Antimicrob Agents Chemother. 2010 January; 54(1): 45–51.
Published online 2009 November 2. doi: 10.1128/AAC.00427-09.
Copyright © 2010, American Society for Microbiology
Molecular and Biochemical Characterization of the Natural Chromosome-Encoded Class A β-Lactamase from Pseudomonas luteola
Institut Pasteur, Laboratoire des Bactéries Pathogènes Entériques, Paris, France,1 INRA, UR1282 Infectiologie Animale Santé Publique, Nouzilly, France,2 CHU de Clermont-Ferrand, Laboratoire de bactériologie, Clermont-Ferrand, France,3 Université Clermont 1, UFR de Médecine, Laboratoire de Bactériologie, JE2526 usc INRA2018, Clermont-Ferrand, France,4 Hôpital St-Louis, Service de Microbiologie, Paris, France,5 Institut Pasteur, Unité de Biodiversité des Bactéries Pathogènes Emergentes, Paris, France6
*Corresponding author. Mailing address: Laboratoire des Bactéries Pathogènes Entériques, Institut Pasteur, 28 rue du Docteur Roux, 75724 Paris cedex 15, France. Phone: 33-(0)1 45 68 83 45. Fax: 33-(0)1 45 68 88 37. E-mail: firstname.lastname@example.org
Received March 30, 2009; Revised May 22, 2009; Accepted October 23, 2009.
Pseudomonas luteola (formerly classified as CDC group Ve-1 and named Chryseomonas luteola) is an unusual pathogen implicated in rare but serious infections in humans. A novel β-lactamase gene, blaLUT-1, was cloned from the whole-cell DNA of the P. luteola clinical isolate LAM, which had a weak narrow-spectrum β-lactam-resistant phenotype, and expressed in Escherichia coli. This gene encoded LUT-1, a 296-amino-acid Ambler class A β-lactamase with a pI of 6 and a theoretical molecular mass of 28.9 kDa. The catalytic efficiency of this enzyme was higher for cephalothin, cefuroxime, and cefotaxime than for penicillins. It was found to be 49% to 59% identical to other Ambler class A β-lactamases from Burkholderia sp. (PenA to PenL), Ralstonia eutropha (REUT), Citrobacter sedlakii (SED-1), Serratia fonticola (FONA and SFC-1), Klebsiella sp. (KPC and OXY), and CTX-M extended-spectrum β-lactamases. No gene homologous to the regulatory ampR genes of class A β-lactamases was found in the vicinity of the blaLUT-1 gene. The entire blaLUT-1 coding region was amplified by PCR and sequenced in five other genetically unrelated P. luteola strains (including the P. luteola type strain). A new variant of blaLUT-1 was found for each strain. These genes (named blaLUT-2 to blaLUT-6) had nucleotide sequences 98.1 to 99.5% identical to that of blaLUT-1 and differing from this gene by two to four nonsynonymous single nucleotide polymorphisms. The blaLUT gene was located on a 700- to 800-kb chromosomal I-CeuI fragment, the precise size of this fragment depending on the P. luteola strain.
Pseudomonas luteola (formely known as CDC group Ve-1 or Chryseomonas luteola) is a motile, strictly aerobic, gram-negative rod, producing a distinct yellow-orange pigment (4). This organism is nonfermentative, oxidase negative, and catalase positive. P. luteola has been isolated from many sources in nature (water, soil, and damp environments) and is considered to be a saprophyte or commensal organism only rarely pathogenic to humans (11, 19). Clinical infections due to this microorganism have rarely been reported (fewer than 25 cases) and have mostly presented as septicemia, meningitis, peritonitis, endocarditis, and ulcer infections, usually in association with surgical operations or the use of catheters or prostheses (11, 13-15, 17, 19, 20, 24, 36, 42). It has been suggested that this organism is likely to become more frequent as a nosocomial pathogen (19). The clinical isolates of P. luteola have generally been shown to be susceptible to extended-spectrum cephalosporins (ESC), aminoglycosides, and fluoroquinolones (11, 20, 36, 42). In most studies in which isolates were tested with a large panel of β-lactam antibiotics, resistance to original-spectrum and broad-spectrum cephalosporins was observed, whereas susceptibility to penicillins was variable (5, 13-15, 17, 20, 36). This β-lactam resistance phenotype suggests that this microbe may produce a natural β-lactamase.
