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In vitro synthesis of peptidoglycan by beta-lactam-sensitive and -resistant strains of Neisseria gonorrhoeae: effects of beta-lactam and other antibiotics.

The synthesis in vitro of peptidoglycan by Neisseria gonorrhoeae was studied in organisms made permeable to nucleotide precursors by treatment with ether. Optimum synthesis occurred at 30 degrees C in tris(hydroxymethyl)aminomethane-maleate buffer (0.05 M; pH 6) in the presence of 20 mM Mg(2+). The incorporation from uridine 5'-diphosphate-N-acetyl-[(14)C]glucosamine into peptidoglycan, measured after precipitation of the cells with trichloroacetic acid, was sensitive to the beta-lactam antibiotics, bacitracin, diumycin, and tunicamycin and relatively resistant to spectinomycin and tetracycline. Differences in sensitivity between preparations from a beta-lactamase producer and a laboratory segregant derived from it were not great. Synthesized peptidoglycan was also fractionated into sodium dodecyl sulfate-soluble and -insoluble portions. beta-Lactam antibiotics at concentrations equivalent to the minimal inhibitory concentrations for growth of the organisms did not inhibit peptidoglycan synthesis, but rather caused a small enhancement. At higher concentrations, above about 0.5 mug/ml, incorporation into sodium dodecyl sulfate-insoluble material was progressively inhibited, whereas the amount of sodium dodecyl sulfate-soluble product increased greatly, more than compensating for the loss of the precipitable fraction. Similar observations were made with three strains, and also with the beta-lactam clavulanic acid, normally considered as a beta-lactamase inhibitor rather than as itself an effective antibiotic.

Anti-Bacterial Agents

LY127935, a novel oxa-beta-lactam: an in vitro comparison with other beta-lactam antibiotics.

The in vitro activities of LY127935 (LY) were compared with those of other beta-lactam antibiotics. LY was highly active (minimal inhibitory concentration [MIC] range 0.06 to 0.25 micrograms/ml) against the common Enterobacteriaceae (including Providencia stuartiia, Enterobacter, and Serrati marcescens), 8 to 16 times more active than cefoxitin, cefuroxime, or cefazolin, and from one-half to one-eighth as active as cefotaxime (HR756). The activity of LY against Pseudomonas aeruginosa (with MICs of 4 and 64 micrograms/ml for 50 and 90% of test strains, respectively) was essentially similar to that of cefotaxime, but was only one-half as active as CGP 7174/E. LY, cefoxitin, and cefotaxime were essentially equally active against Bacteroides fragilis--each was more active than cefuroxime and cefazolin. Against Staphylococcus aureus, LY (50% MIC and 90% MIC of 4 and 16 micrograms/ml, respectively) was less active than cefotaxime, cefoxitin, or cefuroxime and one-eighth as active as cefazolin. The composition and pH of the culture medium had little effect on the activity of LY, although 7.2 appeared to be the optimum pH.

Anti-Bacterial Agents

Escherichia coli mutants tolerant to beta-lactam antibiotics.

Two types of Escherichia coli mutants tolerant to beta-lactam antibiotics were isolated. One is E. coli chi2452, which showed a tolerant response against beta-lactam antibiotics when grown at 42 degrees C, and the others are the mutants C-80 and C-254, selected from mutagenized E. coli chi1776 by cycles of exposure to ampicillin, cephaloridine, and starvation of the nutritionally required diaminopimelic acid. Beta-lactam antibiotics caused rapid loss of viability and lysis in cultures of chi1776 or in chi2452 grown at 32 degrees C. In contrast, the same antibiotics caused only a reversible inhibition of growth in mutants C-80 and C-254 or in cultures of chi2452 grown at 42 degrees C. Beta-lactam antibiotics that show high affinity for penicillin-binding proteins 2 or 3 (mecillinam and cephalexin, respectively) induced similar morphological effects (ovoid cell formation and filament formation) in both parent and mutant strains. In contrast, beta-lactam antibiotics which have a high affinity for penicillin-binding protein 1 (e.g., cephaloridine or cefoxitin), which cause rapid lysis in the parental strains, caused cell elongation in the tolerant bacteria. In contrast to the parental cells, autolytic cell wall degradation was not triggered by beta-lactam treatment of chi2452 cells grown at 42 degrees C or in mutants C-80 and C-254. The total autolytic activity of mutants C-80 and C-254 was less than 30% that of the parent strain. However, virtually identical autolytic activities were found in cells of chi2452 grown either at 42 or 32 degrees C. Possible mechanisms for the penicillin tolerance of E. coli are considered on the basis of these findings.

