Resistant Enterococcus Faecium Research Articles

Epidemiology and genetic diversity of linezolid resistant enterococci clinical isolates in Belgium from 2013 to 2021

ObjectivesLinezolid resistant opportunistic human pathogens Enterococcus faecalis and Enterococcus faecium are an emerging health threat as limited therapeutic options remain. The aim was to investigate the epidemiology, resistance mechanisms and genetic diversity of Belgian linezolid resistant enterococci (LRE) isolated between 2013 and 2021 received at the Belgian National Reference Centre (NRC) for Enterococci. MethodsLinezolid susceptibility testing was performed upon request on 2458 submitted Enterococci strains. Whole genome sequencing was performed on all LRE strains. ResultsSeventy-eight LRE human isolates, of which 63 (81%) E. faecalis and 15 (19%) E. faecium strains, were submitted to the Belgian NRC for Enterococci. Of the linezolid resistant E. faecalis strains, 97% harboured the optrA (56% wild-type pE349) and 3% the poxtA gene. Of the linezolid resistant E. faecium strains, 54% harboured the G2576T point mutation in the V domain of the 23S rRNA genes, 23% the poxtA and 23% the optrA gene. Furthermore two E. faecium strains were identified with a combination of two resistance mechanisms ((i) optrA and poxtA and (ii) cfr(B) and G2576T point mutation respectively). Vancomycin resistance was observed in 15% (n=12) of the LRE. ST480 (n=42/63 typed strains, 67%) was the most frequently detected sequence type (STs) in linezolid resistant E. faecalis strains, while ST203 (n=5/15 typed strains, 33%) was the most frequently detected STs in linezolid resistant E. faecium strains. ConclusionsE. faecalis isolates harbouring optrA were the predominant LRE in Belgium with ST480 as the most prominent MLST. Linezolid resistance in E. faecium could be attributed to either chromosomal mutations or transferable resistance determinants.

Investigation of the mutagenic, cytotoxic and antimicrobial effect of bikaverin mycotoxin

Bikaverin is a reddish pigment produced by different fungi species (Mycogone jaapii, Verticillium agaricinum, Beauveria bassiana, Paecilomyces fumosoroseus, Polyporus sulphureus), mainly of the Fusarium genus. Due to its pigment feature, bikaverin can be used as a dye in various fields in the industry. However, it is extremely important to study the mutagenic/genotoxic effects, cytotoxic effects and antimicrobial properties of bikaverin for application of industrial areas. In the study, the mutagenic, cytotoxic and antimicrobial effects of bikaverin were investigated. The mutagenic effect of bikaverin was studied with the Ames test. Salmonella typhimurium TA97a, TA98, TA100, TA102 and TA1535 strains were used in the test. Five different doses of bikaverin (0.075, 0.1, 0.2, 0.3 and 0.5 μg/plate) were tested against strains. It was determined that there was no mutagenic effect of bikaverin. The cytotoxicity of bikaverin was evaluated by MTT test on L929 fibroblast cell line. Bikaverin demonstrated no cytotoxic effect on L929 fibroblast cell line, according to cell viability calculations that showed >73% for all concentrations (1, 0.5, 0.4, 0.3, 0.2, 0.1, 0.075, 0.05, 0.025, 0.01, 0.005 and 0.001 μg/mL) examined. Bikaverin's IC50 value was determined to be 1.79±0.51 g/mL. The antimicrobial activity of the bikaverin was evaluated by using the microdilution method. Bikaverin was found to have antimicrobial effects on Methicillin resistant Staphylococcus aureus, Vancomycin resistant Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Candida albicans and Candida krusei, as MIC values ranged from 1.25 -5 µg/ mL.

Genomic context as well as sequence of both psr and penicillin-binding protein 5 contributes to β-lactam resistance in Enterococcus faecium.