We report here the cloning and sequencing of the blaLUT-1 gene, encoding the class A β-lactamase of the P. luteola clinical isolate LAM, which was isolated in January 2002 from a blood culture from a patient with an infected indwelling catheter. We investigated the biochemical characteristics of LUT-1. The presence, nucleotide diversity, and location of the blaLUT gene were studied in five other genetically unrelated P. luteola strains.
MATERIALS AND METHODS
Bacterial strains and plasmids.
The bacterial strains and plasmids used in this study are described in Table 1. P. luteola was identified with the API-20 NE system (bioMérieux, Marcy-l'Etoile, France) and by sequencing PCR-amplified rrs (16S rRNA gene) and rpoB (RNA polymerase beta subunit), as previously described (2).
Antimicrobial susceptibility testing.
Antibiotic susceptibility was assessed by the disk diffusion method for 32 antimicrobial drugs (Bio-Rad, Marnes La Coquette, France), as previously described (43). The MIC of each β-lactam antibiotic was determined by Etest (AB Biodisk, Solna, Sweden). Susceptibility was classified according to the guidelines of the Antibiogram Committee of the French Society for Microbiology (CA-SFM) ( ). Escherichia coli ATCC 25922 was used as the control for disk diffusion analyses and MIC determinations.
Cloning experiments and analysis of recombinant plasmids.
Genomic DNA of the P. luteola strain LAM was partially digested with Sau3AI restriction enzyme, ligated into the BamHI-restricted phagemid pBK-CMV, and electroporated into E. coli strain DH10B, as previously described (34). Antibiotic-resistant colonies were selected on Mueller-Hinton (MH) agar (Bio-Rad) containing kanamycin (30 μg/ml) and cefamandole (5 μg/ml).
The 1.5-kb cloned DNA fragment from the recombinant plasmid pBK-L3 was sequenced on both strands by Cogenics (Meylan, France). Analyses of nucleotide sequences and deduced amino acid sequences were performed with EditSeq and Megalign software (DNAstar, Madison, WI). The BLAST programs available from the NCBI were used for database searches ().
We searched for a divergently transcribed regulator gene upstream for the blaLUT-1 gene in various recombinant plasmids shown by PCR to contain the longest DNA sequences upstream from the blaLUT-1 gene. The primers used were either T3 or T7 (binding to the multicloning site of pBK-CMV) and REG (5′-CTTTTGTGACTTGAGGAGATCGCA-3′) (binding 300 bp upstream from the ATG initiation codon of the LUT-1 gene). The amplification conditions were as described below, except that an annealing temperature of 47°C was used.
Isoelectric focusing and β-lactamase preparation.
Isoelectric focusing was performed with polyacrylamide gels containing ampholines with a pH range of 3.5 to 10, as previously described (7, 38). β-Lactamases of known pIs (in parentheses) were used as standards: TEM-1 (5.4), TEM-2 (5.6), TEM-6 (5.9), TEM-24 (6.5), and TEM-28 (6.1).
LUT-1-producing E. coli DH5α(pBK-L3) was grown in 6 liters of 2× yeast-tryptone broth supplemented with 20 μg/ml kanamycin and 32 μg/ml amoxicillin for 18 h at 37°C. The β-lactamase LUT-1 was purified as previously described (8, 37), by ion-exchange chromatography with a Q Sepharose column (Amersham Pharmacia Biotech, Uppsala, Sweden) and gel filtration chromatography with a Superose 12 column (Amersham Pharmacia Biotech). Total protein concentration was estimated with the Bio-Rad protein assay (Bio-Rad, Richmond, CA) with bovine serum albumin (Sigma Chemical Co., St. Louis, MO) used as the standard. The purity of LUT-1 extracts was estimated as previously described (9), by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and staining with Coomassie blue R-250 (Sigma Chemical Co.).
Determination of kinetic constants for β-lactamase activity.
The kinetic constants Km and kcat for β-lactamases were obtained by a computerized microacidimetric method, as previously described (26). The concentrations of the inhibitors (clavulanate and tazobactam) required to inhibit enzyme activity by 50% (IC50s) were determined with penicillin G (9). Penicillin G (100 mM) was used as the reporter substrate for IC50 monitoring. The kinetic constants were determined three times. The coefficients of variation did not exceed 15%.