Ampicillin

Triggering of autolytic cell wall degradation in Escherichia coli by beta-lactam antibiotics.

A biochemical method was developed to quantitatively compare the effectiveness of beta-lactams in triggering murein degradation (autolysin activity) in Escherichia coli. Bacteria prelabeled in their cell walls with radioactive diaminopimelic acid in growth medium were exposed for 10 min to the antibiotics at the appropriate minimal growth inhibitory concentrations and at multiples of these values, and the rate of cell wall degradation was followed during subsequent penicillin-binding protein (PBP)-1 were the most effective triggers of autolytic wall degradation; beta-lactams selective for PBP-2 were the poorest; and antibiotics preferentially binding to PBP-3 showed intermediate activities. The relative effectiveness of beta-lactams in autolysin triggering was found to parallel the effectiveness of the same drugs in causing rapid loss of viability, culture lysis, and spheroplast formation. Autolysin triggering was suppressed by inhibitors of protein and ribonucleic acid biosynthesis but not by inhibitors of deoxyribonucleic acid synthesis. The beta-lactam-induced cell wall degradation did not seem to involve a direct stimulation of enzyme activity or synthesis of new enzyme molecules, and murein sacculi isolated from cells that had been preexposed to a triggering dose of beta-lactam treatment exhibited the same sensitivity to crude, homologous autolysins as sacculi prepared from untreated control bacteria. On the basis of these observations, mechanisms are considered for the triggering of E. coli autolysins and for the role of autolytic activity in bacterial spheroplast formation, lysis, and death.

Anti-Bacterial Agents

Alafosfalin, a new inhibitor of cell wall biosynthesis: in vitro activity against urinary isolates in Japan and potentiation with beta-lactams.

A new phosphonopeptide, alafosfalin, was evaluated for in vitro antibacterial activity and for synergism with beta-lactams, using 475 Japanese clinical isolates from urinary tract infections. Alafosfalin was found to be highly active against Escherichia coli and moderately active against Serratia, Klebsiella, Enterobacter, and Citrobacter, but less active against gram-positive organisms than were beta-lactams such as cephazolin or ampicillin and inactive against indole-positive Proteus, Pseudomonas, and Acinetobacter. Potentiation with the two beta-lactams (fractional inhibitory concentration less than or equal to 0.5) was found in 10 to 40% of susceptible strains in 4:1 and 1:4 combinations, and to a lesser extent in those species or genera that were insensitive to alafosfalin alone. No cross resistance was seen between alafosfalin and the beta-lactams or any other commonly used antibacterial agents tested. Effect on selected ampicillin-resistant strains, differential sensitivity to alafosfalin among resistant strains of various types, and sensitivity of alafosfalin-insensitive E. coli and Klebsiella to other antibiotics are also discussed.

Alanine

Penetration through the gram-negative cell wall: a co-determinant of the efficacy of beta-lactam antibiotics.

