Evaluation of Disk Potentiation Test (DPT) and Double Disk Synergy Test (DDST) for The Detection of Metallo-β-Lactamases (MBLs) in Clinical Isolates of Bangladesh

Objective: Increasing the emergence of Metallo-β-lactamase (MBL) producing gram-negative bacteria and their dexterous horizontal transmission demands rapid and accurate detection. This study was conducted to determine a suitable method to promptly detect MBL-producing gram-negative bacteria. Methods: A total of 103 gram-negative bacteria were identified from various clinical samples at a tertiary care hospital in Dhaka city. MBL producers were detected by two phenotypic methods, the Disk Potentiation Test (DPT) and the Double Disk Synergy Test (DDST) based on β-lactam chelator combinations where EDTA/SMA has been used as an inhibitor and Imipenem, Ceftazidime as substrates. Results: 103 isolates which were identified as Escherichia coli spp, Klebsiella spp, Pseudomonas spp, Acinetobacter spp, Proteus spp, Providencia spp were found to be multidrug-resistant in antibiogram test. Isolates showed complete resistance (100%) to Imipenem, Meropenem, and Amoxiclav. The highest carbapenem-resistant etiological agents were Acinetobacter spp 40 (38.8%) followed by Pseudomonas spp 27 (26.2%), Klebsiella spp 26 (25.2%), Escherichia coli 8 (7.8%), Proteus spp 1 (1%) and Providencia spp 1 (1%). DPT method detected significantly (p = 0.000009) a higher number of MBL-producers (Imipenem with 0.5 M EDTA n = 61, 59.2% & Ceftazidime with 0.5 M EDTA n = 56, 54.4%) compared to the DDST method (Imipenem -0.5 M EDTA n = 43, 41.7%, Imipenem – SMA n = 38, 36.9% & Ceftazidime -0.5 M EDTA n = 15, 14.6%). Conclusion: Pieces of evidence suggest that DPT is a more sensitive method than DDST and could be recommended for identifying MBL-producing bacteria in Bangladeshi hospitals for the proper management of patients, to reduce time constraints and treatment costs.

Identification and Distribution of the Clinical Isolates of Imipenem-resistant Pseudomonas aeruginosa Carrying Metallo-β-lactamase and/or Class 1 Integron Genes

To investigate the distribution of the genes of two major metallo-β-1actamases （MBL;i.e.,IMP and VIM） and class 1 integrons （intI） in the clinical imipenem-resistant Pseudomonas aeruginosa, a total of 65 isolates, from a university hospital in Sichuan between December 2004 and April 2005 were screened for MBL genes by PCR using primers specific for blaIMP-1, blaVIM and blaVIM-2 genes. The MBL-positive isolates were further assessed for class 1 integrons by PCRusing specific primers. The nucleotide sequences of several PCR products were also determined. The results revealed that the blaVIM gene was found in 81.5% （53/65） of all isolates, blaVIM-2 gene was found in only 1 isolate and the intl gene was observed in 45.3% （24/53） of blaVIM-positive isolates. One isolate carried simultaneously both blaIMP-1 and intl genes, and to the best of our knowledge this is the first report of such isolate in southwest China. These observations highlight that the genes for VIM β-1actamase and class 1 integrons were predominantly present among the imipenem-resistant P. aeruginosa tested, confirming the current widespread threat of imipenem-resistant, integron-borne P.aeruginosa.

Numerical Simulation and Technological Parameter Optimization for Quenching Process of a Gas Turbine Compressor Disk Based on Metallo-Thermo-Mechanics

Thermal, mechanical and microstructural phenomena are involved in the process of steel quenching. Based on the coupled metallo-thermo-mechanics theory, a calculation model has been developed in this study to simulate the quenching process of a gas turbine compressor disk by finite element method. The thermal physical and mechanical properties were treated as a functions of temperature. Moreover, a series of subroutines were developed on the MARC software platform. Consequently, simulated results on temperature, internal stress and distortion during the quenching were illustrated. With the aid of the simulated results, an optimum quenching scheme was proposed. The quenching process simulated in this study appears to be a promising tool in design of heat-treatment processing parameters for gas turbine compressor disks.