The genetic diversity of P. luteola was assessed by pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with XbaI or SpeI (Roche), as previously described (43).
PCR amplification and sequencing of the blaLUT gene in P. luteola.
The entire coding region of the blaLUT gene of all P. luteola strains was amplified by PCR, using the primers UpPlut (5′-ACCGTCTAGGCTGCTACTTCA-3′) and LoPlut (5′-CCGCTGCGCATGAGCGTA-3′), binding 200 bp upstream from the ATG initiation codon of LUT-1 and 10 bp downstream from the stop codon, respectively. The PCR products (1,100 kb) were sequenced at the Plateforme de Génotypage des Pathogènes et Santé Publique, PF8 (Institut Pasteur).
Phylogenetic analysis of the amino acid sequences.
The ClustalW program (40). Phylogenetic analysis was carried out with the bioinformatics tool TOPALi v2.5 (28, 29). A phylogenic tree was constructed by the Bayesian method, as implemented in the MRBAYES program (22). LUT-1 was compared with 37 class A β-lactamases. The consensus tree calculated by MRBAYES was imported into MEGA4 for the purposes of displaying and printing the tree (25, 39).) was used to align the amino acid sequences obtained (
Resistance transfer determination.
Conjugation and transformation experiments were carried out on the P. luteola LAM isolate, as previously described (43). The β-lactam antibiotic used for selection was cefotaxime with a final concentration of 0.25 μg/ml.
Chromosomal location of blaLUT genes, as determined by PFGE-I-CeuI.
For determination of the chromosomal location of the blaLUT-1 gene, we digested agarose plugs, prepared as described previously, with the I-CeuI endonuclease (New England Biolabs, Beverly, MA) (27). I-CeuI restriction fragments were subjected to Southern blot hybridization with a PCR-generated probe for the blaLUT-1 gene and with an rrs (16S rRNA gene) probe, as described above. Hybridization, labeling, and detection were performed according to the manufacturer's recommendations, using a nonradioactive enhanced chemiluminescence kit (ECL; GE Healthcare, United Kingdom).
Nucleotide sequence accession numbers.
The nucleotide sequences of the blaLUT-1 to blaLUT-6 genes of the P. luteola strains have been deposited in the GenBank database under accession numbers, , , , , and , respectively.
RESULTS AND DISCUSSION
Antimicrobial susceptibility of P. luteola.
The disk diffusion method showed the five P. luteola isolates and the type strain to be resistant to cephalothin, cefamandole, cefoxitin (resistance or intermediate susceptibility), nalidixic acid, trimethoprim, and trimethoprim-sulfamethoxazole. All strains were susceptible to ciprofloxacin and aminoglycosides. Additional resistance to sulfonamides and chloramphenicol was observed only in the LAM isolate. The MICs of the β-lactams determined by Etest are shown in Table 2. The addition of clavulanic acid slightly decreased (by a factor of 2 to 4) the MICs of amoxicillin, ticarcillin, and piperacillin. The MICs of the ESC and also aztreonam were slightly affected within the susceptible or intermediate range. Only the cefotaxime MICs of some P. luteola strains were in the resistant (>2-μg/ml) range according to the guidelines of the CA-SFM. By using the Etest ESBL cefepime/cefepime plus clavulanic acid strips, a deformation of the cefepime inhibition ellipse was observed for two strains with the highest MICs of cefepime (isolate 03-5093 and type strain CIP 102995T). The MICs of nalidixic acid and ciprofloxacin ranged from 16 to >256 μg/ml and from 0.032 to 0.25 μg/ml, respectively.
Cloning and sequence analysis of the bla gene from P. luteola.
