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Antimicrobial Agents and Chemotherapy, October 1999, p. 2366-2371, Vol. 43, No. 10
0066-4804/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Characterization of the Chromosomal
aac(6')-Iz Gene of Stenotrophomonas
maltophilia
Thierry
Lambert,1,2,*
Marie-Cécile
Ploy,1,3
François
Denis,3 and
Patrice
Courvalin1
Unité des Agents Antibactériens,
Institut Pasteur, 75724 Paris Cedex 15,1
Centre d'Etudes Pharmaceutiques, 92296 Châtenay-Malabry,2 and Laboratoire
de Bactériologie-Virologie-Hygiène, CHU Dupuytren, 87000 Limoges,3 France
Received 7 April 1999/Returned for modification 30 June
1999/Accepted 27 July 1999
 |
ABSTRACT |
The aac(6')-Iz gene of Stenotrophomonas
maltophilia BM2690 encoding an aminoglycoside
6'-N-acetyltransferase was characterized. The gene was
identified as a coding sequence of 462 bp corresponding to a protein
with a calculated mass of 16,506 Da, a value in good agreement with
that of ca. 16,000 found by in vitro coupled transcription-translation. Analysis of the deduced amino acid sequence indicated that the protein
was a member of the major subfamily of aminoglycoside 6'-N-acetyltransferases. The enzyme conferred resistance to
amikacin but not to gentamicin, indicating that it was an AAC(6') of
type I. The open reading frame upstream from the aac(6')-Iz
gene was homologous to the fprA gene of Myxococcus
xanthus (61% identity), which encodes a putative pyridoxine
(pyridoxamine) 5'-phosphate oxidase. Pulsed-field gel electrophoresis
of total DNA from BM2690 and S. maltophilia ATTC 13637 digested with XbaI, DraI, and SpeI followed by hybridization with rRNA and aac(6')-Iz-specific
probes indicated that the gene was located in the chromosome. The
aac(6')-Iz gene was detected by DNA-DNA hybridization in
all 80 strains of S. maltophilia tested. The MICs of
gentamicin against these strains of S. maltophilia were
lower than those of amikacin, netilmicin, and tobramycin, indicating
that production of AAC(6')-Iz contributes to aminoglycoside resistance
in S. maltophilia.
 |
INTRODUCTION |
Stenotrophomonas
maltophilia (formerly Xanthomonas maltophilia) is a
free-living, ubiquitous, nonfermentative gram-negative bacillus. It is
an important opportunistic nosocomial pathogen in neutropenic,
immunocompromised, and debilitated patients. S. maltophilia
is associated with a wide variety of clinical infections, including
bacteremia, endocarditis, meningitis, respiratory and urinary tract
infections, and wound sepsis (13). More recently, increasing
chronic colonization by this bacterial species of the lower respiratory
tract in patients with cystic fibrosis has been reported (2,
12).
S. maltophilia is characteristically resistant to most
broad-spectrum antimicrobial agents, including aminoglycosides,
carbapenems, cephalosporins, penicillins, and quinolones. These
antibiotics are seldom used alone (13), and synergism in
vitro has been observed for certain combinations (5, 29,
49). The resistance of S. maltophilia is mainly
attributed to permeability barriers (8, 25, 47). For
instance, growth temperature-dependent variation in susceptibility to
aminoglycosides, between 30 and 37°C, could be due to changes in the
conformation of the outer membrane (30, 31, 46). Efflux
pumps could also play a role in multiple resistance, but this mechanism
has not yet been documented in this species. In addition to intrinsic
resistance by impermeability, S. maltophilia can inactivate
antibiotics by synthesis of detoxifying enzymes. Metallo-
-lactamases
and cephalosporinases have been extensively investigated (9, 26,
36), and modification of aminoglycosides by
O-nucleotidylation and N-acetylation has been
reported, but the responsible genes have not been identified (20,
45). Among the various aminoglycoside-modifying enzymes, the
AAC(6') family is of particular interest, since it modifies antibiotics
of therapeutic importance, such as amikacin, isepamicin, gentamicin,
netilmicin, and tobramycin. The sequences of 22 aac(6') genes encoding type I enzymes which modify amikacin but not gentamicin have been determined. Certain genes are associated with mobile elements, including plasmids, transposons, and integron cassettes (4, 40), whereas others are species specific, such as
aac(6')-Ic of Serratia marcescens
(41); aac(6')-Ii of Enterococcus
faecium (6); and aac(6')-Ig, -Ij,
-Ik, and -Ir to -Iw of proteolytic genomospecies of Acinetobacter (22, 23, 34, 35).
