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Applied and Environmental Microbiology, January 2006, p. 306-312, Vol. 72, No. 1
0099-2240/06/$08.00+0 doi:10.1128/AEM.72.1.306-312.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Department of Biological Sciences, 107 Life Sciences Building, Louisiana State University, Baton Rouge, Louisiana 70803,1 Department of Veterinary Science, 111 Dalrymple Building, Louisiana State University Agricultural Center, Baton Rouge, Louisiana 70803,2 UR86 Bio-Agresseurs, Santé, Environnement, Institut National de la Recherche Agronomique, Centre de Recherche de Tours, 37380 Nouzilly, France,3 Department of Biological Sciences, 202 Life Sciences Building, Louisiana State University Agricultural Center, Baton Rouge, Louisiana 708034
Received 23 June 2005/ Accepted 7 October 2005
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Gentamicin belongs to the aminoglycoside family of antibiotics. The two major classes of 2-deoxystreptamine aminoglycosides are the 4,5-disubstituted, which includes neomycin (NEO), paramomycin, and ribostamycin, and the 4,6-disubstituted, which includes gentamicin, kanamycin (KAN), and amikacin (AMK) (36, 42, 45). Aminoglycosides are highly potent, broad-spectrum, bactericidal antibiotics that are often used in combination therapy with cell wall active agents to treat infections caused by gram-positive organisms, such as Staphylococcus aureus and streptococci (27, 42, 45), as well as intracellular bacteria (24, 42). Gram-negative aerobic bacilli are also sensitive to these antibiotics, which makes them a treatment of choice for these infections (42, 45). Aminoglycoside antibiotics act by inhibiting prokaryotic protein synthesis (12, 25). They induce misreading of the genetic code by binding to the 16S rRNA A site in bacteria (6, 28). The most important mechanism of aminoglycoside resistance is the enzymatic modification of the antibiotic by aminoglycoside-modifying enzymes, which are divided according to their enzymatic activity into the aminoglycoside phosphoryltransferases, the aminoglycoside nucleotidyltransferases, and the aminoglycoside acetyltransferases (AACs) (12, 36, 42, 45). In spite of the resistance problems that have arisen since the early 1970s and their relatively high toxicity for the host, they are still clinically antibiotics of choice, especially in combined therapeutic use with ß-lactams (27, 42, 45).
Antibiotic use constitutes a selective pressure which can ultimately result in the emergence of resistant strains; thus, bacteria resistant to a particular antibiotic are often detected following its implementation or use (11, 23, 25, 27). Gentamicin resistance in Salmonella spp. isolated from pet turtles was originally reported in Canada, 1990, in a study stating that turtles imported from Louisiana carried gentamicin-resistant Salmonella spp. (10). Concerns on the emergence of gentamicin-resistant Salmonella enterica subsp. arizonae which could survive gentamicin treatment had been previously reported in the turkey industry (15, 21). In July 1999, several Louisiana pet turtle export shipment lots failed to gain certification. We received bacterial isolates from failed-lot turtle samples from the certification laboratory and detected strains that were resistant to concentrations of gentamicin of >2,000 µg/ml. The goal of the present study was to identify the gene or genes which contribute to the high-level gentamicin resistance phenotype observed in enteric bacteria, particularly Salmonella spp., from environmental samples with turtle farming activity in Louisiana and to determine the incidence of such genes in the turtle farm environment.
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TABLE 1. Bacterial strains and plasmids used in this study
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The Kirby-Bauer disk diffusion assay was done using MH agar plates according to CLSI standards (29), using the following antibiotics: GEN (10 µg), KAN (30 µg), TOB (10 µg), AMK (30 µg), ampicillin (AMP) (10 µg), tetracycline (30 µg), chloramphenicol (30 µg), polymixin B (300 units), cephalothin (30 µg), cefotaxime (30 µg), trimethoprim (5 µg), and nitrofurantoin (300 µg) (Difco). Inhibition zone breakpoints were interpreted according to information supplied by the manufacturer and to CLSI standards (29).