Partially Sau3AI-digested DNA from the P. luteola clinical isolate LAM was inserted into the BamHI site of pBK-CMV. Ten E. coli DHB10B recombinant clones were obtained after selection on kanamycin and cefamandole (5 μg/ml). The inserts of the recombinant plasmids were between 1.5 and 3.6 kb in size. The pBK-L3 plasmid, which had a 1.5-kb insert, was selected for sequence analysis. An open reading frame (ORF) of 891 bp, preceded by a putative promoter region (339 bp), was identified and shown to encode a 296-amino-acid sequence. These nucleotide and amino acid sequences were absent from databases. However, the deduced protein had amino acid motifs typical of Ambler class A β-lactamases (70SXXK73, 130SDN132, 166EXXXN170, and 234KTG236) (3). We therefore named this putative novel class A β-lactamase and the corresponding gene LUT-1 and blaLUT-1, respectively. We used the SignalP 3.0 server (available at: ) to determine whether this protein had a putative signal peptide. A putative cleavage site was identified between the 27th and 28th amino acids of the N-terminal region, giving a putative mature protein with a theoretical molecular mass of 28.9 kDa. A phylogenic study was carried out to assess the relationship between LUT-1 and its closest relatives and between this enzyme and members of the major lineages of class A β-lactamases (Fig. (Fig.1).1). The predicted LUT-1 protein showed similarities to several other chromosome-encoded class A β-lactamases identified in beta- and gammaproteobacteria. Figure Figure22 shows an alignment of the amino acid sequence of LUT-1 with representative members of the various branches of naturally occurring and acquired class A β-lactamases displaying similarity to LUT-1. The LUT-1 β-lactamase was 53 to 59% similar to the chromosomal β-lactamases of Burkholderia cepacia complex (Pen-A to Pen-L), 56% identical to that of Ralstonia eutropha (REUT), 54% identical to that of Citrobacter sedlakii (SED-1), 52% identical to that of Serratia fonticola (FONA-5), and 51% identical to that of Klebsiella oxytoca (OXY-5) (16, 33, 34, 44). LUT-1 also showed similarities with acquired β-lactamases such as KPC-7 from Klebsiella pneumoniae and SFC-1 from S. fonticola (class A carbapenemases) (21, 30, 44). Interestingly, the LUT-1 β-lactamase was also 49 to 52% identical to members of the extended-spectrum β-lactamase (ESBL) CTX-M family (6).
We identified no putative Lys-R-type regulator upstream from the ORF encoding LUT-1 in pBK-L3. The upstream regions of the blaLUT-1 gene were amplified from nine other recombinant plasmids with the T3 and REG primers. The three plasmids containing the longest regions (750 bp, 600 bp, and 500 bp, respectively) were sequenced, but no regulator gene was identified. However, our results do not completely rule out the possibility that there is a regulator gene.
Properties of the LUT-1 β-lactamase.
The recombinant E. coli(pBK-L3) clone had a β-lactam resistance phenotype different from that of the parental strain P. luteola LAM (Table 2). In E. coli, LUT-1 conferred resistance to amoxicillin and ticarcillin and an intermediate level of susceptibility to piperacillin and cephalothin. However, E. coli(pBK-L3) remained susceptible to cefoxitin, ESC, and imipenem. The β-lactamase inhibitors lowered the MICs of amoxicillin, ticarcillin, piperacillin, and cefotaxime by factors of 8 to 32. By using the Etest ESBL cefepime/cefepime plus clavulanic acid strips, a deformation of the cefepime inhibition ellipse was observed indicative of ESBLs. The discrepancy between P. luteola LAM and E. coli(pBK-L3) β-lactam resistance phenotypes may be due to the production of larger amounts of enzyme when the gene is expressed on a high-copy-number plasmid in E. coli. β-Lactam resistance phenotypes of the clinical P. luteola isolates (i.e., susceptibility to hydrolyzable penicillins) suggested a small amount of LUT. This hypothesis is strengthened by the kinetic parameters of LUT described below. Efflux mechanisms and/or differences in outer membrane permeability may also alter periplasmic β-lactam concentrations, thereby affecting apparent enzyme activity.
Both P. luteola isolate LAM and E. coli(pBK-L3) produced a single β-lactamase with an isoelectric point (pI) of approximately 6 (data not shown), consistent with the calculated theoretical pI. The purified LUT-1 protein appeared on SDS-polyacrylamide gels as a single band (≥98% pure) of approximately 29 kDa (data not shown). Kinetic parameters indicated that the LUT-1 enzyme had a broad substrate profile including penicillins and cephalosporins, such as cephalothin, cefuroxime, and cefotaxime in particular (Table 3). As observed for CTX-M, LUT-1 displayed stronger hydrolytic activity against cefotaxime than against ceftazidime or aztreonam (kcat, 452 versus 1.3 or 1.5 s−1, respectively). It was inhibited by low concentrations of clavulanic acid (IC50, 36 nM) and tazobactam (IC50, 40 nM). Given its susceptibility to clavulanate and its ability to cleave ESC, we can classify LUT-1 as a member of the 2e group in the functional classification of β-lactamases (10). Particular residues of LUT-1 such as Ser104, Thr167, Thr237, and Arg276, identified as important positions for the action of other ESBLs (TEMs and CTX-Ms), may be involved in the activity of LUT-1 against oxyiminocephalosporins (12, 18, 23, 31, 32, 35).