The findings of this study shed light on ampicillin resistance in Enterococcus faecium clade A strains. They underscore the significance of alterations in the amino acid sequence of penicillin-binding protein 5 (PBP5) and the pivotal role of the psr region in PBP5 expression and ampicillin resistance. Notably, the presence of a full-length psrB leads to reduced PBP5 expression and lower minimum inhibitory concentrations (MICs) of ampicillin compared to the presence of a shorter psrA, regardless of the pbp5 allele involved. Additionally, clade B E. faecium strains exhibit lower AMP MICs when both psr alleles from clades A and B are present, although it is important to consider other distinctions between clade A and B strains that may contribute to this effect. It is intriguing to note that the divergence between clade A and clade B E. faecium and the subsequent evolution of heightened AMP MICs in hospital-associated strains appear to coincide with changes in Pbp5 and psr. These changes in psr may have resulted in an inactive Psr, facilitating increased PBP5 expression and greater ampicillin resistance. These results raise the possibility that a mimicker of PsrB, if one could be designed, might be able to lower MICs of ampicillin-resistant E. faecium, thus potentially resorting ampicillin to our therapeutic armamentarium for this species.

A Versatile Thioesterase Involved in Dimerization during Cinnamoyl Lipid Biosynthesis

AbstractThe cinnamoyl lipid compound youssoufene A1 (1), featuring a unique dearomatic carbon‐bridged dimeric skeleton, exhibits increased inhibition against multidrug resistant Enterococcus faecalis as compared to monomeric youssoufenes. However, the formation process of this intriguing dearomatization/dimerization remains unknown. In this study, an unusual “gene‐within‐gene” thioesterase (TE) gene ysfF was functionally characterized. The gene was found to naturally encodes two proteins, an entire YsfF with α/β‐hydrolase and 4‐hydroxybenzoyl‐CoA thioesterase (4‐HBT)‐like enzyme domains, and a nested YsfFHBT (4‐HBT‐like enzyme). Using an intracellular tagged carrier‐protein tracking (ITCT) strategy, in vitro reconstitution and in vivo experiments, we found that: i) both domains of YsfF displayed thioesterase activities; ii) YsfF/YsfFHBT could accomplish the 6π‐electrocyclic ring closure for benzene ring formation; and iii) YsfF and cyclase YsfX together were responsible for the ACP‐tethered dearomatization/dimerization process, possibly through an unprecedented Michael‐type addition reaction. Moreover, site‐directed mutagenesis experiments demonstrated that N301, E483 and H566 of YsfF are critical residues for both the 6π‐electrocyclization and dimerization processes. This study enhances our understanding of the multifunctionality of the TE protein family.

A Versatile Thioesterase Involved in Dimerization during Cinnamoyl Lipid Biosynthesis.

The cinnamoyl lipid compound youssoufene A1 (1), featuring a unique dearomatic carbon-bridged dimeric skeleton, exhibits increased inhibition against multidrug resistant Enterococcus faecalis as compared to monomeric youssoufenes. However, the formation process of this intriguing dearomatization/dimerization remains unknown. In this study, an unusual "gene-within-gene" thioesterase (TE) gene ysfF was functionally characterized. The gene was found to naturally encodes two proteins, an entire YsfF with α/β-hydrolase and 4-hydroxybenzoyl-CoA thioesterase (4-HBT)-like enzyme domains, and a nested YsfFHBT (4-HBT-like enzyme). Using an intracellular tagged carrier-protein tracking (ITCT) strategy, in vitro reconstitution and in vivo experiments, we found that: i) both domains of YsfF displayed thioesterase activities; ii) YsfF/YsfFHBT could accomplish the 6π-electrocyclic ring closure for benzene ring formation; and iii) YsfF and cyclase YsfX together were responsible for the ACP-tethered dearomatization/dimerization process, possibly through an unprecedented Michael-type addition reaction. Moreover, site-directed mutagenesis experiments demonstrated that N301, E483 and H566 of YsfF are critical residues for both the 6π-electrocyclization and dimerization processes. This study enhances our understanding of the multifunctionality of the TE protein family.

