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Uptake of gentamicin by Staphylococcus aureus possessing gentamicin-modifying enzymes: enhancement of uptake by puromycin and N,N'-dicyclohexylcarbodiimide.

Uptake of gentamicin by a gentamicin-resistant strain of Staphylococcus aureus possessing the aminoglycoside-modifying phosphotransferase enzyme APH(2") was enhanced by the protein synthesis inhibitor, puromycin or by the proton-translocating ATPase inhibitor, N,N'-dicylohexylcarbodiimide. Such enhanced uptake was inhibited by carbonyl cyanide p trifluoromethoxyphenylhydrazone or by valinomycin in the presence of potassium ions, suggesting a role for the transmembrane proton motive force in the process. The accumulated gentamicin did not cause loss of cell viability and exhibited altered chromatographic mobility compared with a control (unmodified) preparation of gentamicin.

Carbodiimides↗

Correlation between apramycin and gentamicin use in pigs and an increasing reservoir of gentamicin-resistant Escherichia coli.

OBJECTIVES: Resistance towards the veterinary drug apramycin can be caused by the aac(3)-IV gene, which also confers resistance towards the important human antibiotic gentamicin. The objectives of this study were to investigate the temporal occurrence and the genetic background of apramycin and gentamicin resistance in Escherichia coli strains from pork, healthy pigs and diagnostic submissions from pigs and to investigate potential relationships to the use of apramycin and gentamicin at farm and national levels. METHODS: Data on Danish E. coli isolates from healthy pigs (indicator bacteria), diagnostic submissions from pigs (clinical isolates) and pork were obtained from the national surveillance of antimicrobial resistance and from routine diagnostic laboratories. Antimicrobial consumption data were obtained from the Danish Medicines Agency (1997-2000) and from the VetStat database (2001-2004). The genetic background for gentamicin resistance was investigated by PCR. Relationships between antimicrobial usage and resistance were analysed by chi2 test and logistic regression. RESULTS: At the farm level, the occurrence of apramycin/gentamicin cross-resistance was correlated to the use of apramycin (P < 0.001). At the national level, occurrence of apramycin/gentamicin cross-resistance in clinical E. coli O149 isolates was significantly correlated with the amounts and duration of apramycin use. The aac(3)-IV gene was detected in all tested cross-resistant isolates. CONCLUSIONS: Apramycin consumption at farm level is most probably driving the increasing occurrence of apramycin/gentamicin cross-resistant [aac(3)-IV positive] E. coli in diseased pigs and healthy finishers at slaughter. The duration of use and amounts used both had a significant effect on the prevalence of apramycin/gentamicin cross-resistance in diseased weaning pigs at the national level.

Animals↗

Effects of membrane-energy mutations and cations on streptomycin and gentamicin accumulation by bacteria: a model for entry of streptomycin and gentamicin in susceptible and resistant bacteria.

Several mutants of Escherichia coli affecting aerobic energy generation and energization of the bacterial membrane have been examined for their effect on streptomycin and gentamicin accumulation and susceptibility. A heme-deficient mutant (K207) and two mutants (CJ-8 [colicin K insensitive] and NR-70) associated with defective aerobic active transport were associated with decreased transport of streptomycin and gentamicin and increased resistance to those antibiotics. These mutants also exhibited increased resistance to several other aminoglycoside antibiotics, but not the aminocyclitol spectinomycin. The same observations were made with a ubiquinone-deficient mutant, but a strA derivative of this mutant was shown additionally to be saturable for streptomycin accumulation at a concentration four or more times lower than that required for saturation of the parent. A mutant uncoupled for adenosine 5'-triphosphate synthesis from electron transport and membrane Mg-adenosine 5'-triphosphatase deficient was hypersensitive to those aminoglycosides tested and spectinomycin, and showed enhanced transport of streptomycin and gentamicin. A variety of compounds structurally related to streptomycin were examined at high concentrations for inhibition of streptomycin uptake in a strA mutant of E. coli K-12 SA 1306, but no evidence for competition was detected, suggesting the absence of a common transport carrier. Four different divalent cations were shown to inhibit streptomycin and gentamicin accumulation in E. coli K-12 SA 1306. Divalent cations were shown to inhibit uptake of these two drugs in two bacterial species with distinct cell wall structures, Pseudomonas aeruginosa and Staphylococcus aureus, and to inhibit streptomycin uptake in spheroplasts of streptomycin-susceptible and -resistant E. coli. However, calcium had almost no inhibitory effect on streptomycin uptake by the ubiquinone-deficient mutant E. coli AN66. These and previous findings have been used to formulate a model for aminoglycoside entry into bacteria using a low-affinity membranous complex involved in membrane energization that includes respiratory quinones, which probably act to bind and transport aminoglycosides across the cell membrane. This phase of transport is associated with the lowest accumulation rate (termed energy-dependent phase I) that is rate limiting for susceptibility. It is further proposed that subsequent association of the membrane-bound aminoglycoside with higher-affinity binding sites on membrane-associated ribosomes carrying out a normal ribosomal cycle and protein synthesis results in a more rapid transport rate (termed energy-dependent phase II). The increased rate could result from a state of membrane energization analogous to that causing enhanced aminoglycoside transport rates seen in the uncoupled mutant, AN120. How this model explains the mechanism by which enzymatically modified aminoglycosides render cells resistant to unmodified aminoglycosides is also discussed.

