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A class 1 integron, In111, carried by a self-transferable plasmid from an Escherichia coli clinical strain was characterized. The variable region of In111 constituted an array of gene cassettes encoding the extended-spectrum beta-lactamase IBC-1, the aminoglycoside-modifying enzymes AAC(6')-Ib and ANT(3")-Ia, dihydrofolate reductase I and a putative polypeptide (SMR-2) sharing similarity with the Qac transporters. Transcription of the gene cassettes was driven by a hybrid-type P1 promoter located in a typical 5' conserved segment (CS). The 3'CS included sulI, qacEDelta1, orf5 and orf6. In111 was bounded on the right by an inversely oriented IRt. The 5'CS was preceded by an intact IS26 element followed by an aphA1 gene.

Seventy-nine Klebsiella pneumoniae and 124 Escherichia coli clinical strains, isolated consecutively during August-October 2001 in two Greek hospitals, were examined for production of extended-spectrum beta-lactamases (ESBLs). Seventy-one (35%) isolates (46 K. pneumoniae and 25 E. coli) were ESBL-positive by phenotypic methods. Isoelectric focusing of beta-lactamases and PCR assays for bla genes showed that SHV-5-type ESBLs were the most frequent (45 isolates, 22%) followed by CTX-M (24 isolates, 12%) and IBC (three isolates, 1.5%). The latter two ESBL types may have been established recently in this setting.

An Escherichia coli clinical strain resistant to all beta-lactams except carbapenems was isolated in a Greek hospital. Analysis of beta-lactamase content by isoelectric focusing, PCR assays specific for various bla genes, and DNA sequencing showed that the strain produced TEM-1, a Citrobacter freundii AmpC-related cephalosporinase, and CTX-M-3. The blaCTX.M-3 gene was carried by a 120-kb plasmid that was readily transferable to a susceptible E. coli host.

The non-naturally occurring TEM-1 beta-lactamase mutant R164S:G238S, as well as the R164S (TEM-12) and G238S (TEM-19) beta-lactamases, were constructed and expressed in Escherichia coli under isogenic conditions. Comparison of susceptibilities to beta-lactam antibiotics and substrate profiles showed that the combination of R164S with G238S drastically reduced the extended-spectrum activity of the respective single mutants.

The in vitro activity of loracarbef was evaluated against Escherichia coli strains producing TEM extended-spectrum beta-lactamases (ESBLs). The MICs of loracarbef were lower than those of cefaclor and cephalothin. The antibiotic was active (MICs < or = 2 mg/l) against strains producing TEM-6, TEM-8, TEM-10, TEM-16, TEM-26 and TEM-28 beta-lactamases. The MICs for TEM-3-, TEM-5- and TEM-24-producing strains were higher (> or = 16 mg/l). Hydrolysis studies indicated that the latter beta-lactamases inactivated loracarbef more efficiently than the remaining TEM-type ESBLs examined.

The effect of replacement of Met-69 by Ile or Val on the properties of the extended-spectrum beta-lactamase SHV-5 was studied. Mutant enzymes were constructed by site-specific mutagenesis and expressed under isogenic conditions in Escherichia coli DH5alpha cells. Compared with SHV-5, the mutant beta-lactamases conferred lower levels of beta-lactam resistance and were less efficient in hydrolyzing ampicillin, cephalothin, and cefotaxime. The substitutions rendered SHV-5 less susceptible to inhibition by clavulanate, sulbactam, and tazobactam; however, the MICs of penicillin-inhibitor combinations remained similar, suggesting an attenuation of penicillinase activity.

The conserved residue Arg-244 was substituted by the smaller uncharged amino acids Cys and Ser in SHV-1 and SHV-5 beta-lactamases by a PCR-based site-specific mutagenesis procedure. The mutant beta-lactamases displayed decreased susceptibility to clavulanate and, to a lesser extent, to tazobactam and sulbactam. As shown in comparative MIC determinations, R244C and R244S enzymes retained a residual penicillinase activity while their activity towards cephalosporins was drastically diminished. The respective SHV-5 mutants were unable to hydrolyze oxyimino-beta-lactams except aztreonam. The impaired catalytic activity of the mutant beta-lactamases was mainly due to the lowering of affinity for beta-lactam substrates. The above alterations were more pronounced in the R244C mutants. These results provide information on the mode of involvement of Arg-244 in (a) inactivation by beta-lactamase inhibitors and (b) the proper positioning of beta-lactams in the active site of SHV enzymes.