Resistance of gram-negative bacteria to beta-lactam antibiotics is based mainly on two mechanisms: hydrolysis by beta-lactamases and exclusion of the antibiotics from their target sites in the inner membrane. This article describes the use of Pseudomonas aeruginosa K 799/WT and a mutant of this strain (K 799/61) to assess the role of the outer membrane as a permeability barrier to penicillins and cephalosporins. The data confirm the importance of good penetration for a beta-lactam to be active against Pseudomonas. The second part illustrates the interplay of beta-lactamases and the outer membrane in the resistance of Escherichia coli to beta-lactams. A method to determine membrane permeability parameters parameters is given. The results support the idea that only a combined consideration of inactivating enzymes and penetration barriers can lead to a better understanding of the efficiency of the defence mechanisms which gram-negative bacteria can invoke against beta-lactam antibiotics.

Anti-Bacterial Agents

Effects on learning and memory of 2-week treatments with chlordiazepoxide lactam, N-desmethyldiazepam, oxazepam and methyloxazepam, alone or in combination with alcohol.

A double-blind study with 40 healthy students was done in order to measure the effects of a 2-week treatment with chloridiazepoxide lactam (5 mg), nordiazepam (10 mg), oxazepam (15 mg) and methyloxazepam (20 mg) on immediate memory and associative learning. The drugs were administered t.i.d. and the tests were done after the very last capsule was given. It was ingested with a placebo drink and 0.5 g alcohol/kg body weight. Oxazepam and methyloxazepam alone behaved similar to the placebo. Immediate memory was significantly impaired following the treatment with nordiazepam, chlordiazepoxide lactam, alcohol, and after the simultaneous administration of nordiazepam and chlordiazepoxide lactam with alcohol. Chlordiazepoxide lactam was the only drug which alone impaired associative learning. Also alcohol alone, and all the drugs in combination with alcohol retarded learning acquisition.

Adult

Monocyclic antibiotic beta-lactams.

The preparation and antimicrobial activity of a series of beta-lactams (3a-f) are described. These compounds were prepared from the 2+2 cycloaddition of beta,beta-disubstituted enamines with aryl isocyanates; compounds 3a-f underwent facile beta-lactam ring fission between aminal carbon atom C4 and the lactam nitrogen N1. The resisting formylacetanilide derivatives were devoid of antibiotic activity.

Anti-Bacterial Agents

Nocardicin A, a new monocyclic beta-lactam antibiotic III. In vitro evaluation.

Nocardicin A, a new monocyclic beta-lactam antibiotic, exerts a comparatively potent antimicrobial activity against gram-negative organisms, especially Pseudomonas aeruginosa, the indole-positive and indole-negative Proteus groups (except Pr. morganii), Serratia marcescens and the Neisseria groups. The in vitro antimicrobial activity of nocardicin A against clinical isolates of Ps. aeruginosa was about twice that of carbenicillin. The mean MICs of nocardicin A for Pr. mirabilis, Pr. rettgeri and Pr. inconstans ranged from 3.13 to 12.5 microgram/ml and were 25 similar to 50 microgram/ml for Pr. vulgaris. Nocardicin A in concentrations of 12.5 similar to 50 microgram/ml inhibited 30 strains (48 percent) of S. marcescens usually resistant to beta-lactam antibiotics. However, nocardicin A had no significant in vitro activity against Staphylococci and Escherichia coli. No cross-resistance was seen between nocardicin A and other beta-lactam antibiotics. This antibiotic was stable to beta-lactamase. The in vitro activity of nocardicin A against Ps. aeruginosa and Pr. mirabilis was greatly influenced by the assay media used. Nocardicin A was bactericidal and appeared to act synergistically with serum bactericidal factors against Ps. aeruginosa and with polymorphonuclear leukocytes against Ps. aeruginosa, E. coli and Pr. vulgaris. The bactericidal activity of nocardicin A against the above 3 organisms, therefore, increased markedly in the presence of fresh serum and polymorphonuclear leukocytes.

Animals

[Resistance to beta-lactam antibiotics and aminoglycosides in gram negative bacteria. 2. Mechanism of resistance (author's transl)].