Adenosine Triphosphatases↗

Ophthalmic fluorometholone-gentamicin versus ophthalmic betamethasone-gentamicin following cataract surgery.

A prospective, randomised, investigator-masked, parallel-group study was performed to compare fluorometholone-gentamicin eye drops and ointment with betamethasone-gentamicin eyedrops and ointment in the control of ocular inflammation after cataract surgery. Seventy patients (35 in each treatment group) of both sexes undergoing cataract-lens implant surgery for visually disabling cataract were enrolled in the study. The demographic and baseline parameters on day I, the day after surgery, were similar in the two study groups. After treatment, on day 3 and day 6 post-operatively, the reduction in cells in the anterior chamber and conjunctival hyperaemia were similar in the two study groups. Both treatments were equally well-tolerated. Ophthalmic fluorometholone-gentamicin was as effective as ophthalmic betamethasone-gentamicin in the control of ocular inflammation after cataract surgery.

Aged↗

In vitro activity of fosfomycin-gentamicin, fosfomycin-ceftazidime, fosfomycin-imipenem and ceftazidime-gentamicin combinations against ceftazidime-resistant Pseudomonas aeruginosa.

The effects of antimicrobial combinations against ceftazidime-resistant Pseudomonas aeruginosa strains isolated from hospitalized patients were investigated. Using the checkerboard titration method, combination of fosfomycin-gentamicin, fosfomycin-ceftazidime, fosfomycin-imipenem and ceftazidime-gentamicin was synergistic against 4, 11, 38 and 39% of 22, 18, 29 and 18 strains tested respectively and additive effect of the combinations against the strains tested was 41, 33, 14 and 44%, respectively. Antagonistic effects against the isolates were noted when fosfomycin was combined with gentamicin (27%), ceftazidime (22%) and imipenem (7%). No antagonistic effect was observed in the ceftazidime-gentamicin combination.

Anti-Bacterial Agents↗

[Immunochemical determination of gentamicin in serum. I. Preparation of gentamicin-carrier conjugate].

The author describes the procedure for the preparation of the complex gentamicin-carrier needed for the preparation of specific antibodies against gentamicin. As carriers bovine serum albumin, thyroglobulin and haemocyanin were used. The conjugate was purified by separation on a Sephadex G-25 column and its activity was tested by the microbiological diffusion method. The results indicate that the method described in the paper is suitable for the preparation of the complex gentamicin--bovine serum albumin and gentamicin--thyroglobulin.

Drug Carriers↗

Randomized study of minocycline + gentamicin compared with metronidazole + gentamicin for prophylaxis or treatment of mixed infections in abdominal surgery.

Seventy patients admitted for abdominal surgery requiring short-term perioperative prophylaxis were randomized to receive minocycline + gentamicin or metronidazole + gentamicin. Thirty patients were considered to be infected at the time of surgery and were treated with the same regimen. In the prophylactic cohort, one patient from each group developed postoperative fever. One patient receiving minocycline developed a wound infection. The overall infection rate was 2.6%. In the treatment cohort, it appeared that the patients receiving metronidazole had more severe underlying diseases than those receiving minocycline. Consequently, more postoperative non-infectious complications were observed in the former. Minocycline + gentamicin appeared at least as effective than metronidazole + gentamicin in preventing postoperative infectious complications associated with abdominal surgery or in treating intra-abdominal infections.