Inhibiting Peptidoglycan Hydrolase Alleviates MRSA Pneumonia Through Autolysin-Mediated MDP-NOD2 Pathway.

Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of staph infection that is difficult to treat because of resistance to some antibiotics. A recent study indicated that diarylurea ZJ-2 is a novel antibacterial agent against multi-drug resistant Enterococcus faecium. In this work, we refined the bactericidal mechanism of ZJ-2 as a peptidoglycan (PG) hydrolase by affecting AtlA-mediated PG homeostasis. A wild-type strain (WT) and a mutant strain (ΔatlA) were used to investigate the effects of ZJ-2 on the cell wall, PG, and autolysin regulatory system by antimicrobial susceptibility testing, hemolytic toxin assay, microanalysis, autolysis assay, qRT-PCR, ELISA and mouse model of pneumonia. The results revealed that ZJ-2 down-regulated the expression of genes related to peptidoglycan hydrolase (PGH) (sprX, walR, atlA, and lytM), and reduced the levels of PG, muramyl dipeptide (MDP), cytokines, and hemolytic toxin, while ΔatlA interfered with the genes regulation and PG homeostasis. In the mouse MRSA pneumonia model, the same trend was observed in the nucleotide oligomerization domain protein 2 (NOD2) and relative proinflammatory factors. ZJ-2 may act as a novel inhibitor of PG hydrolyse, disrupting autolysin-mediated PG homeostasis, and reducing inflammation by down-regulating the MDP-NOD2 pathway.

Protective effect of microbisporicin (NAI-107) against vancomycin resistant Enterococcus faecium infection in a Galleria mellonella model.

Increasing antimicrobial resistance in Enterococcus faecium necessitates the search for novel treatment agents, such as bacteriocins. In this study, we conducted an in vivo assessment of five bacteriocins, namely Lacticin Z, Lacticin Q, Garvicin KS (ABC), Aureocin A53 and Microbisporicin (NAI-107), against vanB-resistant Enterococcus faecium using a Galleria mellonella model. Our in vitro experiments demonstrated the efficacy of all five bacteriocins against vanB-resistant E. faecium with only NAI-107 demonstrating in vivo efficacy. Notably, NAI-107 exhibited efficacy across a range of tested doses, with the highest efficacy observed at a concentration of 16µg/mL. Mortality rates in the group treated with 16µg/mL NAI-107 were lower than those observed in the linezolid-treated group. These findings strongly suggest that NAI-107 holds promise as a potential alternative therapeutic agent for treating infections caused by resistant E. faecium and warrants further investigation.

Antimicrobial resistance profile of Enterococcus species and molecular characterization of Vancomycin resistant Enterococcus faecium from the fecal samples of newly diagnosed adult HIV patients in Dar es Salaam, Tanzania

BackgroundEnterococci are becoming clinically more important especially among immunocompromised patients. Of concern are vancomycin resistant enterococci (VRE) which have both intrinsic and acquired forms of resistance. This work aimed to determine the antimicrobial resistance patterns of Enterococcus spp. and characterize VRE isolate obtained from HIV-infected patient using whole genome sequencing (WGS).Methods:Antimicrobial susceptibility testing was done on 57 enterococci isolates by both the disk diffusion method and Epsilometer test (E-Test). WGS was performed on VRE isolate determined by E-test.ResultsOut of the 57 enterococci isolates; 58% (33/57) were E. faecalis, 39% (22/57) E. faecium and 4% (2/57) were E. gallinarum. The highest antimicrobial resistance was observed in E. faecalis isolates. The most prevalent antimicrobial resistance was observed towards quinupristin-dalfopristin (56%, 32/57), followed by ciprofloxacin (28%), tigecycline (18%), daptomycin (16%), chloramphenicol (14%), ampicillin and teicoplanin (2%). Multidrug resistance (MDR) was detected in 11% (6/57) of the isolates. Vancomycin resistance and high-level gentamycin resistance (HLGR) were observed in one E. faecium and one E. faecalis isolates respectively. The VRE was typed as ST80, carried vanA and other resistance genes for aminoglycosides, tetracyclines, quinolones and ampicillin. Furthermore, the isolate had chromosomal mutations responsible for quinolone (gyrA (p.S83I) and parC (p.S80I) and ampicillin (pbp5) resistance.ConclusionsThe detection of VRE, HLGR and MDR in the study settings underscores the sustained surveillance of VRE in high-risk groups and institution of infection control measures for prompt identification and isolation of carriers to prevent the spread of VRE in the community and hospital settings.

