1. Differential DNA accessibility to polymerase enables 30-minute phenotypic β-lactam antibiotic susceptibility testing of carbapenem-resistant Enterobacteriaceae
- Author
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Rustem F. Ismagilov, Eric J. Liaw, Nathan G. Schoepp, Alexander Winnett, Emily S. Savela, and Omai B. Garner
- Subjects
0301 basic medicine ,Bacterial Diseases ,Time Factors ,Physiology ,Antibiotics ,Artificial Gene Amplification and Extension ,Carbapenem-resistant enterobacteriaceae ,DNA-Directed DNA Polymerase ,Urine ,Pathology and Laboratory Medicine ,Polymerase Chain Reaction ,Biochemistry ,Polymerases ,law.invention ,Klebsiella Pneumoniae ,chemistry.chemical_compound ,0302 clinical medicine ,law ,Klebsiella ,Medicine and Health Sciences ,Biology (General) ,Polymerase chain reaction ,biology ,Antimicrobials ,General Neuroscience ,Enterobacteriaceae Infections ,Methods and Resources ,Drugs ,Enterobacteriaceae ,3. Good health ,Anti-Bacterial Agents ,Body Fluids ,Bacterial Pathogens ,Phenotype ,Infectious Diseases ,Medical Microbiology ,Enterobacter Infections ,Ceftriaxone ,Anatomy ,Pathogens ,General Agricultural and Biological Sciences ,Ertapenem ,medicine.drug ,DNA, Bacterial ,Genotype ,QH301-705.5 ,medicine.drug_class ,Microbial Sensitivity Tests ,beta-Lactams ,Research and Analysis Methods ,Meropenem ,Microbiology ,General Biochemistry, Genetics and Molecular Biology ,beta-Lactamases ,03 medical and health sciences ,Antibiotic resistance ,Microbial Control ,DNA-binding proteins ,medicine ,Humans ,Molecular Biology Techniques ,Microbial Pathogens ,Molecular Biology ,Pharmacology ,General Immunology and Microbiology ,Bacteria ,Organisms ,Reproducibility of Results ,Biology and Life Sciences ,Proteins ,biology.organism_classification ,030104 developmental biology ,Carbapenem-Resistant Enterobacteriaceae ,chemistry ,Antibiotic Resistance ,Antimicrobial Resistance ,030217 neurology & neurosurgery - Abstract
The rise in carbapenem-resistant Enterobacteriaceae (CRE) infections has created a global health emergency, underlining the critical need to develop faster diagnostics to treat swiftly and correctly. Although rapid pathogen-identification (ID) tests are being developed, gold-standard antibiotic susceptibility testing (AST) remains unacceptably slow (1–2 d), and innovative approaches for rapid phenotypic ASTs for CREs are urgently needed. Motivated by this need, in this manuscript we tested the hypothesis that upon treatment with β-lactam antibiotics, susceptible Enterobacteriaceae isolates would become sufficiently permeabilized, making some of their DNA accessible to added polymerase and primers. Further, we hypothesized that this accessible DNA would be detectable directly by isothermal amplification methods that do not fully lyse bacterial cells. We build on these results to develop the polymerase-accessibility AST (pol-aAST), a new phenotypic approach for β-lactams, the major antibiotic class for gram-negative infections. We test isolates of the 3 causative pathogens of CRE infections using ceftriaxone (CRO), ertapenem (ETP), and meropenem (MEM) and demonstrate agreement with gold-standard AST. Importantly, pol-aAST correctly categorized resistant isolates that are undetectable by current genotypic methods (negative for β-lactamase genes or lacking predictive genotypes). We also test contrived and clinical urine samples. We show that the pol-aAST can be performed in 30 min sample-to-answer using contrived urine samples and has the potential to be performed directly on clinical urine specimens., By directly linking beta-lactam-induced cell wall damage to a rapid DNA measurement, this study introduces a new concept for creating phenotypic antibiotic-susceptibility tests. The concept was validated with carbapenem-resistant Enterobacteriaceae, considered one of the top three most-urgent antibiotic resistant threats by the Centers for Disease Control.
- Published
- 2020