R-plasmid isolation and characterization.
Conjugation was done to detect plasmids carrying GEN resistance determinants. In each bacterial mating experiment, a GEN-resistant organism was used as the donor. Representative isolates of each genus and species (chosen based on similar resistance phenotypes) were used as donors and included S. enterica subsp. enterica serovar Enteritidis, S. enterica subsp. arizonae, Enterobacter cloacae, Citrobacter freundii, Pseudomonas aeruginosa, Acinetobacter baumanii, Stenotrophomonas maltophilia, Proteus vulgaris, and Providencia stuartii. Escherichia coli strain BM14, resistant to sodium azide (AZI), was used as the recipient (8). Bacterial mating was done by mixing 1 ml of a log-phase culture of GEN-resistant donor cells with 4 ml of log-phase recipient AZI-resistant E. coli BM14 cells and incubating at 37°C for 16 h, with no shaking. Transconjugant AZI-resistant, GEN-resistant E. coli colonies were selected on heart infusion plates supplemented with 100 µg/ml GEN and 500 µg/ml AZI.
R plasmids from GEN-resistant bacteria were purified using QIAfilter plasmid kits (QIAGEN, Valencia, CA), following instructions provided by the manufacturer for low-copy-number plasmids. Plasmids were eluted in molecular-grade water at 65°C and stored at 20°C. To minimize the possibility of working with strains carrying more than one plasmid (mobilizable plasmids that might cotransfer during conjugation) and to better assess the resistance phenotypes (AZI-resistant transconjugant E. coli has a slower growth rate), plasmids isolated from transconjugants were used to transform naive OneShot TOP10 E. coli cells (Invitrogen, Carlsbad, CA), using a Bio-Rad Gene Pulser II electroporator (Bio-Rad, Hercules, CA), following recommendations from the manufacturer. Briefly, 50 µl electrocompetent cells were transferred to a chilled 0.1-cm cuvette with 1 to 2 µl of diluted plasmid DNA. Pulses were given at 2.0 kV, 25 µF, and 100 to 200
for 5 ms. Transformant GEN-resistant E. coli cells were selected on LB plates supplemented with 100 µg/ml GEN.
To compare their restriction fragment profiles, R plasmids were isolated as described above from environmental GEN-resistant isolates, transconjugant E. coli, and transformant E. coli cells. The DNA concentration of uncut plasmids was estimated by comparison to a Supercoiled Plasmid DNA ladder (Bayou Biolabs, Harahan, LA) after 0.5% Agarose I (Sigma) in 0.5x Tris-borate-EDTA (TBE) (Bio-Rad) gel electrophoresis migration. R plasmids were digested separately with EcoRI, HindIII, or BamHI (New England Biolabs, Beverly, MA), following recommendations from the manufacturer for each restriction enzyme. Restriction enzyme digestion profiles were assessed using 0.5% agarose III (Amresco, Solon, OH) gel electrophoresis in TAE buffer (33). The 1-kb DNA ladder and
DNA-HindIII Digest (New England BioLabs) were used as molecular size standards. Image analysis was done by UV transillumination of ethidium bromide-stained gels using Quantity One imaging software (Bio-Rad).
The sizes of the large R plasmids were estimated using pulsed-field gel electrophoresis (PFGE). Briefly, 0.8% Pulse Field Electrophoresis agarose plugs (Sigma) were made with R plasmids isolated as described above. Agarose plugs were loaded onto a 90-ml, 1% agarose (Sigma) gel in 0.5x TBE buffer and run in 0.5x TBE buffer using a CHEF-DR II system (Bio-Rad). Electrophoresis was carried out for 22 h at 6 V/cm, 120° and 14°C, with switch times ramping 1 to 25 s. The Midrange I PFG marker (New England BioLabs) and the BAC-Tracker Supercoiled DNA ladder (Epicentre Biotechnologies, Madison, WI) were used as molecular size standards. Image analysis was done after staining with ethidium bromide, using Quantity One imaging software.