Antibacterial biofilm efficacy of calcium hydroxide loaded on Gum Arabic nanocarrier: an in-vitro study

BackgroundAn innovative intracanal medication formulation was introduced in the current study to improve the calcium hydroxide (Ca(OH)2) therapeutic capability against resistant Enterococcus faecalis (E. faecalis) biofilm. This in-vitro study aimed to prepare, characterize, and evaluate the antibacterial efficiency of Ca(OH)2 loaded on Gum Arabic (GA) nanocarrier (Ca(OH)2-GA NPs) and to compare this efficiency with conventional Ca(OH)2, Ca(OH)2 nanoparticles (NPs), GA, and GA NPs.Materials and methodsThe prepared nanoparticle formulations for the tested medications were characterized using Transmission Electron Microscope (TEM) and Fourier-Transform Infrared Spectroscopy (FTIR). 141 human mandibular premolars were selected, and their root canals were prepared. Twenty-one roots were then sectioned into 42 tooth slices. All prepared root canals (n = 120) and teeth slices (n = 42) were divided into six groups according to the intracanal medication used. E. faecalis was inoculated in the samples for 21 days to form biofilms, and then the corresponding medications were applied for 7 days. After medication application, the residual E. faecalis bacteria were assessed using CFU, Q-PCR, and SEM. Additionally, the effect of Ca(OH)2-GA NPs on E. faecalis biofilm genes (agg, ace, and efaA) was investigated using RT-PCR. Data were statistically analyzed at a 0.05 level of significance.ResultsThe synthesis of NPs was confirmed using TEM. The results of the FTIR proved that the Ca(OH)2 was successfully encapsulated in the GA NPs. Ca(OH)2-GA NPs caused a significant reduction in the E. faecalis biofilm gene expression when compared to the control (p < 0.001). There were significant differences in the E. faecalis CFU mean count and CT mean values between the tested groups (p < 0.001) except between the Ca(OH)2 and GA CFU mean count. Ca(OH)2-GA NPs showed the least statistical E. faecalis mean count among other groups. SEM observation showed that E. faecalis biofilm was diminished in all treatment groups, especially in the Ca(OH)2-GA NPS group when compared to the control group.ConclusionsCa(OH)2 and GA nanoparticles demonstrate superior anti-E. faecalis activity when compared to their conventional counterparts. Ca(OH)2-GA NPs showed the best antibacterial efficacy in treating E. faecalis biofilm. The tested NP formulations could be considered as promising intracanal medications.

Antibacterial activity evaluation of cambuí extract against multi-resistant Enterococcus faecium

Bacterial resistance is a global public health issue. Among these pathogens, Enterococcus faecium nosocomial has been highlighted due to its potential to cause bacteremia infections. The incidence of resistant Enterococcus faecium bacteremia has enhanced over time, thereby, it has caused high rates of mortality. Hence, it led to the interest in natural drugs. Plant extracts from the Myrtaceae family have a broad-spectrum antimicrobial action. Among the plants of this family, we can highlight cambuí, due to its wide variety of bioactive compounds such as phenolic compounds. Polyphenols are bioactive molecules that can inhibit the growth of resistant bacteria such as Enterococcus faecium. For this, the present study aimed to obtain bioactive extracts from cambuí using pressurized hot water to grow inhibition of multi-resistant Enterococcus faecium nosocomial. In the present study, antibacterial compounds were obtained after extraction kinetics over 120 minutes at a temperature of 50º C, a flow rate of 1 mL/min-1, and a constant pressure of 200 bar using water as the extraction solvent. Flavonoids and other phenolic compounds from cambuí extracts were quantified by spectrophotometric methods. The TSA using the well-diffusion method was used to verify the sensitivity of the bacterium Enterococcus faecium against cambuí aqueous extract. The results showed that the best extraction time was 60 minutes using 60 mL of water. The cambuí aqueous extract showed a relevant amount of flavonoids and other phenolic compounds, hence, this extract was able to inhibit the growth of the bacterium Enterococcus faecium resistant to Ampicillin, Imipenem, Vancomycin, and Teicoplanin.