Metallo-β-lactamase producing nonfermentative gram-negative bacteria:An increasing clinical threat among hospitalized patients

Objective:To detect and evaluate the various methods for metallo-β-lactamases(MBL) production in Pseudomonas aeruginosa(P.aeruginosa) and Acinetobacter species.Methods:A total of 109 P.aeruginosa and 85 Acinetobacter species were screened for imipenem resistance by Kirby- Bauer disc diffusion methods.Detection of MBL production was(lone by imipenem-EDTA combined disc test,double disc synerygy test(DDST) and imipenem-EDTA MBL E test.Results: A total of 63(57.8%) strains of P.aeruginosa and 46(54.1%) strains of Acinetobacter spp.were found to be resistant to imipenem.Of the 63 imipenem resistant P.aeruginosa tested for MBL production.44(69.89;) were found to be positive and among 46 imipenem resistant Acinetobacter. 19(41.3%) were shown to be the MBL producers.Conclusions:Imipenem-EDTA combined disc test and MBL E test are equally effective for MBL detection in both P.aeruginosa and Acinetobacter spp.,but given the cost-constraints,combined disc can be used as a convenient screening method in the clinical microbiology laboratory.

Metallo-β-Lactamases:A Major Threat to Human Health

Antibiotic resistance is one of the most significant challenges facing global healthcare. Since the 1940s, antibiotics have been used to fight infections, initially with penicillin and subsequently with various derivatives including cephalosporins, carbapenams and monobactams. A common characteristic of these antibiotics is the four-memberedβ-lactam ring. Alarmingly, in recent years an increasing number of bacteria have become resistant to these antibiotics. A major strategy employed by these pathogens is to use Zn(II)-dependent enzymes, the metallo-β-lactamases (MBLs), which hydrolyse theβ-lactam ring. Clinically useful MBL inhibitors are not yet available. Consequently, MBLs remain a major threat to human health. In this review biochemical properties of MBLs are discussed, focusing in particular on the interactions between the enzymes and the functionally essential metal ions. The precise role(s) of these metal ions is still debated and may differ between different MBLs. However, since they are required for catalysis, their binding site may present an alternative target for inhibitor design.

Prevalence and Antimicrobial Susceptibility Profile of Metallo-<i>β</i>-Lactamase Producing <i>Pseudomonas aeruginosa</i>Isolates at Kenyatta National Hospital

Pseudomonas aeruginosa is a major cause of nosocomial infections with high mortality rates. The organism is highly resistant to most classes of drugs used and can develop resistance during treatment. One of the resistance mechanisms of P. aeruginosais is Metallo-β-Lactamase (MBL) production. MBL producing P. aeruginosa is a major health concern given it’s resistance to almost all available drugs. The prevalence of this resistant strain is unknown since there is no standardized method for testing MBL production. This was a laboratory based cross-sectional prospective study that was carried out from September 2015 to March 2016 at Kenyatta National Hospital. Ninety-nine isolates of P. aeruginosa were collected during the period and tested for antimicrobial susceptibility and isolates found to be resistant to imipenem tested for MBL production. The results indicated high resistance of P. aeruginosa to commonly used drugs. Of the isolates tested 69.7% were resistant to piperacillin, 63.6% were resistant to aztreonam, 58.6% were resistant to levofloxacin, 55.6% were resistant to cefipime, 65.7% were resistant to ceftazidime, 68.7% were resistant to ticarcillin-clavulanate, 72.2% were resistant to meropenem, 64.9% were resistance to imipenem while 86.4% of urine isolates were resistant to ofloxacin. Of the isolates resistant to imipenem 87.3% were found to be MBL producers. In conclusion, P. aeruginosais highly resistant to the drugs currently is used for treatment and resistance to carbapenems is largely due to MBL production.