Cloning and identification of GEN resistance gene(s).
A vast number of genes are known to confer GEN resistance in gram-negative bacteria (36, 42, 45). To determine which gene(s) confer GEN resistance in the isolates of this study, these were cloned and sequenced as follows. R plasmids isolated as described above were digested with EcoRI, HindIII, or BamHI, according to the manufacturer's recommendations. Restriction fragments were purified using QIAquick spin columns (QIAGEN) and ligated into previously digested pGEM-7Zf (Promega, Piscataway, NJ). Ligation reactions were used to transform E. coli TOP10 chemically competent cells (Invitrogen), following the protocol provided by the manufacturer. Recombinant clones carrying GEN resistance determinants were selected on LB plates supplemented with 100 µg/ml GEN and 50 µg/ml AMP. Recombinant plasmids were purified with QIAprep spin columns (QIAGEN), and inserts were sequenced using the vector's internal sequencing primers.
Sequencing and computer analysis.
Sequencing was done with fluorescent dye-labeled dideoxynucleotides with an ABI Prism 310 genetic analyzer (Applied Biosystems, Foster City, CA). Sequence analysis was done using VectorNTI (Invitrogen), BLAST (2), and GenBank (National Center for Biotechnology Information, available through http://www.ncbi.nlm.nih.gov/BLAST/).
Screening for GEN resistance genes.
Multiplex PCR assays were designed to screen environmental isolates for the GEN resistance genes that were identified through cloning and sequencing of GEN resistance determinants. Multiplex PCRs included primers to detect resistance genes aac(3)-IIa and aac(3)-VIa, as well as a fragment of the 16S rRNA gene as an internal control for each reaction (43). Primers were designed using Vector NTI (Invitrogen). PCR screening of genes intI and sul1, commonly associated with class 1 integrons (40, 44), and of armA, rmtA, and rmtB, the only genes reported to confer high-level aminoglycoside resistance in gram-negative bacteria (47), was done in separate reactions using published primers (13, 18, 34, 41, 47, 48). All primers used are summarized in Table 2. To prepare DNA for PCR, pelleted cells from 1 ml of overnight cultures were resuspended in 100 µl distilled H2O and lysed through two 5-min freeze-boil cycles. Two microliters of the supernatants were used as templates in 50-µl PCRs. PCR was done using the FailSafe PCR system, buffer "G" (Epicentre Biotechnologies), according to instructions provided by the manufacturer. Thermocycler conditions were set as follows: (1 cycle at 96°C for 5 min; 35 cycles at 96°C for 30 s, 58°C for 30 s, and 1 final cycle at 70°C for 60 s; and 70°C for 7 min). To amplify the armA gene, PCR was done using the same conditions stated above, but various annealing temperatures (40°C, 42.2°C, 44.1°C, 46.9°C, 48.9°C, 50.2°C, and 51°C) were assayed in different reactions. PCR products were visualized by agarose gel electrophoresis using 2% Agarose I in 0.5x TBE buffer and staining with ethidium bromide. Some PCR products were sequenced to confirm amplification of the appropriate genes and to compare with published sequences in the databases. For this, PCR products were purified using QIAquick spin columns and ligated into pCR2.1-TOPO using the TOPO-TA cloning kit (Invitrogen), as suggested by the manufacturer. Sequencing of appropriate clones was done using the internal vector sequencing primers, as described above.
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TABLE 2. Primers used for PCR and sequencing
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TABLE 3. Prevalence of gentamicin resistance genes among bacterial isolates from turtle farmse
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R-plasmid isolation.