Role of membrane vesicles in the transmission of vancomycin resistance in Enterococcus faecium

Clonal transmission and horizontal gene transfer (HGT) contribute to the spread of vancomycin-resistant enterococci (VRE) in global healthcare. Our study investigated vesiduction, a HGT mechanism via membrane vesicles (MVs), for vanA and vanB genes that determine vancomycin resistance. We isolated MVs for VRE of different sequence types (STs) and analysed them by nanoparticle tracking analysis. Selected MV samples were subjected to DNA sequence analysis. In resistance transfer experiments, vancomycin-susceptible enterococci were exposed to MVs and bacterial supernatants of VRE. Compared to bacteria grown in lysogeny broth (MVs/LB), cultivation under vancomycin stress (MVs/VAN) resulted in increased particle concentrations of up to 139-fold (ST80). As a key finding, we could show that VRE isolates of ST80 and ST117 produced remarkably more vesicles at subinhibitory antibiotic concentrations (approx. 9.2 × 1011 particles/ml for ST80 and 2.4 × 1011 particles/ml for ST117) than enterococci of other STs (range between 1.8 × 1010 and 5.3 × 1010 particles/ml). In those MV samples, the respective resistance genes vanA and vanB were completely verifiable using sequence analysis. Nevertheless, no vancomycin resistance transfer via MVs to vancomycin-susceptible Enterococcus faecium was phenotypically detectable. However, our results outline the potential of future research on ST-specific MV properties, promising new insights into VRE mechanisms.

Unveiling the Relationship between Ceftobiprole and High-Molecular-Mass (HMM) Penicillin-Binding Proteins (PBPs) in Enterococcus faecalis.

Low-affinity PBP4, historically linked to penicillin resistance in Enterococcus faecalis, may still have affinity for novel cephalosporins. Ceftobiprole (BPR) is a common therapeutic choice, even with PBP4-related overexpression and amino acid substitution due to mutations. Our study aims to explore the interaction between BPR and High-Molecular-Mass (HMM) low-reactive PBPs in Penicillin-Resistant-Ampicillin-Susceptible/Ceftobiprole Non-Susceptible (PRAS/BPR-NS) E. faecalis clinical isolates. We conducted competition assays examining class A and B HMM PBPs from four PRAS/BPR-NS E. faecalis strains using purified membrane proteins and fluorescent penicillin (Bocillin FL), in treated and untreated conditions. Interaction strength was assessed calculating the 50% inhibitory concentration (IC50) values for ceftobiprole, by analyzing fluorescence intensity trends. Due to its low affinity, PBP4 did not display significant acylation among all strains. Moreover, both PBP1a and PBP1b showed a similar insensitivity trend. Conversely, other PBPs showed IC50 values ranging from 1/2-fold to 4-fold MICs. Upon higher BPR concentrations, increased percentages of PBP4 inhibition were observed in all strains. Our results support the hypothesis that PBP4 is necessary but not sufficient for BPR resistance, changing the paradigm for enterococcal cephalosporin resistance. We hypothesize that cooperation between class B PBP4 and at least one bifunctional class A PBP could be required to synthesize peptidoglycan and promote growth.

Sex pheromone-responsive conjugative antibiotic resistance in Enterococcus faecalis: How to control it?

Sex pheromone-responsive conjugative antibiotic resistance in Enterococcus faecalis: How to control it?