In this work, we describe the aac(6')-Iz gene indigenous to
S. maltophilia which contributes to aminoglycoside
resistance in the species.
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MATERIALS AND METHODS |
Bacterial strains and plasmids.
Epidemiologically unrelated
clinical isolates of S. maltophilia from different sources,
including strain BM2690 isolated from the sputum of a patient with
cystic fibrosis, were used. The strains were isolated between 1992 and
1998 at the Hopital Saint Michel in Paris, France. Eight additional
strains isolated from cystic fibrosis patients were from Hopital Robert
Debré in Paris. S. maltophilia ATCC 13637 was also
included in this study. Certain strains and plasmids used in this study
are listed in Table 1.
Strain identification and growth conditions.
Identification
was performed with API 20 NE strips (bioMérieux,
La-Balme-les-Grottes, France). All the isolates were resistant to
imipenem. The strains were grown in brain heart infusion broth (Difco
Laboratories, Detroit, Mich.) or on Mueller-Hinton (MH) agar (Sanofi
Diagnostics Pasteur, Marnes-la-Coquette, France). MH medium
supplemented with 0.005%
5-bromo-4-chloro-3-indolyl-
-D-galactopyranoside (IPTG)
was used to detect production of
-galactosidase. MICs on MH agar
containing serially twofold-diluted aminoglycosides were determined by
the method of Steers et al. (42) with ca. 104
CFU per spot. The plates were incubated at 37°C for 18 h. The activity of 2'- and 6'-N-ethylnetilmicin was studied by
diffusion on MH agar at 37°C with disks containing 100 µg of antibiotic.
Assay for aminoglycoside-modifying enzymes.
The activity of
aminoglycoside-modifying enzymes was detected in bacterial extracts by
the phosphocellulose paper-binding technique (17). The
reaction was allowed to proceed for 30 min at 30°C.
Genetic techniques.
Transformation of Escherichia
coli JM83 was performed as described previously (38).
The antibiotics for selection were ampicillin (100 µg/ml) and
tobramycin (5 µg/ml).
Preparation and analysis of DNA.
Isolation of total DNA and
small- and large-scale preparation of plasmid DNA was done as described
previously (38). Electrophoresis was performed in 0.8%
agarose gels (Sigma Chemical Co., St. Louis, Mo.) with a Tris-borate
buffer system.
For the analysis of total DNA by pulsed-field gel electrophoresis
(PFGE), strains were grown in 2-ml volumes of brain heart infusion
broth. After centrifugation at 32 × g for 10 min, the cell
pellet was suspended in 750 µl of 10 mM Tris base, 10 mM EDTA, 10 mM
EGTA, 1 M NaCl (pH 7.5). Agarose plugs were made from a 1:1 mixture of
1.8% insert agarose (FMC BioProducts, Rockland, Maine) and the cell
suspension. Each plug was placed in 1 ml of lysis buffer (6 mM
Tris-HCl, 1 M NaCl, 100 mM EDTA, 0.5% Brij 58 [Sigma], 0.2%
deoxycholic acid [Sigma], 0.5% N-lauroyl sarcosine [Sigma], 1 mg of lysozyme [Sigma]/ml) for 1 h at 37°C.
Genomic DNA in agarose plugs was then treated for 16 h at 55°C
with 1 ml of TE buffer (10 mM Tris base, 1 mM EDTA) containing 100 µg of proteinase K (Sigma). After three 1-h washes with TE buffer, the
plugs were stored in TE buffer at 4°C. The plugs were digested with
20 U of restriction enzyme DraI, XbaI, or
SpeI (Boehringer, Mannheim, Germany) for 20 h at
37°C. They were then loaded into the wells of a 0.8% agarose gel in
45 mM Tris-borate, 1 mM EDTA (pH 8.0), and genomic DNA was separated by
PFGE at 4.5 V/cm for 21 h at 14°C with a Chef DRIII apparatus
(Bio-Rad, Ivry-sur-Seine, France). The pulse time was 5 to 50 s
with linear ramping. Lambda ladder PFGE I (Boehringer) was incorporated
as a size standard. The electrophoresis products were visualized by
ethidium bromide staining for 30 min.