When checked for plasmids, environmental GEN-resistant isolates showed one or more plasmids. Nevertheless, transconjugant E. coli resistant to GEN and AZI were obtained only from the strains of S. enterica subsp. enterica, S. enterica subsp. arizonae, E. cloacae, and C. freundii. Transconjugants' GEN MICs were all >2,000 µg/ml. Likewise, the antibiograms were similar between donor organisms and their E. coli transconjugants. Furthermore, OneShot TOP10 E. coli cells transformed with R plasmids isolated from these transconjugants acquired the same resistance phenotypes as the transconjugants that the R plasmids had been isolated from. The resulting phenotypes and genotypes of these transformant E. coli cells are summarized in Table 4.
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TABLE 4. R plasmids isolated from bacteria recovered from turtle farms
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Preliminary screening done to detect gene aac(3)-IIa in other environmental isolates revealed that some GEN-resistant organisms did not carry aac(3)-IIa. Thus, R plasmid pEnt19, originally from E. cloacae (strain E19) (Table 4), was used for cloning and sequencing, since this plasmid conferred GEN resistance but did not carry aac(3)-IIa. The recombinant plasmid pGEnt19b was obtained from a 5-kb BamHI fragment of the R plasmid pEnt19 ligated into pGEM-7Zf. Sequence analysis of pGEnt19b revealed the presence of the aminoglycoside acetyltranferase gene aac(3)-VIa, which was 99% identical to that in the GenBank database, accession no. L22613 (31). Sequencing and PCR additionally revealed the integron class 1-associated genes intI1 and sul1 (Table 4), indicating the presence of aac(3)-VIa as a gene cassette of a class 1 integron.
The genes aac(3)-IIa and aac(3)-VIa have not been reported to confer high-level GEN resistance (1, 4, 31, 42). We thus attempted to amplify by PCR the recently reported 16S rRNA methylase genes which do confer a high-level aminoglycoside resistance phenotype in gram-negative bacteria, namely, armA (18), rmtA (46, 48), and rmtB (13). Nevertheless, these genes were not detected in the isolates tested (Table 4).
Distribution of GEN resistance genes in bacterial isolates from turtle farms.
Multiplex PCR assays designed to screen for the presence of the resistance genes aac(3)-IIa and aac(3)-VIa on bacterial isolates from turtle farms (n = 336) revealed that every GEN-resistant organism tested carried one of these acetyltransferase genes (Table 3). The gene aac(3)-IIa was present in 37% of the GEN-resistant isolates tested (n = 101); it was detected mainly in nonfermentors but was also found in S. enterica subsp. enterica and C. freundii. Gene aac(3)-VIa accounted for 94% of GEN resistance in Salmonella spp. (n = 35). Neither gene was detected in GEN-sensitive organisms, including GEN-sensitive controls previously described. IntI1 was detected by PCR in all GEN-resistant bacteria carrying aac(3)-VIa but not in organisms carrying aac(3)-IIa.
Plasmid heterogeneity.
The R plasmids pSal5, pAri40, and pEnt19 showed different HindIII and BamHI restriction fragment length polymorphism profiles (Fig. 1). Multiplex PCR of the resistance genes aac(3)-IIa and aac(3)-VIa (Table 4) plus hybridization of these genes with digested R plasmids (Fig. 1) showed that pSal5 carried aac(3)-IIa and that pAri40 and pEnt19 carried aac(3)-VIa, confirming that these genes are plasmid borne. The mentioned R plasmids differed in size as well, as visualized after PFGE and ethidium bromide staining. These results are summarized in Table 4.
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FIG. 1. HindIII and BamHI digestion profiles of R plasmids pSal5 (lanes 1 and 4), pAri40 (lanes 2 and 5), and pEnt19 (lanes 3 and 6). A -DNA-HindIII digest, used as a molecular standard, is indicated on the left. Arrowheads indicate bands carrying the genes aac(3)-IIa ( ) and aac(3)-VIa ( ).
