Abstract (eng)
In the present study, the issue of antibiotic resistance in clinically relevant bacteria has been discussed intensively. Due to the large number of different resistance mechanisms, the focus was on one of the most important classes of resistance genes, the β-lactamases. It is a protein category, which is defined by its enzymatic activity. These enzymes cleave β-lactam antibiotics, and thus, deactivate them. β-Lactams are the most important bactericides against human pathogens which mainly belong to the Enterobacteriaceae. β-Lactams share a structural similarity with D-alanyl-D-alanine, which is a component of the bacterial cell wall. It is involved in the molecular cross-linking of the bacterial murein by a peptidase. β-Lactams bind irreversibly to the peptidase, which provokes after a cascade of further reactions, bacterial cell lyses.
More than 950 different naturally occurring β-lactamases are already known and divided into four phylogenetically different classes (A-D). Although they have a similar enzymatic activity, the catalytic sites and protein sequences differ strongly between these classes. One goal of this work was to obtain an overview of the distribution of β-lactamase genes in Austria's largest urban areas Vienna and Graz. For this purpose, clinical isolates taken from patients and phenotypically determined as β-lactamase-positive were analysed genetically. The first step was the creation of a β-lactamase DNA sequence database. Based on this data, 25 primer pairs were designed targeting the clinically most important β-lactamase genes. To double check, also 24 already published primer pairs were used in the analysis. All 33 clinical isolates from Graz and 108 from Vienna were analysed with these 49 primer pairs by PCR twice. The detected genes were amplified, sequenced and used for further statistical analyses. The Chao1, ACE and Rarefaction curve algorithms, which are widely used in ecology, have been applied in a clinical study for the first time. They were used to estimate the number of β-lactamase genes in the investigated hospitals. In the present study, a large number of genes have been described in Austria and Europe for the first time. Members of all four classes of β-lactamases were among the detected genes. The statistical analyses showed that the majority of β-lactamase genes in clinical isolates of Enterobacteriaceae were identified in the surveyed hospitals. The number of different β-lactamase genotypes could not be determined due to the high diversity among the genotypes.
The second objective of this work was the development of a multiplex detection method. The immobilization of the PCR on a glass slide was an obvious approach for this purpose. A primer pair was covalently bound with a microarray spotter to a nonpolar surface. Based on this reaction environment, many different parameters such as reaction mixture, annealing temperature, primer sequence, product length, etc. were evaluated. The DNA was amplified on a glass surface successfully during the on-chip PCR, but it was not possible to determine parameters for specific amplification. Based on the experience obtained from on-chip PCR experiments, a multiplex ligation reaction with immobilized probes was developed. A newly developed type of probes (looplock probes) was compared with linear probes. Parameters that were essential for the specificity of the on-chip ligation reaction were studied systematically. The proof-of-principle with the new probes and the on-chip ligation reaction could be shown, but for routine use, further optimization of specificity is required.
In addition to the tested surface-based methods, also a liquid phase multiplex detection method was developed based on padlock probes. These padlock probes were ligated in the presence of a target sequence resulting in single-stranded, circular DNA molecules. The ligated padlock probes were amplified in two successive rolling circle amplification reactions and then fluorescently labelled in a linear PCR. The labelled amplification products were detected with a microarray. With this method, nearly 100 different target sequences could be determined in parallel. An assay detecting all clinically important β-lactamase genes in a single reaction was developed. The assay was successfully evaluated with clinical isolates and produces results with excellent sensitivity and specificity. Compared to existing products on the market, the developed assay can detect three to four times more genes in parallel. In addition, it has a very high development potential because the detection of all antibiotic resistance genes in a single assay is possible with this method.