DNA techniques.
For dot blotting and Southern hybridization,
DNA was immobilized on Nytran membranes (Schleicher & Schuell, Dassel,
Germany). Prehybridization and hybridization were carried out as
described previously (38). The
aac(6')-Iz-specific probe was obtained by amplification of a
367-bp fragment by PCR from plasmid DNA obtained from E. coli JM83/pAT680 with primers 5' TGTACCCGTGATCGCCA and
5' ACTGTCCGAAGCCAGTT deduced from the sequence shown in Fig. 1. PCR was performed in a DNA Thermal
Cycler 480 (Perkin-Elmer Cetus, Norwalk, Conn.) with primer annealing
at 55°C, as described previously (28). The 367-bp fragment
was separated by electrophoresis in low-temperature-gelling agarose
type VII (Sigma), extracted and purified with a Qiagen (Chatsworth,
Calif.) kit, and radiolabeled with [
-32P]dCTP with the
nick translation kit from Bethesda Research Laboratories Inc.
(Gaithersburg, Md.) as described previously (38). The cDNA of the 16S and 23S rRNA of E. coli MRE 600 (Boehringer) was
obtained with avian myeloblastosis virus reverse transcriptase
(Boehringer) and radiolabeled with [
-32P]dCTP
according to the recommendations of the manufacturer. The physical link
between aac(6')-Iz and the pdxH-like gene was
studied with primers C (5' AGCCAGATTGGCGCGTGG) and D
(5' TAGACGACCCGTTCGGTCTC) located in these genes,
respectively (Fig. 1), under PCR conditions similar to those indicated
above.

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FIG. 1.
Sequence of S. maltophilia aac(6')-Iz and
part of pdxH-like gene and predicted amino acid sequences.
The putative ribosome binding site (RBS) and potential 35 and 10
promoter sequences are underlined. The start and stop codons are
depicted in boldface, with the stop codons indicated by asterisks.
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DNA sequencing.
The 1.1-kb PstI fragment was
cloned into bacteriophage M13 derivatives (Boehringer) and sequenced by
the dideoxynucleotide chain terminator technique with synthetic
oligonucleotides and the Sequenase version 2.0 DNA-sequencing kit
(United States Biochemical Corp., Cleveland, Ohio) according to the
recommendations of the manufacturer. DNA fragments were resolved by
electrophoresis on 8% polyacrylamide gels containing 8 M urea.
Nucleotide and amino acid sequences were analyzed and compared by using
the GenBank, EMBL, and Swiss-Prot databases with the FASTA program
(Genetics Computer Group, Madison, Wis.).
Analysis of plasmid-encoded proteins.
The proteins specified
by the recombinant plasmids were synthesized in a coupled in vitro
transcription-translation system (50). The proteins were
labeled with L-[35S]methionine and processed
for electrophoresis in a sodium dodecyl sulfate-polyacrylamide gel as
described previously (38).
Enzymes and chemicals.
T4 DNA ligase was from Amersham
(Little Chalfont, Buckinghamshire, England), lysozyme was from Sigma
Chemical Co., and RNaseA (bovine pancreas) was from Calbiochem-Behring
(La Jolla, Calif.). [
-32P]dCTP,
[1-14C]acetyl coenzyme A, and [
-35S]dATP
(400 Ci/mmol) were obtained from the Radiochemical Centre, Amersham.
Antibiotics were provided by the following laboratories: amikacin,
ampicillin, and kanamycin B, Bristol-Myers Squibb (Princeton, N.J.);
tobramycin, Eli Lilly & Co. (Indianapolis, Ind.); gentamicin, gentamicins C1a, C1, and C2, isepamicin, netilmicin,
2'-N-ethylnetilmicin, and 6'-N-ethylnetilmicin,
Schering-Plough Research Institute (Kenilworth, N.J.); and nalidixic
acid, Sterling Winthrop (New York, N.Y.).
Nucleotide sequence accession number.