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The majority of aminoglycoside-modifying enzymes can provide effective resistance to aminoglycosides, but only certain phosphotransferase enzymes detected in gram-positive bacteria have been reported to produce high levels of resistance to these antibiotics (7, 16, 36, 42, 45). When we started this study, there had been no reports, to the best of our knowledge, of the acquisition of genes conferring high-level aminoglycoside resistance in environmental gram-negative bacteria (M. A. Diaz, E. C. Achberger, V. R. Srinivasan, and R. J. Siebeling, Abstr. 100th Am. Soc. Microbiol. Gen. Meet., abstr. Z-4, 2000). Recently, however, Galimand et al. (18) found that the high-level aminoglycoside resistance phenotype in a clinical strain of Klebsiella pneumoniae was due to the presence of the aminoglycoside resistance gene armA. This strain of K. pneumoniae also presented the genes aac(3)-II, blaTEM1, blaCTX-M, dfrA12, sul1, and ant(3'')-9, conferring resistance to aminoglycosides, ß-lactams, trimethroprim, sulfonamides, and streptomycin-spectinomycin, respectively (18). In this study, we did not detect the gene armA by PCR in any of the isolates screened, in spite of detecting certain shared elements in some of the strains, such as the genes aac(3)-IIa and sul1 (Table 4). We also screened for two other high-level aminoglycoside resistance genes: rmtA, cloned and identified from a clinical isolate of P. aeruginosa AR-2 in Japan (48), and plasmid-borne 16S rRNA methylase gene rmtB, isolated from Serratia marcescens (13). Nevertheless, we did not detect by PCR any other resistance gene that could act in synergy with the already-identified aac(3)-IIa or aac(3)-VIa gene products or by itself to give the high-level GEN resistance phenotype observed in the bacteria we isolated in the turtle farms.
The current study is the first to report the genes which confer GEN resistance to bacteria in the turtle farm environment, namely aac(3)-IIa and aac(3)-VIa. PCR and sequencing experiments confirmed that these resistance genes are present on mobile genetic elements that can facilitate their horizontal transfer among bacteria in the environment (1, 5, 17, 20, 31, 44). Both genes are found on R plasmids of the Enterobacteriacea (1, 4, 31), and yet until recently (18), only the gene aac(3)-VIa had been reported as a gene cassette within a class 1 integron (31, 44, 45, 47). Recent studies, however, have also detected the aac(3)-II gene surrounded by integron elements (18). In fact, the molecular environment of the armA gene has been depicted as a composite or complex integron environment and is found downstream of orf513 coding for a putative recombinase or transposase (30). We are currently conducting research to examine the molecular environment of the genes found.
GEN-resistant isolates were more prevalent in samples where exposure to GEN was greater but were also detected in turtle pond water and nest eggs, consonant with the notion that antibiotic use can favor the selection of resistant strains (23, 27). The presence of these genes on mobile molecular elements can facilitate their transfer and spread among different bacteria in the turtle farm environment (5, 17, 20). However, additional studies are required to determine if the interspecies dissemination of these genes occurred at the turtle farms. This study illustrates the potential for transfer of antibiotic resistance genes, particularly GEN resistance, between different genera in the turtle farms, a matter of particular public health concern as it involves the human pathogen Salmonella spp. The epidemiological data presented stress the need to develop an alternative method for the eradication of Salmonella spp. from turtle eggs. This is the first study to describe the genes involved in GEN resistance in S. enterica subsp. arizonae. It is important to monitor the presence of these resistance genes and molecular transfer elements in bacteria like the salmonellae, since these cause zoonosis and represent possible resistance reservoirs and can thus be important in the development of multiresistance in bacteria (3, 5, 14), as well as in its transfer between animals and humans.
Funding was provided by the Louisiana Agricultural Experiment Station under project number LAB03329. This publication was approved as manuscript number 05-44-0285.
We thank E. Jolivet for assistance with PFGE and E. C. Achberger for valuable advice and PCR help. M. A. Díaz thanks the LSU Agricultural Center, the Dept. of Biological Sciences, and the Dept. of Veterinary Science for support in the completion of this work, particularly given the unexpected death of her late mentor and friend, R. J. Siebeling.
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