The level of hydrolysis of oxyiminocephalosporins observed, particularly for cefotaxime, was surprisingly high given their low MICs (Table 2). However, low levels of expression in P. luteola LAM may be responsible for these low MICs, suggesting a possible chromosomal location for the blaLUT gene. The presence of the natural promoter region (in silico analysis [data not shown]) may partly account for the low level of resistance observed in E. coli(pBK-L3).
No biochemical characterization of the five variants of the LUT-1 β-lactamase (LUT-2 to LUT-6) identified on the basis of the blaLUT gene sequences (see below) was performed. The effects of the amino acid substitutions on the hydrolytic profile of the protein therefore remain unclear.
Diversity of the blaLUT gene in P. luteola strains.
We used PCR with the UpPlut and LoPlut primers to determine whether the blaLUT-1 gene was present in the six P. luteola strains and in type strains of P. aeruginosa, B. cepacia, S. fonticola, Yersinia enterocolitica, C. sedlakii, and K. oxytoca. All the P. luteola strains yielded a PCR product of the expected size (1,100 bp). No amplification was observed for the other species. However, the specificity of the PCR requires confirmation through testing in several other rare Pseudomonas species closely related to P. luteola in the phylogenetic tree (e.g., P. anguilliseptica, P. pertucinogena, and P. lundensis) (1). Sequencing of the PCR products on both strands of the DNA revealed that the six blaLUT genes had nucleotide sequences 98.1 to 99.5% identical to that of the blaLUT-1 gene. Two to four nonsynonymous single nucleotide polymorphisms with respect to the LUT-1 β-lactamase were observed. These five variants of the blaLUT-1 gene were named blaLUT-2 to blaLUT-6 and deposited in the GenBank database.
Genomic diversity of P. luteola strains.
The genomic diversity of the six P. luteola strains was assessed by PFGE of XbaI- or SpeI-digested whole-cell DNA. The XbaI enzyme did not appear suitable for this species due to the presence of numerous compressed bands of small molecular size (in the range of 0 to 100 kb) (data not shown). However, the P. luteola strains were found to be genetically unrelated, as each strain harbored an SpeI profile differing from those of the other strains by at least 7 bands (Fig. (Fig.33).
Chromosomal location of blaLUT genes in P. luteola.
β-Lactam resistance could not be transferred by conjugation or by electroporation from the P. luteola LAM isolate to E. coli by using cefotaxime at 0.25 μg/ml for selection. These results suggested that the blaLUT-1 gene might be located on the chromosome. We tested this hypothesis, by digesting high-molecular-weight P. luteola DNAs embedded in agarose plugs with I-CeuI, separating the digestion products by PFGE and Southern blotting, and hybridizing them with a PCR-generated blaLUT-1 probe and an rrs (16S rRNA gene) probe. The blaLUT genes were assigned to a single large I-CeuI fragment, between 700 and 800 kb in size, depending on the strain, which also hybridized with the rrs probe (Fig. 4B and C). All the P. luteola strains harbored 6 chromosomal I-CeuI fragments which hybridized with the rrs probe (Fig. (Fig.4C).4C). These results demonstrated a chromosomal location for blaLUT genes.
In conclusion, we have identified LUT-1, a class A β-lactamase naturally occurring in P. luteola. P. luteola has a weak narrow-spectrum β-lactam-resistant phenotype, but this environmental species may act as a reservoir of β-lactam resistance determinants. Provided that these findings are confirmed with a larger number of P. luteola (sensitivity) and Pseudomonas sp. (specificity) isolates, two practical applications of this study would be the use of the blaLUT gene as a molecular identification marker for P. luteola species and the use of the DNA sequence microvariation of this gene as an alternative to PFGE for strain differentiation during investigations of outbreaks.
