ability. The prevalence of ESBL-E, MRSA and VRE among pregnant women were 16%, 6% and 1%, respectively. The prevalence of ESBL-E and MRSA among neonates were 7.6% and 1.6%, respectively. Maternal-to-neonate transmission rates of ESBL-E and MRSA were 48% and 27.8%, respectively. Maternal and neonatal isolates shared similar characteristics. Maternal-to-neonate transmission of ARB plays an important role in bacterial colonization in newborns. Future studies should investigate the outcomes of the high ESBL-E transmission rate. The biofilm-forming ability of ARB was found to affect transmission. Additional factors should be investigated in order to understand the differences between transmitted and non-transmitted bacteria.

Reduced Susceptibility to Chlorhexidine among Staphylococcus aureus Isolates in Israel: Phenotypic and Genotypic Tolerance.

Antiseptic use for body decolonization is the main activity applied to prevent healthcare-associated infections, including those caused by S. aureus. Consequentially, tolerance to several antiseptics such as chlorhexidine gluconate (CHG) has developed. This study aimed to estimate the prevalence of CHG tolerance among S. aureus strains in Israel and to evaluate factors that may affect this tolerance. Furthermore, it tested the associations between phenotypic and genotypic CHG tolerance. S. aureus strains (n = 190) were isolated from clinical samples of patients admitted to various medical institutions in Israel. Phenotypic susceptibility to CHG was assessed by determining minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Genotypic tolerance was detected using real-time PCR for detection of qac A/B genes. MIC for the antibiotic mupirocin was determined using the Etest method. Presence of the Panton-Valentine Leucocidin (pvl) toxin, mecA and mecC genes was detected using an eazyplex® MRSAplus kit (AmplexDiagnostics GmbH, Gars, Germany). CHG tolerance was observed in 13.15% of the isolates. An association between phenotypic and genotypic tolerance to CHG was observed. Phenotypic tolerance to CHG was associated with methicillin resistance but not with mupirocin resistance. Additionally, most of the CHG-tolerant strains were isolated from blood cultures. In conclusion, this work shed light on the prevalence of reduced susceptibility to CHG among S. aureus strains in Israel and on the characteristics of tolerant strains. CHG-tolerant strains were more common than methicillin-resistant ones in samples from invasive infections. Further research should be performed to evaluate risk factors for the development of CHG tolerance.

Characterization of a new chytrid species parasitic on the dinoflagellate, Peridinium gatunense.

Only a few chytrid fungi have been reported as parasites of dinoflagellates. Among these reports, chytrids are periodically observed growing on the dinoflagellate, Peridinium gatunense, in Lake Kinneret (Sea of Galilee), Israel. Because of the distinctive roles of parasitic chytrid fungi in decreasing phytoplankton populations and in transforming inedible algae into chytrid biomass which zooplankton grazers can eat, characterizing dinoflagellate parasites contributes to our understanding of the sustainability of this important water resource. An undescribed chytrid parasite of P. gatunense from Lake Kinneret has recently been brought into pure culture (KLL_TL-060613), facilitating exploration of its infection process. To evaluate the ability of this chytrid to affect host populations, we determined the effect of: (1) temperature and light (or dark) on prevalence of infection and (2) host growth phase and parasite:host ratio on percentage of infection. The greatest amplification in host infection occurred in cultures grown in the dark at 25 C. The percentage of host cells infected increased as the availability of host cells compared to parasite cells increased. These results demonstrate that environmental factors influence the chytrid's potential to affect Peridinium gatunense populations. Because this chytrid had not been described taxonomically, we characterized its thallus morphology, development, zoospore ultrastructure and phylogenetic relationships. Zoospore ultrastructure was compatible with the Group II type zoospore characteristic of the family Chytridiaceae in the Chytridiales. Consistent with this observation, phylogenetic analyses of nuc 28S rDNA D1-D3 domains (28S) placed the chytrid in a clade among described taxa in the Chytridiaceae. Because thallus morphology was distinct from these other taxa, as well as other described parasites of dinoflagellates, this chytrid is described as a new genus and species, Dinochytrium kinnereticum.