Phenotypic and Genotypic Characterization of Metallo-Beta-Lactamase and Extended-Spectrum Beta-Lactamase among Enterobacteria Isolated at National Public Health Laboratory of Brazzaville

The improper use of antimicrobials against infectious diseases has allowed microorganisms to develop defense mechanisms that give them insensitivity to these agents. All bacteria are concerned by this phenomenon. This work aimed to assess prevalence of beta-lactamase produced by enterobacterial isolates. Then, disc diffusion, double disc synergy test (DDST) and combined disc test (CDT) were respectively used for antimicrobial resistance, detection of Extended-Spectrum Beta-Lactamases (ESBL) and Metallo-Beta-Lactamases (MBL). bla genes were detected by PCR. A total of 132 enterobacterial strains were studied. Resistance to antibiotic families was observed with a greater frequency than 50%. Gentamicin was the least active beta-lactam antibiotic, with a resistance rate of 88%. 40.9% of strains show an ESBL phenotype and 16.6% were MBL. An overall prevalence of 74% (40/54) and respectively rates of 29.6%, 27.7% and 16.7% for blaSHV, blaCTX and blaTEM genes were observed. SHV, CTX, CTX/SHV/TEM, CTX/TEM, SHV/TEM and CTX/SHV were different ESBL genotypes observed. ESBL-producing enterobacteria isolation worried about the future of antimicrobial therapy in the Republic of Congo. This is a public health problem that requires careful monitoring and implementation of a policy of rational antibiotics use.

Identification and preliminary characterization of novel B3-type metallo-β-lactamases

Antibiotic resistance has emerged as a major global threat to human health. Among the strategies employed by pathogens to acquire resistance the use of metallo-β-lactamases (MBLs), a family of dinuclear metalloenzymes, is among the most potent. MBLs are subdivided into three groups (i.e. B1, B2 and B3) with most of the virulence factors belonging to the B1 group. The recent discovery of AIM-1, a B3-type MBL, however, has illustrated the potential health threat of this group of MBLs. Here, we employed a bioinformatics approach to identify and characterize novel B3-type MBLs from Novosphingobium pentaromativorans and Simiduia agarivorans. These enzymes may not yet pose a direct risk to human health, but their structures and function may provide important insight into the design and synthesis of a still elusive universal MBL inhibitor.

Unusual metallo-β-lactamases may constitute a new subgroup in this family of enzymes

Metallo-β-lactamases (MBLs) are a family of Zn2+-dependent enzymes that have contributed strongly to the emergence and spread of antibiotic resistance. Novel members as well as variants of existing members of this family are discovered continuously, compounding their threat to global health care. MBLs are divided into three subgroups, i.e. B1, B2 and B3. The recent discovery of an unusual MBL from Serratia proteamaculans (SPR-1) suggests the presence of an additional subgroup, i.e. B4. A database search reveals that SPR-1 has only one homologue from Cronobacter sakazakii, CSA-1.These two MBLs have a unique active site and may employ a mechanism distinct from other MBLs, but reminiscent of some organophosphate-degrading hydrolases.

IMB-XH1 identified as a novel inhibitor of New Delhi metallo-β-lactamase-1

The problem of drug resistance of Gram-negative bacteria has become increasingly serious and has aroused widespread public concern.The "super bacteria" producing New Delhi metallo-beta-lactamase(NDM-1) are resistant to almost all β-lactam antibiotics.However, clinically existing β-lactamase inhibitors are ineffective against metallo-β-lactamases(MBLs) including NDM-1.Therefore, effective NDM-1 inhibitors are urgently needed.In this study, a high-throughput screening model for NDM-1 inhibitors was optimized and used to screen NDM-1 inhibitors.As a result, IMB-XH1 was screened out as a novel NDM-1 inhibitor from 52 100 compounds of different sources.The combined use of IMB-XH1 can increase the sensitivity of E.coli BL21(DE3)(pET-30 a(+)-NDM-1) to β-lactam antibiotics.Enzymatic kinetic studies indicate that IMB-XH1 is a non-competitive inhibitor of NDM-1 and also has inhibitory activity against other MBLs such as IMP-4, ImiS and L1.As a novel NDM-1 inhibitor, its activity and mechanism of action need to be further explored.