The nucleotide
sequence of aac(6')-Iz has been deposited in the GenBank
data library under accession no. AF140221.
 |
RESULTS AND DISCUSSION |
Aminoglycoside resistance of S. maltophilia
BM2690.
The MICs of aminoglycosides against S. maltophilia BM2690 indicated that amikacin, isepamicin,
netilmicin, and tobramycin were slightly less active against this
strain than gentamicin (Table 2). Similar
results were observed for most S. maltophilia strains (Table
3). The variability in aminoglycoside
MICs could be due to alterations in penetration of the antibiotics in
the cells, as has been observed in Pseudomonas spp.
Disk-agar diffusion tests indicated that the activity of
2'-N-ethylnetilmicin against S. maltophilia
BM2690 was diminished compared with that of
6'-N-ethylnetilmicin. These two compounds have
similar intrinsic activities against aminoglycoside-susceptible
strains, and the difference observed can be taken as evidence for
production of a 6'-N-acetyltransferase.
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TABLE 2.
MICs of various aminoglycosides against S. maltophilia BM2690 and E. coli JM83 with and without
the aac(6')-Iz gene
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Aminoglycoside-modifying enzyme in S. maltophilia BM2690.
Extracts of S. maltophilia BM2690 were shown to contain aminoglycoside
acetyltransferase activity. The substrate profile of the enzyme was
consistent with an AAC(6')-I, since amikacin, gentamicins C1a and C2,
isepamicin, kanamycin B, netilmicin, tobramycin, and 2'-N-ethylnetilmicin were modified whereas gentamicin C1 and
6'-N-ethylnetilmicin were not (data not shown).
Cloning and sequencing of the aac(6')-I gene.
Total DNA from BM2690 and pUC18 DNA were digested with PstI,
mixed, ligated, and introduced by transformation into E. coli JM83. Transformants selected on medium containing ampicillin
plus tobramycin were screened for their plasmid content by agarose gel
electrophoresis of crude bacterial lysates. The smallest recombinant plasmid, pAT680, contained a 1.1-kb PstI fragment that
conferred aminoglycoside resistance by synthesis of an AAC(6')-I.
Analysis of the insert in pAT680 revealed two open reading frames
(ORFs) homologous to sequences in the GenBank sequence library.
Nucleotides 1 to 393 were 69% identical to the 3' terminus of the
fprA gene, which encodes a putative pyridoxaminephosphate
oxidase in Myxococcus xanthus (18). Nucleotides
411 to 849 were 59% identical to the aac(6')-Ic gene of
S. marcescens. The search for stop codons indicated that the
aac(6')-Iz gene was included in an ORF located between the
TGA codons at coordinates 335 and 849 (Fig. 1). Two potential translation initiation codons, CTG and GTG, were located at positions 366 and 390, respectively, but neither was preceded by a typical ribosome binding site. This may account for the low-level
aminoglycoside resistance observed in E. coli JM83/pAT680
(Table 1). Promoter sequences were not readily apparent by analysis of
the region upstream from aac(6')-Iz; a putative promoter may
consist of
35 (TTGGCG) (position 149 to 154)
and
10 (TCGAAG) motifs separated by 17 nucleotides (the underlined nucleotides indicate identity with
the consensus
35 and
10 promoter elements recognized by the
E. coli
70 factor). It is also possible that
aac(6')-Iz and a pdxH-like gene form a single
transcription unit, similar to aacC3 and cysC in
Pseudomonas aeruginosa (44).
Analysis of the AAC(6')-Iz protein.
To confirm that the ORF
between nucleotides 335 and 849 encodes the AAC(6')-Iz protein, a
903-bp EcoRI-PstI fragment was subcloned into
pUC18, generating pAT681. The proteins specified by pUC18 and pAT681
were characterized in an E. coli in vitro coupled
transcription-translation system. A band of approximately 16,000 Da,
which should correspond to the resistance protein, was encoded by
pAT681 but not by the pUC18 control (data not shown). This apparent
molecular mass was in good agreement with the 16,506 Da calculated for
the predicted amino acid sequence. On the basis of sequence
relationships, three subfamilies of AAC(6') have been distinguished.
