Emergence of linezolid-resistant Enterococcus faecium during treatment of enterococcal infections

ABSTRACTDaptomycin is used off-label for enterococcal infections; however, dosing targets for resistance prevention remain undefined. Doses of 4 to 6 mg/kg of body weight/day approved for staphylococci are likely inadequate against enterococci due to reduced susceptibility. We modeled daptomycin regimensin vitroto determine the minimum exposure to prevent daptomycin resistance (Dapr) in enterococci. Daptomycin simulations of 4 to 12 mg/kg/day (maximum concentration of drug in serum [Cmax] of 57.8, 93.9, 123.3, 141.1, and 183.7 mg/liter; half-life [t1/2] of 8 h) were tested against oneEnterococcus faeciumstrain (S447) and oneEnterococcus faecalisstrain (S613) in a simulated endocardial vegetation pharmacokinetic/pharmacodynamic model over 14 days. Samples were plated on media containing 3× the MIC of daptomycin to detect Dapr. Mutations in genes encoding proteins associated with cell envelope homeostasis (yycFGandliaFSR) and phospholipid metabolism (cardiolipin synthase [cls] and cyclopropane fatty acid synthetase [cfa]) were investigated in Daprderivatives. Daprderivatives were assessed for changes in susceptibility, surface charge, membrane depolarization, cell wall thickness (CWT), and growth rate. Strains S447 and S613 developed Daprafter simulations of 4 to 8 mg/kg/day but not 10 to 12 mg/kg/day. MICs for Daprstrains ranged from 8 to 256 mg/liter. Some S613 derivatives developed mutations inliaForcls. S447 derivatives lacked mutations in these genes. Daprderivatives from both strains exhibited lowered growth rates, up to a 72% reduction in daptomycin-induced depolarization and up to 6-nm increases in CWT (P< 0.01). Peak/MIC and AUC0–24/MIC ratios (AUC0–24is the area under the concentration-time curve from 0 to 24 h) associated with Daprprevention were 72.1 and 780 for S447 and 144 and 1561 for S613, respectively. Daptomycin doses of 10 mg/kg/day may be required to prevent Daprin serious enterococcal infections.

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Chloride-Inducible Expression Vector for Delivery of Antimicrobial Peptides Targeting Antibiotic-Resistant Enterococcus faecium

Applied and Environmental Microbiology ◽

10.1128/aem.00227-15 ◽

2015 ◽

Vol 81 (11) ◽

pp. 3889-3897 ◽

Cited By ~ 17

Author(s):

Kathryn Geldart ◽

Juan Borrero ◽

Yiannis N. Kaznessis

Keyword(s):

Antimicrobial Peptides ◽

Protein Expression ◽

Enterococcus Faecium ◽

Inducible Promoter ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

Content Type ◽

Vancomycin Resistant ◽

Enterococcal Infections

ABSTRACTAntibiotic-resistant enterococcal infections are a major concern in hospitals where patients with compromised immunity are readily infected.Enterococcus faeciumbacteria are of particular interest as these pathogens account for over 80% of vancomycin-resistant enterococcal infections. Antimicrobial peptides (AMPs) produced at the site of infection by engineered bacteria may offer a potential alternative to traditional antibiotics for the treatment of resistant bacteria such asE. faecium. For this mode of delivery to be effective, it is essential to identify a suitable protein expression system that can be used in the desired delivery bacterium. In this study, we describe a promising chloride-inducible promoter and its application in the bacterial delivery of AMPs fromLactococcus lactisto reduce counts ofE. faeciumbacteriain vitro. Reporter gene studies show that at chloride concentrations found within the human intestines, the chloride-inducible promoter exhibits high levels of protein expression compared to those of the commonly used nisin-inducible promoter. These results indicate that this system is powerful and would not require the exogenous administration of an inducer molecule. In its application for AMP production againstE. faeciumin vitro,L. lactisproducing AMPs under the chloride promoter rapidly decreasedE. faeciumcounts by nearly 10,000-fold. As an extension of this application, we also demonstrate the potential in using this type of delivery system in combination with traditional antibiotics to slow the development of resistance. Collectively, this study shows the promise of using a chloride-inducible promoter for the bacterial delivery of AMPs in the body for the treatment of vancomycin-resistant enterococci (VRE) and other antibiotic-resistant bacteria.

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