Dissemination of carbapenem-non-susceptible Acinetobacter baumannii isolates collected from educational hospitals in Qazvin province of Iran

Background:Acinetobacter baumannii(A.baumannii)is known as an opportunistic pathogen related to health-care-associated infection that has a high antibiotic resistance potential,notably against carbapenems that are widely used to combat A.baumannii infections.This study aimed to detect oxacillin-hydrolyzing(OXA)carbapenemases and metallo-β-lactamases(MBL)among carbapenem-resistant A.baumannii isolated strains and to determine their clonal relationship by repetitive extragenic palindromic PCR(rep-PCR).Methods:In the present study,a total of 211 non-repetitive isolates of A.baumannii were collected from Qazvin educational hospitals(2016–2017).The disk diffusion method was used to investigate the antibiotic susceptibility of studied strains,followed by the detection of MBL and OXA-type genes using polymerase chain reaction(PCR)and sequencing methods.The rep-PCR method assessed the clonal relationship of carbapenem-non-susceptible A.baumannii isolates.Result:The obtained results showed that 87.2%and 86.7%of isolates were non-susceptible to imipenem and meropenem.The blaOXA-24(93.5%)was the most frequent gene,followed by the blaOXA-23(4.34%),blaIMP-1(1.63%),and blaVIM-1(0.54%).Meanwhile,blaOXA-58 and blaOXA-143 genes were not found.81.5%and 66.1%of isolates contained ISAba1 upstream of the blaOXA-23 and blaOXA-58 genes,respectively.Rep-PCR results revealed the carbapenem non-susceptible isolates belonged to three distinct clones:A 171(81%),B 34(16.1%),and C 6(2.8%).Conclusions:The results indicated a high prevalence of carbapenem-non-susceptible A.baumannii,with the emergence of the blaOXA-24 gene as the most common gene and the notable prevalence of MBL genes.These results revealed the need for appropriate therapeutic and infection control strategies and monitoring susceptibility patterns for controlling A.baumannii infections.

Characterization of multidrug-resistant and metallo-beta- lactamase-producing Pseudomonas aeruginosa isolates from a paediatric clinic in China

Background In the present study, we characterized multidrug-resistant Pseudomonas aeruginosa （MDRP） clinical isolates from a paediatric facility and investigated the types and features of the metallo-β-lactamases （MBLs） produced by carbapenem-resistant strains. Methods Four hundred and ninety-eight strains of Pseudomonas aeruginosa were isolated from patients at Beijing Children＇s Hospital between January 2005 and December 2006. The minimal inhibition concentrations （MICs） of the strains for 13 antibiotics were measured. A combination of the E test and PCR amplification/DNA sequencing was used to define the carbapenem-resistant strains. Results We found that 24.1% （120/498） of the isolates were MDRP. The frequencies of resistance to imipenem and meropenem were 34.2% and 35.8%, respectively, and the MIC50 and MIC90values for the two antibiotics were identical at 4 pg/ml and 32 pg/ml, respectively. The detection rate for carbapenem resistance was 49.2% （59/120）. Among the 59 carbapenem-resistant Pseudomonas aeruginosa strains, 39 （66.1%） were positive for the MBL genotype; 35 （89.7%） strains carried the blaiMp gene and 4 （10.3%） strains carried the blavm gene. Neither blasPM nor blaGiM was amplified from any of the 59 isolates. DNA sequencing revealed that IMP-1 was present in 35 IMP-producing isolates and VIM-2 was detected in four VIM-producing isolates. Conclusions These MDRP isolates exhibited high frequencies of resistance to carbapenems among clinical isolates from a paediatric facility in Beijing, China. The production of MBL appears to be an important mechanism for carbapenem resistance in Pseudomonas aeruginosa.