AAC(6')-Iz is a member of the major subfamily which contains AAC(6')-Ic
specific for S. marcescens (41) (46% identity);
AAC(6')-Id found in Klebsiella pneumoniae (39)
(42% identity); AAC(6')-If from Enterobacter cloacae (43) (45% identity); AAC(6')-Il from
Enterobacter aerogenes (4) (44% identity);
AAC(6')-Ih from Acinetobacter baumannii (23)
(42% identity); and AAC(6')-Ig, -Ij, -Ik, -Ir, -Is, -It, -Iu, -Iv,
-Iw, and -Ix specific for the various species of proteolytic Acinetobacter (22, 23, 34, 35) (42 to 46%
identity) (Fig. 2). The relatedness of
the major subfamily AAC(6')-I is shown in Fig.
3.

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FIG. 2.
Alignment of the deduced amino acid sequences of
AAC(6')-I. In addition to S. maltophilia AAC(6')-Iz, the
sequences are from S. marcescens [AAC(6')-Ic]
(41), K. pneumoniae [AAC(6')-Id]
(39), E. cloacae [AAC(6')-If] (43),
Acinetobacter haemolyticus [AAC(6')-Ig] (22),
A. baumannii [AAC(6')-Ih] (23),
Acinetobacter sp. 13 [AAC(6')-Ij] (23),
Acinetobacter sp. 6 [AAC(6')-Ik] (34), the
pBWH301 plasmid of E. aerogenes [AAC(6')-Il]
(4), Acinetobacter sp. 14 [AAC(6')-Ir]
(35), Acinetobacter sp. 15 [AAC(6')-Is]
(35), Acinetobacter sp. 16 [AAC(6')-It]
(35), Acinetobacter sp. 17 [AAC(6')-Iu]
(35), Acinetobacter ungrouped 631 [AAC(6')-Iv]
(35), Acinetobacter ungrouped 640 [AAC(6')-Iw]
(35), and Acinetobacter ungrouped BM2722
[AAC(6')-Ix] (35). The dashes indicate gaps introduced to
optimize sequence similarity. The alignments were derived with the
Clustal V program (19). Identical amino acids are indicated
by asterisks. The dots indicate conservative amino acid substitutions
corresponding to the following exchange groups: A, G, P, S, and T; H,
K, and R; F, W, and Y; D, E, N, and Q; I, L, M, and V; and C
(11).
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FIG. 3.
Phylogenetic tree of the major subfamily AAC(6')-I
constructed with the Phylip computer program package (15) by
the neighbor-joining method (37). The topology of the tree
was compared to that obtained by the maximum-parsimony method
(16). The numbers shown next to the nodes indicate percent
bootstrap values of the 100 replicates (14). The line below
the alignment indicates the distances that corresponds to approximately
5% divergence. In addition to S. maltophilia AAC(6')-Iz,
proteins are from S. marcescens [AAC(6')-Ic]
(41), K. pneumoniae [AAC(6')-Id]
(39), E. cloacae [AAC(6')-If] (43),
Acinetobacter haemolyticus [AAC(6')-Ig] (22),
A. baumannii [AAC(6')-Ih] (23),
Acinetobacter sp. 13 [AAC(6')-Ij] (23),
Acinetobacter sp. 6 [AAC(6')-Ik] (34), the
pBWH301 plasmid of E. aerogenes [AAC(6')-Il]
(4), Acinetobacter sp. 14 [AAC(6')-Ir]
(35), Acinetobacter sp. 15 [AAC(6')-Is]
(35), Acinetobacter sp. 16 [AAC(6')-It]
(35), Acinetobacter sp. 17 [AAC(6')-Iu]
(35), Acinetobacter ungrouped 631 [AAC(6')-Iv]
(35), Acinetobacter ungrouped 640 [AAC(6')-Iw]
(35), and Acinetobacter ungrouped BM2722
[AAC(6')-Ix] (35).
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Analysis of the protein deduced from the second ORF.
The
deduced C-terminal portion of the putative protein encoded by the
truncated DNA sequence upstream from the aac(6')-Iz gene had
homology with pyridoxine (pyridoxamine) 5'-phosphate oxidase proteins
found in M. xanthus (18) (61% identity),
Saccharomyces cerevisiae (24) (43% identity),
and E. coli (21) (39% identity). It is likely
that this DNA corresponds to the analogous gene in S. maltophilia. Pyridoxine (pyridoxamine) 5'-phosphate oxidase is a
key enzyme in biosynthesis of the essential coenzyme pyridoxal 5'-phosphate, which participates in many aspects of amino acid metabolism. The fact that, in S. maltophilia BM2690,
aac(6')-Iz was adjacent to a gene involved in essential host
metabolism strongly suggests a chromosomal location for that gene.