In a preceding paper the genetics of resistance of 2 representative strains exhibiting resistance to beta-lactam antibiotics (ampicillin, catbenicillin, cephalothin) to aminoglycosides (kanamycin, neomycin, paromomycin, gentamycin, sisomycin, tobramycin, streptomycin, spectinomycin) and further antimicrobials (tetracycline, chloramphenicol, suphonamides) were described. This paper reports about the mechanism of resistance to beta-lactam antibiotics and aminoglycosides in these strains. Enzymatic extracts from K. pneumoniae 1 and Serratia marcescens 2 were produced by the osmotic shock procedure. Incubation of these extracts with aminoglycoside antibiotics, to which the strains are resistant, and ATP resulted in the total inactivation of the antimicrobials, as measured with a Bacillus subtilis assay. Analysis of this inactivation with the radioactive methods of Davies and his colleagues revealed that the kanamycins, neomycins, paromomycin and gentamycin A were phosphorylated. Because butirosin was not a substrate for the phosphorylating enzyme, it was concluded that the strain produced the neomycin/kanamycin phosphototransferase I. Furthermore, it was found that streptomycin and spectinomycin were adenylylated by the enzymatic extracts as well as gentamycin C1a, C1, C2, A, tobramycin, sisomycin and the kanamycins. This substrate profile indicated the presence of two adenylylating enzymes: streptomycin/spectinomycin-adenylyl-transferase and gentamycin-adenylyltransferase. After transfer of multiple drug resistance by conjugation from both strains into C. coli K-12, sonified extracts were prepared and examined for enzymatic activity splitting beta-lactam antibiotics. The relative rates of inactivation of benzylpenicillin, ampicillin and cephaloridine as well as the inhibitory effect of cloxacillin, but not of p-chloro-mercuri-benzoate on the inactivation of cephaloridine indicated that both strains produced a class III/type a (TEM type) beta-lactamase. It is discussed that the increasing frequency of gram-negative organisms form the university hospital with identical resistant phenotypes as the strains examined is the result of the spread of an R-factor among the hospital bacterial flora.

Aminoglycosides

[In vitro experiments on the working of combinations of gentamicin and beta-lactam antibiotics against Pseudonomas aeruginosa (author's transl)].

The M.B.C.'s of gentamicin and carbenicillin against Pseudonomas aeruginosa NCTC 10490 were measured under controlled conditions using a Biophotometer. The M.B.C. of gentamicin was 15 mug/ml but even in a concentration of 1,000 mug/ml carbenicillin was not bactericidal. In further experiments, subinhibitory concentrations of gentamicin (1 mug/ml) together with varying concentrations of carbenicillin were added to a log phase culture of the organism. Under these conditions the M.B.C. of carbenicillin was now 6 mug/ml. In tube dilution test the M.B.C. of carbenicillin alone was 15.6 mug/ml and for gentamicin 3.9 mug/ml. The M.B.C.'s of other beta-lactam antibiotics (ampicillin, penicillin G and cephalothin) were four to five times as great as for carbenicillin whereas that for ticarcillin was identical. Parallel to the "multiplication inhibition" test in the Biophotometer we investigated 51 strains of Pseudomonas aeruginosa freshly isolated from clinical material. Their M.B.C.'s were determined in tube dilution tests against doubling dilutions of beta-lactam antibiotics, with and without the addition of 1 mug/ml gentamicin. With this concentration of gentamicin, the M.B.C.'s of carbenicillin and ticarcillin were considerably lower than for these substances alone. In comparison to carbenicillin, ticarcillin was more effective against Pseudomonas aeruginosa. Our findings indicate that for Pseudomonas aeruginosa infections the combination of gentamicin with other beta-lactam antibiotics (ampicillin, penicillin G and cephalothin) is to be avoided. But the combination of gentamicin with either carbenicillin or ticarcillin appeared to be effective.

Bacteriological Techniques

The peptidoglycan crosslinking enzyme system in Streptomyces strains R61, K15 and rimosus. Kinetic coefficients involved in the interactions of the membrane-bound transpeptidase with peptide substrates and beta-lactam antibiotics.