New Delhi Metallo-β-Lactamase-Mediated Carbapenem Resistance： Origin, Diagnosis, Treatment and Public Health Concern

Objective： To review the origin, diagnosis, treatment and public health concern of New Delhi metallo-β-lactamase （NDM）-producing bacteria. Data Sources： We searched database for studies published in English. The database of PubMed from 2007 to 2015 was used to conduct a search using the keyword term ＂NDM and Acinetobacter or Enterobacteriaceae or Pseudomonas aeruginosa.＂ Study Selection： We collected data including the relevant articles on international transmission, testing methods and treatment strategies of NDM-positive bacteria. Worldwide NDM cases were reviewed based on 22 case reports. Results： The first documented case of infection caused by bacteria producing NDM- 1 occurred in India, in 2008. Since then, 13 blaNDM variants have been reported. The rise of NDM is not only due to its high rate of genetic transfer among unrelated bacterial species, but also to human factors such as travel, sanitation and food production and preparation. With limited treatment options, scientists try to improve available therapies and create new ones. Conclusions： In order to slow down the spread of these NDM-positive bacteria, a series of measures must be implemented. The creation and transmission of blaNDM are potentially global health issues, which are not issues for one country or one medical community, but for global priorities in general and for individual wound care practitioners specifically.

中耳胆脂瘤骨质破坏机制研究进展

中耳胆脂瘤是角化的鳞状上皮脱落后在中耳内形成的囊性结构,为非真性肿瘤,其临床表现与化脓性中耳炎相似,主要为耳流脓、听力下降、眩晕及耳痛等症状。严重者可以压迫周围骨质,造成破坏性骨吸收,引起一系列并发症,严重影响患者健康及预后。近些年,基质金属蛋白酶、核因子κB受体活化因子配体/骨保护素、炎症因子、巨噬细胞和角质细胞生长因子在中耳胆脂瘤骨质破坏中的作用越来越受到人们的关注。本文对中耳胆脂瘤骨质破坏机制研究进展作一综述。

两株携带bla_(NDM)基因肠杆菌目细菌的分子流行病学特征研究

目的:了解平顶山某医院两株携带bla_(NDM)基因肠杆菌目细菌临床分离株的分子流行病学特征,为该类病原菌的院内感染预防与控制提供理论依据。方法:收集2022年1~12月临床分离的耐碳青霉烯类肠杆菌目细菌(CRE)。先通过聚合酶链反应(PCR)筛选携带bla_(NDM)基因的CRE菌株,再对菌株携带的其他耐药基因[包括碳青霉烯酶、超广谱β-内酰胺酶(ESBLs)和喹诺酮类耐药相关基因]进行扩增,并测序确认,通过多位点序列分型(MLST)的方法分析相同种属菌株间的亲缘关系。结果:收集的CRE中有2株检测到携带bla_(NDM)基因,其中1株为携带bla_(NDM)-1的弗氏柠檬酸杆菌,另1株为携带bla_(NDM)-5的大肠埃希菌。这两株菌同时携带多个耐药基因,表现为多重耐药。MLST结果显示,产NDM-1型金属酶的弗氏柠檬酸杆菌为ST85型,产NDM-5型金属酶的大肠埃希菌为ST736型,均不是常见流行克隆类型。采用bla_(NDM)探针进行Southern杂交的结果显示,bla_(NDM)-1基因定位于一个~54kb的质粒上,bla_(NDM)-5基因定位于一个~104kb的质粒上,两个携带bla_(NDM)基因的质粒均不能发生接合。结论:首次在平顶山地区报道携带bla_(NDM)基因的CRE菌株;两株菌均同时携带多个耐药基因;bla_(NDM)基因均位于质粒且都与插入序列(IS)移动元件相关,建议进一步加强院感监测及防控,防止耐药菌株的传播和流行。

First identification of isatin-β-thiosemicarbazones as novel inhibitors of New Delhi metallo-β-lactamase-1： Chemical synthesis, biological evaluation and molecular simulation

New Delhi metallo-b-lactmase-1（NDM-1） catalyzes the hydrolysis of b-lactam antibiotics and cleaves the b-lactam ring of the molecule, conferring bacterial resistance against these medicines. In an effort to discover novel agents to treat this superbug, an old drug methisazone was found to be a weak NDM-1 inhibitor, with an IC50 of 297.6 mmol/L. Based on this result, a series of isatin-β-thiosemicarbazones（IBTs）were synthesized and biologically evaluated as novel NDM-1 inhibitors. Nine of the IBT compounds showed IC50 values of 〈10 mmol/L, the best of which was 2.72 mmol/L. Comparative field analysis（Co MFA） contour maps were generated to depict the structural features and molecular docking was performed to understand the possible binding mode of these inhibitors. The present research hereby has provided valuable information for further discovery of NDM-1 inhibitors.