Abdomen↗

Intraventricular treatment of Serratia marcescens meningitis with gentamicin. Pharmacokinetic studies of gentamicin concentration in one case.

A neurosurgical patient with postoperative meningitis caused by Serratia marcescens was treated with intraventricular as well as intramuscular gentamicin. Gentamicin concentration in serum and CSF was determined at different times after the administration. Serratia marcescens could not be isolated from CSF after 3 days of therapy. Determination of gentamicin concentrations in CSF showed that gentamicin should not be given intraventricularly more than once a day to avoid accumulation of the drug. No adverse effect was noticed although the CSF concentration reached 450 mug/ml.

Bacterial Infections↗

Combined gentamicin-tobramycin-corticosteroid treatment. II. Effect on gentamicin-resistant Pseudomonas keratitis.

In an experimental model of Pseudomonas keratitis produced by a gentamicin sulfate-resistant, tobramycin sulfate-sensitive strain of P aeruginosa, the results of two treatment regimens-(1) with gentamicin and tobramycin alone and (2) with gentamicin, tobramycin, and a steroid-were evaluated. All of the animals exhibited ultimately the same amount of corneal inflammation and corneal scarring. In the group receiving the antibiotic-steroid combination, the corneal lesions healed more slowly.

Animals↗

A comparison of clindamycin-gentamicin and penicillin-gentamicin in the treatment of post-cesarean section endomyometritis.

A random comparison of clindamycin-gentamicin (C-G) and penicillin-gentamicin was made in 200 women who developed endomyometritis following cesarean section. All pretreatment profiles indicated similar populations. The clinical response was more favorable in the women receiving clindamycin-gentamicin. The implications of these results upon clinical practice is discussed.

Adult↗

Epidemic neonatal gentamicin-methicillin--resistant Staphylococcus aureus infection associated with nonspecific topical use of gentamicin.

One hundred sixteen infants in an intensive care nursery acquired Staphylococcus aureus resistant to gentamicin and methicillin; 54 patients acquired S. aureus sensitive to gentamicin and methicillin. Topical application of gentamicin ointment was significantly associated with acquisition of GMRS. Of 78 infants who acquired GMRS, 38 had received GmO before GMRS was first cultured, whereas only one of 49 infants with GMSS had previously received GmO (P = 8.6 X 10(-8)). Infants with GMRS were also more likely than patients with GMSS to have had a lower mean birth weight, Apgar score, and gestational age; systemic antibiotic therapy and incubator care were significantly prolonged for patients with GMRS, but these factors did not explain susceptibility to GMRS infection. Multivariate logistic regression analysis showed that use of GmO was the single most important risk factor.

Bacteriological Techniques↗

Changing phage typing patterns of epidemic gentamicin-resistant Staphylococcus aureus. Evidence for transmission of gentamicin resistance.

In a 10-week period, infection with gentamicin resistant Staphylococcus aureus appeared in 24 adults and infants in one hospital. Medical staff were affected first, and subsequently 16 infants in the neonatal intensive-care unit. The gentamicin-resistant staphyloccal isolates showed three distinct phage susceptibility patterns in two distinct phage groups during the early, middle, and late phases of the outbreak. Although not confirmed with in-vitro or in-vivo laboratory data, this outbreak suggests that gentamicin resistance may be transferred between different strains of Staph. aureus in vivo.

Adult↗

Gentamicin-susceptible or gentamicin-resistant methicillin-resistant Staphylococcus aureus: a case-case study.

Gentamicin-susceptible methicillin-resistant Staphylococcus aureus (GS-MRSA) strains are replacing gentamicin-resistant MRSA (GR-MRSA) strains. We showed that exposure to other patients harboring GS-MRSA was the major risk factor for GS-MRSA acquisition, and that antimicrobial exposure, especially to beta-lactams, was strongly associated with acquisition of GR-MRSA but not GS-MRSA. Gentamicin use was significantly associated with GR-MRSA acquisition in univariate analysis only.

Drug Resistance, Multiple↗

Comparison of LY264826-gentamicin with vancomycin-gentamicin against enterococci from blood cultures.

The combination of the new glycopeptide LY264826 and gentamicin was compared with the combination of vancomycin and gentamicin against 30 strains of enterococci, comprising 20 strains of Enterococcus faecalis, five strains of Enterococcus faecium and five strains of Enterococcus avium, isolated from blood cultures. LY264826 plus gentamicin was synergic against E. faecalis and E. faecium, but not against E. avium.