Furthermore, the G+C content of the aac(6')-Iz was 69%
similar to that of S. maltophilia, in agreement with an
indigenous origin of this gene.
Distribution and location of the aac(6')-Iz gene.
Total DNA from 80 S. maltophilia strains was spotted on a
Nytran membrane and hybridized with an intragenic aac(6')-Iz
probe. The gene was found to be present in all the strains (data not shown). To determine the location of the aac(6')-Iz gene,
PFGE was performed with total DNA of S. maltophilia BM2690
and ATCC 13637 digested with XbaI, DraI, and
SpeI. The fragments were transferred to Nytran membranes and
hybridized successively with an rRNA and an aac(6')-Iz probe
(Fig. 4). The aac(6')-Iz gene
was located in a ca. 510-kb XbaI fragment in S. maltophilia BM2690 and in a ca. 680-kb SpeI fragment in
S. maltophilia ATCC 13637 which cohybridized with the rRNA
probe. These results confirmed that the aac(6')-Iz gene was
located in the chromosome of S. maltophilia. In addition,
the adjacent location of aac(6')-Iz and pdxH-like genes in the remaining strains of S. maltophilia was
demonstrated by amplification of a 676-bp fragment with primers C,
specific for pdxH, and D, specific for aac(6')-Iz
(data not shown).

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FIG. 4.
Analysis of total DNA by PFGE (A) and by hybridization
with probes made from aac(6')-Iz (B) and rRNA (C). Total DNA
was digested with XbaI, DraI, or SpeI,
and the resulting fragments were separated by PFGE, transferred to a
Nytran filter, and hybridized with the 32P-labeled probes.
Lanes: 1, PFGE I ladder (Boehringer Mannheim); 2, 3, and 4, S. maltophilia BM2690 digested with XbaI, DraI,
and SpeI, respectively; 5, 6, and 7, S. maltophilia ATCC 13637 digested with XbaI,
DraI, and SpeI, respectively. The arrowheads
indicate the S. maltophilia ATCC 13637 fragment containing
the aac(6')-Iz which hybridized with the rRNA probe. The
lack of DraI fragments hybridizing with the rRNA probe was
due to their migration out of the gel.
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Conclusions.
Like S. marcescens (41),
E. faecium (6), and the various species of
proteolytic Acinetobacter (35), S. maltophilia harbors a "housekeeping" aac(6')-I.
This gene, probably weakly expressed, contributes to aminoglycoside
resistance in this species as indicated by the slight difference in
susceptibility to gentamicin and to the other aminoglycosides (Table
3). The origin of aminoglycoside resistance genes is still a matter of
controversy (33). A possibility is that they derive from
antibiotic-producing microorganisms in which they are required for
self-protection against the toxic aminoglycosides (3, 7,
10). Alternatively, they could derive from housekeeping genes
involved either in cellular metabolism or in peptidoglycan or
lipopolysaccharide metabolism (27). These two hypotheses are
not mutually exclusive, and there are strong arguments in favor of each
proposal, depending on the bacterial species considered. It has been
established that the resident AAC(2')-Ia in Providencia
stuartii can O-acetylate peptidoglycan (27, 32), and a
similar function for the AAC(2')-Id of Mycobacterium segmatis is possible (1). The functional role, if any,
of AAC(6')-Iz in S. maltophilia remains unknown.
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ACKNOWLEDGMENTS |
This work was supported by a grant from the Association
Française de Lutte contre la Mucoviscidose and by a Bristol-Myers Squibb Unrestricted Biomedical Grant in Infectious Diseases.
We thank E. Bingen for the gift of strains.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Unité des
Agents Antibactériens, 28 rue du Docteur Roux, Institut Pasteur,
75724 Paris Cedex15, France. Phone: (33) (1) 45 68 83 21. Fax: (33) (1)
45 68 83 19. E-mail: tlambert{at}pasteur.fr.
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Antimicrobial Agents and Chemotherapy, October 1999, p. 2366-2371, Vol. 43, No. 10
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