Discovery of thiosemicarbazone derivatives as effective New Delhi metallo-β-lactamase-1(NDM-1) inhibitors against NDM-1 producing clinical isolates

New Delhi metallo-b-lactamase-1(NDM-1)is capable of hydrolyzing nearly allβ-lactam antibiotics,posing an emerging threat to public health.There are currently less effective treatment options for treating NDM-1 positive"superbug",and no promising NDM-1 inhibitors were used in clinical practice.In this study,structure eactivity relationship based on thiosemicarbazone derivatives wassystematically characterized and their potential activities combined with meropenem(MEM)were evaluated.Compounds 19 bg and 19 bh exhibited excellent activity against 10 NDM-positive isolate clinical isolates in reversing MEM resistance.Further studies demonstrated compounds 19 bg and 19 bh were uncompetitive NDM-1 inhibitors with Ki Z 0.63 and 0.44 mmol/L,respectively.Molecular docking speculated that compounds 19 bg and 19 bh were most likely to bind in the allosteric pocket which would affect the catalytic effect of NDM-1 on the substrate meropenem.Toxicity evaluation experiment showed that no hemolysis activities even at concentrations of 1000 mg/m L against red blood cells.In vivo experimental results showed combination of MEM and compound 19 bh was markedly effective in treating infections caused by NDM-1 positive strain and prolonging the survival time of sepsis mice.Our finding showed that compound 19 bh might be a promising lead in developing new inhibitor to treat NDM-1 producing superbug.

Activation free energy of Zn(Ⅱ),Co(Ⅱ) binding to metallo-β-lactamase ImiS

In an effort to understand the recombination of a B2 metallo-β-lactamase（MβL）,the binding of metals to apo-ImiS was studied by isothermal titration calorimetry and fluorescence spectra.The binding of Zn（Ⅱ）,Co（Ⅱ） to apo-lmiS resulted in activation free energies △G_≠~θ values of 93.719 and 92.948 kJ mol^（-1）,respectively,and increasing of fluorescence intensity at maxima emission of 340 nm.

头孢地尔对产金属β-内酰胺酶革兰阴性菌的作用现状研究

产金属β-内酰胺酶(MBLs)革兰阴性菌是临床常见的感染病原菌,该类菌可引起多种严重感染,其中产金属β-内酰胺酶肺炎克雷伯菌(KP)是世界范围内的重要医院获得性感染菌,对当前抗感染治疗构成严重威胁。头孢地尔作为新型头孢菌素,具有抗菌活性强、作用范围广、组织穿透力强等特点,对产碳青霉烯酶的肠杆菌、鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄单胞菌有强大的抗菌活性,其中它对金属β-内酰胺酶也有相当好的活性。本研究针对头孢地尔对产金属β-内酰胺酶革兰阴性菌的作用进行了全面的现况分析研究。

Expression of gelatinases and tissue inhibitors of metallo-proteinases in the rhesus monkey(Macaca mulatta) corpus luteum

Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are believed to play important roles in the formation and regression of corpus luteum (CL). This study is to investigate the expression of gelatinases (MMP-2, -9) and TIMPs in the rhesus monkey CL in both early and late luteal phases and during the early stages of pregnancy. Ovaries were collected from regularly cycling rhesus monkey at D5 and D15 following ovulation and at D12, D18 and D26 of pregnancy. In situ hybridization revealed that in the CL MMP-2 niRNA was expressed during both formation and regression, while MMP-9 mRNA was mainly localized in the late luteal phase. Reduction of MMP-2, -9 transcripts in the CL was observed during pregnancy. MMP-2 mRNA in the CL reduced to an undetectable level at D26 of pregnancy. TIMP-1 mRNA was highly expressed in the CL in both early and late luteal phases and persisted throughout the early stages of pregnancy. Strong signal for TIMP-2 mRNA was also detected in both luteal phases, and the