B.D. was supported by an INRA postdoctoral fellowship.
We thank Isabelle Pogdlajen from Hôpital Européen Georges Pompidou for providing the HEGP strain and Bernadette Grandry and Tania Rybkine for expert technical assistance.
Published ahead of print on 2 November 2009.
1. Ait Tayeb, L., E. Ageron, F. Grimont, and P. A. D. Grimont. 2005. Molecular phylogeny of the genus Pseudomonas based on rpoB sequences and application for the identification of isolates. Res. Microbiol. 156:763-773. [PubMed]
2. Ait Tayeb, L., M. Lefevre, V. Passet, L. Diancourt, S. Brisse, and P. A. D. Grimont. 2008. Comparative phylogenies of Burkholderia, Ralstonia, Comamonas, Brevundimonas, and related organisms derived from rpoB, gyrB and rrs gene sequences. Res. Microbiol. 159:169-177. [PubMed]
3. Ambler, R. P., A. F. W. Coulson, J. M. Frère, J. M. Ghuysen, B. Joris, M. Forsman, R. C. Levesque, G. Tiraby, and S. G. Waley. 1991. A standard numbering scheme for the class A β-lactamases. Biochem. J. 276:269-270. [PMC free article] [PubMed]
4. Anzai, Y., Y. Kudo, and H. Oyaizu. 1997. The phylogeny of the genera Chryseomonas, Flavimonas, and Pseudomonas supports synonymy of these three genera. Int. J. Syst. Bacteriol. 47:249-251. [PubMed]
5. Berger, S. A., Y. Siegman-Igra, J. Stadler, and A. Campus. 1983. Group VE-1 septicemia. J. Clin. Microbiol. 7:926-927.
6. Bonnet, R. 2004. Growing group of extended-spectrum β-lactamases: the CTX-M enzymes. Antimicrob. Agents Chemother. 48:1-14. [PMC free article] [PubMed]
7. Bonnet, R., C. De Champs, D. Sirot, C. Chanal, R. Labia, and J. Sirot. 1999. Diversity of TEM mutants in Proteus mirabilis. Antimicrob. Agents Chemother. 43:2671-2677. [PMC free article] [PubMed]
8. Bonnet, R., C. Dutour, J. L. Sampaio, C. Chanal, D. Sirot, R. Labia, C. De Champs, and J. Sirot. 2001. Novel cefotaximase (CTX-M-16) with increased catalytic efficiency due to substitution Asp-240/Gly. Antimicrob. Agents Chemother. 45:2269-2275. [PMC free article] [PubMed]
9. Bonnet, R., J. L. Sampaio, C. Chanal, D. Sirot, C. De Champs, J. L. Viallard, R. Labia, and J. Sirot. 2000. A novel class A extended-spectrum β-lactamase (BES-1) in Serratia marcescens isolated in Brazil. Antimicrob. Agents Chemother. 44:3061-3068. [PMC free article] [PubMed]
10. Bush, K., G. A. Jacoby, and A. A. Medeiros. 1995. A functional classification scheme for β-lactamases and its correlation with molecular structure. Antimicrob. Agents Chemother. 39:1211-1233. [PMC free article] [PubMed]
11. Casalta, J.-P., P.-E. Fournier, G. Habib, A. Riberi, and D. Raoult. 2005. Prosthetic valve endocarditis caused by Pseudomonas luteola. BMC Infect. Dis. 5:82. [PMC free article] [PubMed]
12. Chen, Y., J. Delmas, J. Sirot, B. Shoichet, and R. Bonnet. 2005. Atomic resolution structures of CTX-M β-lactamases: extended spectrum activities from increased mobility and decreased stability. J. Mol. Biol. 348:349-362. [PubMed]
13. Chihab, W., A. S. Alaoui, and M. Amar. 2004. Chryseomonas luteola identified as the source of serious infections in a Moroccan university hospital. J. Clin. Microbiol. 42:1837-1839. [PMC free article] [PubMed]
14. Connor, B. J., R. T. Kopecky, P. A. Frymoyer, and B. A. Forbes. 1987. Recurrent Pseudomonas luteola (CDC group Ve-1) peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis. J. Clin. Microbiol. 25:1113-1114. [PMC free article] [PubMed]