The transpeptidation reaction performed by the membranes of Streptomyces strain R61 fits the general rate equation for an enzyme-catalysed bimolecular reaction. The same membranes (E) interact with beta-lactams (I) to form inactive penicillin-enzyme-membrane complexes (EI) of rather high stability, which subsequently break down (E + I leads to EI leads to E + degradation products). The enzyme is regenerated and the antibiotic is released in the form of an inactive metabolite. With benzylpenicillin, the degradation product is benzylpenicilloic acid. The reaction is heat-labile. The first step of the reaction (E + I leads to EI) is characterized by a second-order rate constant (kformation in M-1 s-1) and the second step (EI leads to E + degradation products) by a first-order rate constant (kbreakdown in s-1). The effects in vitro of various beta-lactams on the membrane-bound transpeptidase, as expressed by the relevant kformation and kbreakdown values, parallel the effects in vivo of the same antibiotics as expressed by their ability to prevent the germination and growth of conidiospores. The kinetic parameters of the transpeptidase that was solubilized with N-cetyl-N,N,N-trimethylammonium bromide with respect to its interaction with both peptide substrates and beta-lactam antibiotics are quantitatively different from those of the membrane-bound enzyme. Moreover, the solubilized enzyme fragments benzylpenicillin with formation of phenylacetylglycine, a reaction which is similar to that catalysed by the exocellular R61 enzyme. The membranes of Streptomyces strains rimosus and K15 possess an active 'classic' penicillinase. They were not studied but the kinetic coefficients of the corresponding solubilized transpeptidases were determined and compared with those of the solubilized enzyme from strain R61.

Carboxypeptidases

Function of the outer membrane of Escherichia coli as a permeability barrier to beta-lactam antibiotics.

On the basis of a simple theoretical model, the ease of penetration of beta-lactam antibiotics through the outer membrane of Escherichia coli was measured. The cell envelope was found to act as a diffusion barrier to both penicillins and cephalosporins. The validity of the model and the cooperative action of cell-bound beta-lactamase and outer membrane were further verified by comparing calculated and experimentally determined velocities of beta-lactam hydrolysis by intact cells and sonically treated cell suspensions. The results showed good correspondence at five different antibiotic concentrations. Similar conclusions could be drawn from a comparison of beta-lactam concentrations on both sides of the outer membrane, calculated from enzyme kinetic measurements and minimal inhibitory concentrations for both a beta-lactamase-producing E. coli and its enzyme-negative variant. in the case of benzylpenicillin and cephalothin, however, no correspondence was found. The joint action of several parameters determining the efficacy of penicillins and cephalosporins against beta-lactamase-producing E. coli is discussed.

Cell Wall

Irreversible effects of serum proteins on beta-lactam antibiotics.

The chromogenic cephalosporin nitrocefin (87/312) demonstrates rapid and visible instability to serum from many species. This phenomenon was distinct from serum binding, being significantly slower. Destruction of another cephalosporin, 10485, by serum appeared to account for some anomalous results during investigation into its human pharmacokinetics. Many cephalosporins of very different structures also showed serum instability, unrelated to their degrees of serum binding as measured by plate assay. Extrapolation could not be made from one species to another with regard to either binding or instability. Small changes in the chemical structures of the 3- and 7-substituents of the cephalosporins made profound changes in their susceptibility to serum attack. The decomposition is pH dependent, occurring more slowly at acid pH, and is due to a high-molecular-weight component of serum that resists boiling for several minutes. Isoelectric focusing of serum from several animal species gave various species-specific bands that decomposed nitrocefin. The inactivation of nitrocefin was not entirely parallel with that of 10485 and was inhibited by it. All other beta-lactam compounds tested also inhibited the reaction, much greater concentrations usually being necessary when the inhibitor was stable to serum. The complex that causes breakdown of the beta-lactam compounds is not necessarily the same as the one causing serum binding. It is postulated that serum may affect most other beta-lactam antibiotics in a similar way, although in most cases, this only occurs to a very slight extent.

Bacillus subtilis