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Contents Title I Contents II Declaration XI Dedication XII Acknowledgments XIII Poster Presentation XIV Index of Tables XV Index of Figures XIX Abbreviations XXVI Abstract XXX Chapter 1: Introduction 1 1.1 Antimicrobial Resistance: 2 1.2 Extended Spectrum Beta-Lactamases (ESBLs): 3 1.2.1 Classification of ESBL: 4 1.2.1.1 Functional Classification: 4 1.2.1.2 Molecular Classification: 4 1.2.2 Types of ESBL: 5 1.2.2.1 TEM-type ESBLs (class A) 5 1.2.2.2 SHV-type ESBLs (class A) 1.2.2.3 CTX-M type ESBLs (class A): 6 1.2.2.4 OXA-type ESBLs (class D) 7 1.2.2. 5 AmpC-type ESBLs (class C) 7 1.2.2.6 Carbapenemases (class A, B, D) 8 2 6
1.2.3 Emergence of ESBL: 9 1.2.4 Risk factor for ESBL: 9 1.2.5 Treatment of ESBLs: 10 1.3 Acinetobacter: 10 1.3.1 Taxonomy and Historical Features of Acinetobacter: 11 1.3.2 Laboratory Diagnosis: 12 1.3.3 Clinical features of Acinetobacter infections: 12 1.3.4 Pathogenesis of Acinetobacter infection: 14 1.3.4.1 The production of exopolysaccharide: 15 1.3.4.2 Quorum-sensing: 15 1.3.4.3 The property of adhesion to human epithelial cells via the capsule or fimbriae. 1.3.4.4 Surface and mitochondrial porins: 16 1.3.5 Emergence of Resistance: 17 1.3.6 Carbapenem action on Acinetobacter: 18 1.3.7 Mechanisms of Carbapenem Resistance: 18 1.3.8 Acinetobatcer Treatment with Honey: 20 1.4 Alternative Antimicrobial Therapies: 21 1.4.1 Ancient Use of Honey as a Medicine: 22 1.4.2 Honey as a Modern Medicine: 22 1.4.3 Antimicrobial Activity of Honey: 24 1.4.4 Chemical composition of honey: 26 3 15
Page 1: Honey as an antimicrobial agent aga
Page 5 and 6: 2.2.1 Honey sample collection: 51 2
Page 7 and 8: 2.5 Effect of honey on bacterial st
Page 9 and 10: viable count 3.4.2.1 Acinetobacter
Page 11 and 12: Declaration This work has not previ
Page 13 and 14: Acknowledgments I wish to express m
Page 15 and 16: Index of Tables Tables Title Page T
Page 17 and 18: Index of Tables (Continued) Tables
Page 19 and 20: Index of Figures Figure Title Page
Page 21 and 22: Index of Figures (Continued) Figure
Page 27 and 28: ESBL- Extended spectrum beta lactam
Page 29 and 30: TEM- Temoneira UTI- Urinary tract i
Page 31 and 32: Chapter 1 Introduction 31
Page 33 and 34: such as methicillin resistant Staph
Page 35 and 36: Beta-lactamases in this classificat
Page 37 and 38: cefotaxime faster than ceftazidime;
Page 39 and 40: 1.2.3 Emergence of ESBL: The produc
Page 41 and 42: Acinetobacter spp are widespread in
Page 43 and 44: many secretions of normal people an
Page 45 and 46: 1.3.4.1 The production of exopolysa
Page 47 and 48: 1.3.5 Emergence of Resistance: A.ba
Page 49 and 50: In the last few years resistant str
Page 51 and 52: More recently, a study was carried
Page 53 and 54:
Gideonsen 2005), malignant ulcers (
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Nezeako & Hamdi, (2000) tested six
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In addition, honey contains several
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with the help of an enzyme (glucose
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(Wahdan 1998), and vanillic acid, c
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Table 1.2: Comparisons between pero
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Another study compared the effectiv
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of raw honey samples from Acacia, h
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1.5 Aims and Objectives: The aim of
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The materials used throughout this
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Table 2.3: Chemicals and Reagents u
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Table 2.5: Equipment used in electr
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Fifty five clinical isolates belong
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2.1 Characterization of test organi
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2.2 Characterization of honey sampl
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transfered into a large square assa
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2.2.3 Determination of pH: This met
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once the tubing opened at one end a
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was re-suspended in 1 ml liquefied
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difference between this absorbance
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and Omani honey (B) with hydrogen p
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2.3.1.2 Broth dilution method: 2.3.