The first vanE-type vancomycin resistant Enterococcus faecalis isolates in Norway – phenotypic and molecular characteristics

We aimed to characterize the vanE cluster and its genetic support in the first Norwegian vanE-type isolates and assess genetic relatedness to other vanE isolates. Two vanE-type vancomycin resistant Enterococcus faecalis (vanE-VREfs) isolates (E1 and E2) recovered from the same patient 30 months apart were examined for antimicrobial susceptibility, genome sequence, vancomycin resistance induction, vanE transferability, genome mutation rate, and phylogenetic relationship to E. faecalis closed genomes and two vanE-VREfs from North America. The ST34 E1 and E2 strains expressed low-level vancomycin resistance and susceptibility to teicoplanin. Their vanE gene clusters were part of a non-transferable Tn6202. The histidine kinase part of vanSE was expressed although a premature stop codon (E1) and insertion of a transposase (E2) truncated their vanSE gene. The vancomycin resistance phenotype in E1 was inducible while constitutive in E2. E1 showed a 125-fold higher mutation rate than E2. Variant calling showed 60 variants but nearly identical chromosomal gene content and synteny between the isolates. Their genomes also showed high similarity to another ST34 vanE-VREfs from Canada. In-depth genomic analyses of the first two vanE-VREfs found in Europe identified a single chromosomal insertion site of two variants of vanE-conferring Tn6202. Single nucleotide polymorphism (SNP) and core genome multilocus sequence type (cgMLST) analyses show the genomes are different. This can be explained by the high mutation rate of E1 and acquisition of different mobile genetic elements; thus, we believe the two isolates from the same patient are genetically related. Genome similarities also suggest relatedness between the Canadian and Norwegian vanE-VREfs.

Mustard Gel is an Effective Intracanal Medicament Against Enterococcus Faecalis: an In-Vitro Study on Extracted Teeth

&lt;p&gt;&lt;strong&gt;ABSTRACT&lt;/strong&gt;&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Root canal treatment is hampered by the presence of resilient bacteria within the canals of teeth which leads to the need for incorporation of intra-canal medication. This study aimed to assess the effectiveness of mustard gel against the highly resistant Enterococcus faecalis (E. faecalis) bacteria in comparison with calcium hydroxide (Ca(OH)2) paste as an intra-canal medicament.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This experimental study comprised forty extracted single-rooted teeth which were equally divided into two groups. In group 1, Ca(OH)2 paste was applied whereas in group 2, mustard gel was used. After disinfection, each tooth was sectioned horizontally into three equal parts. The standardized middle section was inoculated with a controlled strain of E. faecalis followed by the application of intra-canal medicaments for a week in both groups. The bacterial colonies were counted as colony-forming units (CFU/ml). Data were entered and analyzed by using Statistical Package for Social Sciences version 25.0.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Microscopically, E. faecalis appeared as cocci-round shaped in chains or pairs. The median bacterial count was 1,550 (775-2,500) for group 1 (Ca(OH)2 paste) as compared to only 400 (200-775) in group 2 (mustard gel) (p &amp;lt; 0.001).&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Mustard gel can be used as a cost-effective, readily available, and safe herbal alternative to Ca(OH)2 paste for root canal treatments.&lt;/p&gt;

The first tigecycline resistant Enterococcus faecium in Norway was related to tigecycline exposure

