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The growing challenge of microbial resistance emphasizes the importance of new antibiotics or reviving strategies for the use of old ones. Macrolide antibiotics are potent bacterial protein synthesis inhibitors with a formidable capacity to treat life-threatening bacterial infections; however, acquired and intrinsic resistance limits their clinical application. In the work presented here, we reveal that bicarbonate is a potent enhancer of the activity of macrolide antibiotics that overcomes both acquired and intrinsic resistance mechanisms. With a focus on azithromycin, a highly prescribed macrolide antibiotic, and using clinically relevant pathogens, we show that physiological concentrations of bicarbonate overcome drug resistance by increasing the intracellular concentration of azithromycin. We demonstrate the potential of bicarbonate as a formulation additive for topical use of azithromycin in treating a murine wound infection caused by

Bacteria have evolved sophisticated mechanisms to inhibit the growth of competitors1. One such mechanism involves type VI secretion systems, which bacteria can use to directly inject antibacterial toxins into neighboring cells. Many of these toxins target cell envelope integrity, but the full range of growth inhibitory mechanisms remains to be determined2. Here, we discover a novel type VI secretion effector, Tas1, in the opportunistic pathogen Pseudomonas aeruginosa. A crystal structure of Tas1 reveals similarity to enzymes that synthesize (p)ppGpp, a broadly conserved signaling molecule in bacteria that modulates cell growth rate, particularly in response to nutritional stress3. Strikingly, however, we find that Tas1 does not synthesize (p)ppGpp, and instead pyrophosphorylates adenosine nucleotides to produce (p)ppApp at rates of nearly 180,000 per min. Consequently, delivery of Tas1 into competitor cells drives the rapid accumulation of (p)ppApp, depletion of ATP, and widespread dysregulation of essential metabolic pathways, resulting in target cell death. Collectively, our findings reveal a new mechanism for interbacterial antagonism and demonstrate, for the first time, a physiological role for the metabolite (p)ppApp in bacteria.

The Comprehensive Antibiotic Resistance Database (CARD; https://card.mcmaster.ca) is a curated resource providing reference DNA and protein sequences, detection models and bioinformatics tools on the molecular basis of bacterial antimicrobial resistance (AMR). CARD focuses on providing high-quality reference data and molecular sequences within a controlled vocabulary, the Antibiotic Resistance Ontology (ARO), designed by the CARD biocuration team to integrate with software development efforts for resistome analysis and prediction, such as CARD’s Resistance Gene Identifier (RGI) software. Since 2017, CARD has expanded through extensive curation of reference sequences, revision of the ontological structure, curation of over 500 new AMR detection models, development of a new classification paradigm and expansion of analytical tools. Most notably, a new Resistomes & Variants module provides analysis and statistical summary of in silico predicted resistance variants from 82 pathogens and over 100 000 genomes. By adding these resistance variants to CARD, we are able to summarize predicted resistance using the information included in CARD, identify trends in AMR mobility and determine previously undescribed and novel resistance variants. Here, we describe updates and recent expansions to CARD and its biocuration process, including new resources for community biocuration of AMR molecular reference data.