Anti-Bacterial Agents↗

Acquired cross resistance to aminoglycosides in gentamicin-sensitive and gentamicin-resistant strains of enterobacteria.

The development of non-specific resistance ot gentamicin, tobramycin and amikacin was studied in 12 clinical isolates of enterobacteria with various patterns of aminoglycoside resistance. Strains were characterised with respect to MIC, transferability of resistance and possession of acetylating and adenylylating enzymes. An increase in aminoglycoside resistance was induced in 10 strains by a single exposure to the concentration of gentamicin, tobramycin or amikacin immediately below the MIC. Such resistance was non-specific; all three aminoglycosides were affected irrespective of which one had been used to induce the increase. Increments in non-specific aminoglycoside resistance were also evoked by exposure of enterobacteria to changing drug concentrations similar to those achieved in plasma during therapy. When strains already resistant to gentamicin or other aminoglycosides were exposed to therapeutically achievable drug concentrations, no further increase in resistance was observed in most cases. This suggests that use of an aminoglycoside to which the organism is resistant, as during "blind" therapy, will not usually compromise subsequent treatment with related antibiotics. The possible relevance of non-specific aminoglycoside resistance to therapy is discussed.

Amikacin↗

An improved radioimmunoassay for serum gentamicin levels using 125I-labelled gentamicin.

1. A radioimmunoassay is described for the measurement of gentamicin in serum or plasma. 2. The assay technique uses a tracer labelled with iodine-125 rather than tritium, and has advantages over previously reported radioimmunoassay methods (Longmore et al., 1976; Lewis, Nelson & Elder, 1972) with regard to rapidity, precision and simplicity of preparation of labelled gentamicin. 3. The iodination technique is simple and gives tracer in high yield, at high specific activity, and with complete immunological identity to unlabelled gentamicin. 4. There is a significant correlation between results obtained by this technique and by a microbial assay method but the radioimmunoassay is more rapid, specific and accurate.

Acylation↗

Genetic analysis of gentamicin resistance in methicillin- and gentamicin-resistant strains of Staphylococcus aureus isolated in Dublin hospitals.

Methicillin- and gentamicin-resistant strains of Staphylococcus aureus isolated in Dublin hospitals have been classified into groups I, II, and III based on resistance to antimicrobial agents and plasmid profiles. Each group expresses a characteristic level of resistance to gentamicin, tobramycin, and sisomicin. Enzyme assays showed that resistant strains expressed 2"-aminoglycoside phosphotransferase-6'-aminoglycoside transferase activity by a determinant which is known to be chromosomally located. The gentamicin resistance (Gmr) determinants were transferred from group I, II, or III strains by transduction into a laboratory strain where each expressed the same low level of resistance. This finding suggests that high-level resistance in some clinical strains is due to a second, unlinked resistance mechanism. No evidence was obtained by hybridization experiments that clinical isolates or spontaneous mutants expressing high-level Gmr carried more than one copy of the Gmr determinant, thus eliminating the possibility that a gene dosage effect was responsible for high-level resistance. Hybridization experiments with transductants and wild strains suggested that the Gmr determinant was located at homologous sites in wild strains from different groups, although restriction site differences were observed in flanking sequences. Electron microscope analysis of a cloned Gmr determinant and genetic evidence suggested that a Dublin clinical isolate harbored a transposon very similar to Tn4001.

Anti-Bacterial Agents↗

Ionic binding of 3H-gentamicin and short-time bactericidal activity of gentamicin against Pseudomonas aeruginosa isolates with different lipopolysaccharide structures.

The clinical isolates of Pseudomonas aeruginosa can be roughly classified into long- and short-LPS strains and LPS-deficient strains. Ionic binding of 3H-gentamicin was the highest in the long-LPS strains followed in descending order by short-LPS and LPS-deficient strains. However, PAC605 strain, completely lacking in the repeated units of O-polysaccharide and also lacking in some of the neutral sugar residues of the core oligosaccharide region, highly bound to 3H-gentamicin and it is suggested that the negatively charged sites on the deep-core oligosaccharide region and/or on lipid A participated in the binding to 3H-gentamicin. This manner of binding may be also applied to P. aeruginosa No. 45 (LPS-deficient), a clinical isolate.

Gentamicins↗