15. Engel, J. M., F. S. Alexander, and C. T. Pachucki. 1987. Bacteremia caused by CDC group Ve-1 in previously healthy patient with granulomatous hepatitis. J. Clin. Microbiol. 25:2023-2024. [PMC free article] [PubMed]
16. Fevre, C., M. Jbel, V. Passet, F.-X. Weill, P. A. D. Grimont, and S. Brisse. 2005. Six groups of the OXY β-lactamase evolved over millions of years in Klebsiella oxytoca. Antimicrob. Agents Chemother. 49:3453-3462. [PMC free article] [PubMed]
17. Freney, J., W. Hansen, J. Etienne, F. Vandenesch, and J. Fleurette. 1988. Postoperative infant septicemia caused by Pseudomonas luteola (CDC group Ve-1) and Pseudomonas oryzihabitans (CDC group Ve-2). J. Clin. Microbiol. 26:1241-1243. [PMC free article] [PubMed]
18. Gazouli, M., N. J. Legakis, and L. S. Tzouvelekis. 1998. Effect of substitution of Asn for Arg-276 in the cefotaxime-hydrolyzing class A β-lactamase CTX-M-4. FEMS Microbiol. Lett. 169:289-293. [PubMed]
19. Ghosh, S. K. 2000. A rare infection caused by Chryseomonas luteola. J. Infect. 41:109-110. [PubMed]
20. Hawkins, R. E., R. A. Moriarty, D. E. Lewis, and E. C. Oldfield. 1991. Serious infections involving the CDC group Ve bacteria Chryseomonas luteola and Flavimonas oryzihabitans. Rev. Infect. Dis. 13:257-260. [PubMed]
21. Henriques, I., A. Moura, A. Alves, M. J. Saavedra, and A. Correia. 2004. Molecular characterization of a carbapenem-hydrolyzing class A β-lactamase, SFC-1, from Serratia fonticola UTAD54. Antimicrob. Agents Chemother. 48:2321-2324. [PMC free article] [PubMed]
22. Huelsenbeck, J. P., and F. Ronquist. 2001. MRBAYES: Bayesian inference of phylogenetic trees. Bioinformatics 17:754-755. [PubMed]
23. Knox, J. R. 1995. Extended-spectrum and inhibitor-resistant TEM-type β-lactamases: mutations, specificity, and three-dimensional structure. Antimicrob. Agents Chemother. 39:2593-2601. [PMC free article] [PubMed]
24. Kostman, J. R., F. Solomon, and T. Fekete. 1991. Infections with Chryseomonas luteola (CDC group Ve-1) and Flavimonas oryzihabitans (CDC group Ve-2) in neurosurgical patients. Rev. Infect. Dis. 13:233-236. [PubMed]
25. Kumar, S., M. Nei, J. Dudley, and K. Tamura. 2008. MEGA: a biologist-centric software for evolutionary analysis of DNA and protein sequences. Brief. Bioinform. 9:299-306. [PMC free article] [PubMed]
26. Labia, R., J. Andrillon, and F. Le Goffic. 1973. Computerized microacidimetric determination of β-lactamase Michaelis-Menten constants. FEBS Lett. 33:42-44. [PubMed]
27. Liu, S. L., and K. E. Sanderson. 1995. I-CeuI reveals conservation of the genome of independent strains of Salmonella typhimurium. J. Bacteriol. 177:3355-3357. [PMC free article] [PubMed]
28. Milne, I., D. Lindner, M. Bayer, D. Husmeier, G. McGuire, D. F. Marshall, and F. Wright. 2009. TOPALi v2: a rich graphical interface for evolutionary analyses of multiple alignments on HPC clusters and multi-core desktops. Bioinformatics 25:126-127. [PMC free article] [PubMed]
29. Milne, I., F. Wright, G. Rowe, D. F. Marshall, D. Husmeier, and G. McGuire. 2004. TOPALi: software for automatic identification of recombinant sequences within DNA multiple alignments. Bioinformatics 20:1806-1807. [PubMed]
30. Nordmann, P., G. Cuzon, and T. Naas. 2009. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect. Dis. 9:228-236. [PubMed]
31. Pérez-Llarena, F. J., M. Cartelle, S. Mallo, A. Beceiro, A. Pérez, R. Villanueva, A. Romero, R. Bonnet, and G. Bou. 2008. Structure-function studies of arginine at position 276 in CTX-M β-lactamases. J. Antimicrob. Chemother. 61:792-797. [PubMed]