We describe the first tigecycline resistant enterococcal isolate in Norway and the mechanisms involved. The Norwegian National Advisory Unit on Detection of Antimicrobial Resistance (K-res). received in 2022 an Enterococcus faecium blood culture isolate with decreased susceptibility to tigecycline from a hospitalized patient in the South-Eastern Norway Health region for confirmatory testing. K-res verified a tigecycline-resistant E. faecium (TigR) with broth microdilution MIC of 0.5 mg/L. The patient had received treatment with tigecycline because of an infection with a linezolid- and vancomycin-resistant but tigecycline susceptible E. faecium (TigS) 47 days prior to the detection of the corresponding tigecycline-resistant isolate. Whole-genome comparisons, cgMLST and SNP analyses revealed that the two ST117 strains were closely related. The TigR isolate showed a novel deletion of 2 amino acids (K57Y58) in a polymorphic region of ribosomal protein S10 previously associated with tigecycline resistance and a deletion of the tet(M) leader peptide previously related to increased expression of tet(M) and tigecycline resistance in enterococci. Genomic and epidemiological analyses confirm that the two E. faecium (TigR and TigS) are closely related isolates of the same strain and that the two deletions (in rpsJ and of tet(M) leader peptide) account for the tigecycline resistance in TigR.

Nitrogen and phosphorus eutrophication enhance biofilm-related drug resistance in Enterococcus faecalis isolated from Water Sources

Antibiotic resistance is a critical topic worldwide with important consequences for public health. So considering the rising issue of antibiotic-resistance in bacteria, we explored the impact of nitrogen and phosphorus eutrophication on drug resistance mechanisms in Enterococcus faecalis, especially ciprofloxacin, oxytetracycline, and ampicillin. For this purpose we examined the antibiotic-resistance genes and biofilm formation of Enterococcus faecalis under different concentration of nitrogen and phosphorus along with mentioned antibiotics. Mesocosms were designed to evaluate the impact of influence of eutrophication on the underlying mechanism of drugn resistence in Enterococcus faecalis. For this purpose, we explored the potential relation to biofilm formation, adhesion ability, and the expression levels of the regulatory gene fsrA and the downstream gene gelEI. Our results demonstrated that the isolates of all treatments displayed high biofilm forming potential, and fsrA and gelE genes expression. Additionally, the experimental group demonstrated substantially elevated Enterococcus faecalis gelE expression. Crystal violet staining was applied to observe biofilm formation during bacterial development phase and found higher biofilm formation. In conclusion, our data suggest that E. faecalis resistance to ciprofloxacin, oxytetracycline, and ampicillin is related to biofilm development. Also, the high level of resistance in Enterococcus faecalis is linked to the expression of the fsrA and gelE genes. Understanding these pathways is vital in tackling the rising problem of bacterial resistance and its potential effect on human health.

Bacteriophage endolysin Ply113 as a potent antibacterial agent against polymicrobial biofilms formed by enterococci and Staphylococcus aureus.

Antibiotic resistance in Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus remains a major public health concern worldwide. Furthermore, these microbes frequently co-exist in biofilm-associated infections, largely nullifying antibiotic-based therapy. Therefore, it is imperative to develop an efficient therapeutic strategy for combating infections caused by polymicrobial biofilms. In this study, we investigated the antibacterial and antibiofilm activity of the bacteriophage endolysin Ply113 in vitro. Ply113 exhibited high and rapid lytic activity against E. faecium, E. faecalis, and S. aureus, including vancomycin-resistant Enterococcus and methicillin-resistant S. aureus isolates. Transmission electron microscopy revealed that Ply113 treatment led to the detachment of bacterial cell walls and considerable cell lysis. Ply113 maintained stable lytic activity over a temperature range of 4-45°C, over a pH range of 5.0-8.0, and in the presence of 0-400 mM NaCl. Ply113 treatment effectively eliminated the mono-species biofilms formed by E. faecium, E. faecalis, and S. aureus in a dose-dependent manner. Ply113 was also able to eliminate the dual-species biofilms of E. faecium-S. aureus and E. faecalis-S. aureus. Additionally, Ply113 exerted potent antibacterial efficacy in vivo, distinctly decreasing the bacterial loads in a murine peritoneal septicemia model. Our findings suggest that the bacteriophage endolysin Ply113 is a promising antimicrobial agent for the treatment of polymicrobial infections.

