Characterization of four novel bacteriophages targeting multi-drug resistant Klebsiella pneumoniae strains of sequence type 147 and 307

Introduction: the development of alternative antimicrobial strategies is deemed to be a high priority to deal with the challenge caused by the spread of multidrug-resistant (MDR) bacteria in clinical settings. according to several international organizations, phages or components thereof are one of these possible options that could be useful to treat bacterial infections. among the drug-resistant bacteria, carbapenem resistant Klebsiella pneumoniae (CR-Kp) are particularly worrisome, given the extensive MDR profiles, their pandemic dissemination and primary role in healthcare associated and life-threatening infections. In this study we isolated and characterised four lytic bacteriophages targeting two major high-risk clones of CR-Kp circulating in hospital environments, i.e., those belonging to Sequence Type (ST) 307 and ST147. Materials and methods: wastewater samples collected from hospitals located in central Italy were screened for the presence of phages by using a previously characterized collection of K. pneumoniae clinical isolates as hosts and the top-agar overlay technique. host specificity and infection efficiency was assessed by spot test and efficiency of plating, respectively. Dynamic of bacterial infections was determined by the one-step growth curve method. Phages were visualized through transmission electron microscopy (TEM) and their genomes were obtained and analysed by a Next Generation Sequencing approach followed by bioinformatics analysis. Results: four bacteriophages, named GP-1, GP-2, GP-4 and GP-5, have been isolated, purified and produced at high titres. collectively, two phages were able to selectively lyse 12/14 K. pneumoniae strains of ST307, while the other two were active only against all the tested K. pneumoniae strains of ST147 (n=12). phages maintain an overall good stability to temperature and pH changes and were characterized by infection cycles having latency periods ranging from 10 to 50 minutes and burst sizes of 10-100 PFU. results from TEM analysis and genome sequencing demonstrated that the four phages were of different families and allowed to rule out the presence of antibiotic resistance genes, virulence factors or toxins. Discussion and Conclusions: Considering their strictly lytic nature and their high selectivity towards two of the major high-risk clones of K. pneumoniae, the isolated phages can be considered as good candidates for their evaluation in animal models as members of cocktails for applications to treat severe infections caused by CR-Kp strains

Etest® versus broth microdilution for ceftaroline MIC determination with Staphylococcus aureus: results from PREMIUM, a European multicentre study

Objectives: To compare the concordance of ceftaroline MIC values 24 by reference broth microdilution (BMD) and Etest (BioMérieux, France) for MSSA and MRSA isolates, respectively, in isolates from PREMIUM (D372SL00001), a European multi-centre study.  Methods: Ceftaroline MICs were determined by reference BMD and by Etest for 1,242 MSSA and MRSA from adult patients with community-acquired pneumonia or complicated skin and soft tissue infections collected between February and May 2012; tests were performed across six European laboratories. Selected isolates with ceftaroline resistance in broth (MIC >1 mg/L) were retested in three central laboratories to confirm their behaviour.  Results: Overall concordance between BMD and Etest was good, with >97% essential agreement and >95% categorical agreement. Nevertheless, 12 of the 26 MRSA isolates found resistant by BMD scored as susceptible by Etest, with MICs ≤1 mg/L, thus counting as very major errors, whereas only five of 380 MRSA found ceftaroline susceptible in BMD were mis-categorised as resistant by Etest. Twenty-one of the 26 isolates with MICs of 2 mg/L by BMD were then re-tested twice by each of three central laboratories: BMD MICs of 2 mg/L were consistently found for 19 of the 21 isolates. Among 147 Etest results for these 21 isolates (original plus six repeats per isolate) 112 were >1 mg/L.  Conclusions: BMD and Etest have good overall agreement for ceftaroline against Staphylococcus aureus; nevertheless, reliable Etest-based discrimination of the minority of ceftaroline-resistant (MIC 2 mg/L) MRSA is extremely challenging, requiring careful reading of strips, ideally with duplicate testing

Beta-lactamases, an old but ever renascent problem

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