32. Petit, A., L. Maveyraud, F. Lenfant, J. P. Samama, R. Labia, and J. M. Masson. 1995. Multiple substitutions at position 104 of β-lactamase TEM-1: assessing the role of this residue in substrate specificity. Biochem. J. 305:33-40. [PMC free article] [PubMed]
33. Petrella, S., D. Clermont, I. Casin, V. Jarlier, and W. Sougakoff. 2001. Novel class A β-lactamase from Citrobacter sedlakii: genetic diversity of β-lactamases within the Citrobacter genus. Antimicrob. Agents Chemother. 45:2287-2298. [PMC free article] [PubMed]
34. Poirel, L., J.-M. Rodriguez-Martinez, P. Plésiat, and P. Nordmann. 2009. Naturally occurring class A β-lactamases from the Burkholderia cepacia complex. Antimicrob. Agents Chemother. 53:876-882. [PMC free article] [PubMed]
35. Poirel, L., T. Naas, I. Le Thomas, A. Karim, E. Bingen, and P. Nordmann. 2001. CTX-M-type extended-spectrum β-lactamase that hydrolyzes ceftazidime through a single amino acid substitution in the omega loop. Antimicrob. Agents Chemother. 45:3355-3361. [PMC free article] [PubMed]
36. Rastogi, S., and S. J. Sperber. 1998. Facial cellulitis and Pseudomonas luteola bacteremia in an otherwise healthy patient. Diagn. Microbiol. Infect. Dis. 32:303-305. [PubMed]
37. Robin, F., J. Delmas, C. Chanal, D. Sirot, J. Sirot, and R. Bonnet. 2005. TEM-109 (CMT-5), a natural complex mutant of TEM-1 β-lactamase combining the amino acid substitution of TEM-6 and TEM-33 (IRT-5). Antimicrob. Agents Chemother. 49:4443-4447. [PMC free article] [PubMed]
38. Sirot, D., C. Chanal, C. Henquell, R. Labia, J. Sirot, and R. Cluzel. 1994. Clinical isolates of Escherichia coli producing multiple TEM-mutants resistant to β-lactamase inhibitors. J. Antimicrob. Chemother. 33:1117-1126. [PubMed]
39. Tamura, K., J. Dudley, M. Nei, and S. Kumar. 2007. MEGA4: Molecular Evolutionary Genetics Analysis (MEGA) software version 4.0. Mol. Biol. Evol. 24:1596-1599. [PubMed]
40. Thompson, J. D., D. G. Higgins, and T. J. Gibson. 1994. CLUSTAL W: improving the sensitivity of progressive multiple sequence alignment through sequence weighting, position-specific gap penalties and weight matrix choice. Nucleic Acids Res. 22:4673-4680. [PMC free article] [PubMed]
41. Trépanier, S., A. Prince, and A. Huletsky. 1997. Characterization of the penA and penR genes of Burkholderia cepacia 249, which encode the chromosomal class A penicillinase and its LysR-type transcriptional regulator. Antimicrob. Agents Chemother. 41:2399-2405. [PMC free article] [PubMed]
42. Tsakris, A., H. Hassapopoulou, L. Skoura, S. Pournaras, and J. Douboyas. 2002. Leg ulcer due to Pseudomonas luteola in a patient with sickle cell disease. Diagn. Microbiol. Infect. Dis. 42:141-143. [PubMed]
43. Weill, F. X., R. Lailler, K. Praud, A. Kérouanton, L. Fabre, A. Brisabois, P. A. D. Grimont, and A. Cloeckaert. 2004. Emergence of extended-spectrum-β-lactamase (CTX-M-9)-producing multiresistant strains of Salmonella enterica serotype Virchow in poultry and human in France. J. Clin. Microbiol. 42:5767-5773. [PMC free article] [PubMed]
44. Wolter, D. J., P. M. Kurpiel, N. Woodford, M.-F. I. Palepou, R. V. Goering, and N. D. Hanson. 2009. Phenotypic and enzymatic comparative analysis between the novel KPC variant, KPC-5, and its evolutionary variants, KPC-2 and KPC-4. Antimicrob. Agents Chemother. 53:557-562. [PMC free article] [PubMed]