2110. Enhancing Antibiotic Efficacy Against Enterococcal faecium with Bacteriophage and Antimicrobial Peptides

Abstract Background The urgency to find new alternatives has increased as multidrug-resistant organisms enhance their defense mechanisms. In recent years, there has been a renewed interest in bacteriophages as potential alternatives or adjuncts to antibiotic therapy. However, there is limited information on the impact of bacteriophages with the innate immune system. Cathelicidin LL-37, a cationic peptide with antimicrobial properties, functions in coordination with the immune system to eradicate pathogens. We aim to evaluate how the survival of daptomycin (DAP) and ampicillin (AMP) resistant or non-susceptible Enterococcus faecium isolates are impacted by the interaction between bacteriophage, LL-37, and the addition of DAP/AMP. Methods Two E. faecium clinical isolates were utilized: R497 and HOU503. Bacteriophages provided by the Naval Medical Research Command, NV- 503-01 and NV-497 were quantified and propagated to approximately 108 PFU/mL. LL-37 was prepared at a final concentration of 640μM and diluted in RPMI intentionally to a suboptimal concentration of 0.5μM to adjust for a 70-80% survival rate. This was done to detect a synergistic interaction more easily with the addition of phage. Samples were incubated at 37 °C and plated in triplicate on brain heart infusion agar at 2h. After 24h of incubation, colonies were counted for and analyzed. Data was expressed as a mean percent survival with standard deviation. ANOVA with Tukey's HSD post-hoc test was used to determine the variations between each combination used. Results The targeted bacterial survival rate against E. faecium isolates was attained by LL-37 at a concentration of 0.5μM. However, when R497 and HOU503 was combined with LL-37, bacteriophage, and DAP/AMP the percentage of bacterial survival was significantly (P&amp;lt; 0.05) lower than that of the growth control, LL-37, AMP/DAP, and bacteriophage alone. Conclusion By conducting bacterial survival assays, we observed a notable enhancement in the elimination of multi-drug resistant E. faecium when LL-37, bacteriophage, and DAP/AMP were added. Examining this interaction over longer periods, both with and without varying antimicrobials, will yield more understanding regarding the potential involvement of bacteriophage in the innate immune system's response to fighting infections. Disclosures Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant

First report of vancomycin resistant Enterococcus faecalis and Enterococcus faecium isolated from water buffalo clotted cream in Turkey

This study aimed to isolate the Enterococcus species from homemade water buffalo clotted cream sold in Afyonkarahisar, investigate the vancomycin resistance genes in isolated strains by PCR and determine the antibiotic resistance of strains to some antibiotics commonly used in Turkey. A total of 107 buffalo clotted cream samples sold in public bazaars of Afyonkarahisar were collected. Following the phenotypic identification using a commercial identification kit, PCR was applied to strains using by species specific primers. Forty Enterococcus strains were obtained from 107 samples by PCR. Of 40 strains, 31 (77.5%) and 9 (22.5%) were identified to be E. faecalis and E. faecium, respectively. One vanA (2.5%) and 14 vanB (35%) genes were determined in tested 40 strains. While of strains having the vanB gen, 10 and four were found to be E. faecalis and E. faecium, respectively, one E. faecium strain also harboured the vanA gen. Thus, while the vanB gen positivity was found to be 32.3% in 31 E. faecalis strains and 44.4% in 9 E. faecium strains, the vanA gen positivity was determined to be 11.1% in 9 E. faecium strains. It was not found the vanC1 and vanC2/C3 genes in none of the strains. While all of strains were phenotypically resistant to streptomycin and fusidic acid, high resistance rates were also determined in the strains to kanamycin (87.5%), cephalothin (80%), erythromycin (80%), gentamicin (77.5%), tetracycline (75%) and vancomycin (60%). Resistance to all tested antibiotics except teicoplanin was determined in E. faecalis strains and except chloramphenicol in E. faecium strains harbouring the vancomycin resistance genes. In conclusion, it was thought the buffalo clotted creams offered for consumption in Afyonkarahisar may have potential risk for public health in terms of VRE species. To our knowledge, this is the first study showing the presence of VRE in the clotted cream samples by PCR in Turkey.