Trimethoprim resistance in 64 Escherichia coli urinary isolates from five hospitals in Greece was studied. Of the 40 isolates exhibiting transferable high-level resistance (MIC > 1024 mg/L), 21 hybridized with a specific probe for dihydrofolate reductase (DHFR) I, 13 with a probe for DHFR II, and one with a probe for DHFR V. Eleven isolates hybridized with a probe for transposon Tn7. Among the 17 isolates with non-transferable high-level resistance, seven hybridized with the probe for DHFR I, three with the probe for DHFR II, and eight were Tn7-positive. None of the seven isolates with low-level resistance (MIC 4-1024 mg/L) reacted with the probes used. Of the 28 isolates positive for DHFR I, 12 (43%) failed to hybridize with the Tn7 probe. Conversely, three isolates hybridized with the Tn7 probe, but not with the probe for DHFR I. Colony hybridization experiments showed that all but three transconjugants reacted similarly to their respective parent strains. The plasmids coding for trimethoprim-resistant DHFRs were found to differ on the basis of restriction enzyme analysis. These findings suggest that trimethoprim resistance among E. coli urinary isolates in Greece is mediated predominantly by heterogeneous transferable plasmids encoding either DHFR I or DHFR II. The dissociation between DHFR I and Tn7, together with the high incidence of trimethoprim-resistant isolates which did not hybridize with the probes for the common DHFR I or II types, indicates the continued evolution of trimethoprim resistance determinants.

Analysis with a double-disc synergy test (DDST) of clinical isolates of Klebsiella pneumoniae and Escherichia coli during the period October 1988-September 1989 revealed that 24% of the former and 4% of the latter, mainly isolated from urine, possessed an extended-spectrum beta-lactamase. During this period no DDST was positive for isolates of other enterobacterial species. Transfer of ceftazidime resistance was demonstrated from six K. pneumoniae and two E. coli isolates resistant to third generation cephalosporins and aztreonam. Apart from one strain of K. pneumoniae, these strains harboured self-transferable multiresistance plasmids (c. 91 kb) with closely related EcoRI, HindIII, AvaII and PstI restriction patterns. These plasmids encoded an extended-spectrum beta-lactamase that conferred an unusually high level of resistance to ceftazidime and aztreonam (MIC greater than or equal to 64 mg/l). This enzyme had a pI of 8.2 and a substrate profile similar to that of the SHV-5 enzyme isolated initially in Chile, and later in France (CAZ-4). The remaining K. pneumoniae isolate harboured a transmissible multiresistance plasmid (c. 182 kb) that encoded the widely distributed SHV-2 enzyme. The resistance to cefoxitin that was observed in some of these strains was associated with outer membrane protein alterations.

Clinical isolates of Escherichia coli sensitive and resistant to penicillin were compared in lipid composition and 14C-labelled penicillin uptake, as possible factors in resistance. Except for a slight increase in the triglyceride fraction in sensitive strains there were no qualitative or quantitative differences in the classes of extractable lipids present. Gas-liquid chromatography of the phospholipid and triglyceride fatty acids of the polar and non-polar fatty acids of the bound lipids showed that the same kinds of fatty acids were present. There was an increase of myristate in the chloroform-methanol extractable lipids of highly resistant strains accompanied by a rather general decrease of other fatty acids. Gas-chromatographic analysis of the polar-bound lipids showed an increase of the beta-hydroxydecanoic acid in the resistant strains. By studying the uptake of 14C-labelled benzylpenicillin and the crypticity of the beta-lactamase, evidence has been produced that a decreased permeability of resistant strains to penicillin cooperates with beta-lactamase to induce a high level of resistance. The altered lipid metabolism may reflect the special architectural changes in the cell wall which cause decreased permeability.

alpha-Carboxy-3-thienylmethyl penicillin (ticarcillin) is a relatively new semisynthetic penicillin which is more active than carbenillin against Pseudomonas aeruginosa. Among the strains tested, those isolated from the respiratory tract showed an increased susceptibility to carbenicillin and ticarcillin. As with carbenicillin, synergistic activity against P. aeruginosa could be demonstrated with ticarcillin in combination with gentamicin. Like other penicillins, the antibacterial activity was influenced by the inoculum size. The antibacterial activity of ticarcillin showed the compound to be almost equally active with carbenicillin and ampicillin against Escherichia coli and Klebsiella aerogenes, but less active than acrbenicillin and ampicillin against indole-negative Proteus strains. Regarding the indole-positive Proteus species, at relatively low antibiotic concentrations the proportion of strains sensitive to ticarcillin was greater than to carbenicillin or ampicillin whereas at relatively high antibiotic concentrations the converse was the case. It is interesting to note that a high proportion of strains of E. coli and K. aerogenes were resistant to the three penicillins even at a concentration of 200 mug/ml, while 70% of Proteus strains were inhibited by these drugs at the same concentration. Disc susceptibility tests with ticarcillin were carried out according to BAUER-KIRBY method.