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2.4 Time Kill Curve Assay: 2.4.1 St
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2.5.1.2 Preparation of cells in the
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2.5.2.2 Preparation of cells for tr
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Table 2.14: Reagents and buffers us
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samples (Fig 2.3). Each sample was
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tray was covered and wrapped in sar
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Chapter 3 Results 109
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Table 3.1a: Identification and anti
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Table 3.2: Confirmation of identity
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Page 117 and 118:
Page 119 and 120:
The diameter of the zones of inhibi
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Table 3.7: Antibacterial activity o
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with visual estimation. The colour
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Figure 3.3: Image of pollen present
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3.3 Determination of antibacterial
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3.3.1.2 Broth dilution method: The
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The MIC range of 30 Acinetobacter i
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Mean MIC and MBC (%w/v) values of m
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Table 3.15: Susceptibility of 15 En
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3.3.2 Sensitivity of MDR and ESBLs
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Table 3.18: Susceptibility of 11 Kl
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Table 3.20: Susceptibility of 15 En
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Table 3.22: Susceptibility of 8 Ser
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3.4 Time Kill Curves One representa
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Figure 3.6: The effect of manuka ho
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3.4.2 Inhibition of test organisms
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This data was done in triplicate Nu
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This data was done in triplicate Fi
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Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Figure 3.15: The effect of manuka h
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All isolates showed statistically s
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Figure 3.16: Growth curve of Acinet
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Figure 3.20: Growth curve of Citrob
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(Table 3.26). The length of individ
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Figure 3.24: SEM micrograph of untr
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Figure 3.28: SEM micrographs of unt
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C D Cell division Multiple septa in
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Figure 3.31: SEM micrographs of Aci
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3.5.2.3 SEM of Klebsiella Klebsiell
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Page 185 and 186:
Figure 3.39: SEM micrographs of Kle
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Figure 3.40: SEM micrographs of Kle
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C D 189
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3.5.2.5 SEM of Citrobacter For Citr
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Figure 3.47: SEM micrographs of Cit
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Figure 3.49: SEM micrographs of Cit
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Table 3.26: Comparison of changes i
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Figure 3.54: Transmission micrograp
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3.5.2.2. TEM for E.coli: TEM images
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Page 213 and 214:
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Figure 3.62: 2-D protein electropho
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“The therapeutic potential of unc
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Non-peroxide honey shown to be effe
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Sugars are the major content of hon
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Acacia (thorn trees), Myrtacae euca
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major wound pathogens, consistently
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MIC % (w/v) Previous studies MIC %
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Figure 4.3: Mean MIC and MBC (%w/v)
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4.4 Inhibition of test organisms by
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honey chemistry. Nevertheless, obse
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In TEM, the cell membrane was inter
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with more than (3-log10 reduction).
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To date there is little research on
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The effect of defensin peptide was
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4.6 Further investigations: There i
Page 245 and 246:
Chapter 5 References 245
Page 247 and 248:
� Al-Jabri, A. A., Nzeako, B. C.,
Page 249 and 250:
� Bang, L. M., Buntting, C. and M
Page 251 and 252:
� Bou, G., Oliver, A. and Martine
Page 253 and 254:
� Cooper, R. (2005) The Antimicro
Page 255 and 256:
� Efem, S. E., Udoh, K. T. and Iw
Page 257 and 258:
� Greenwood, D., Finch, P., Davey
Page 259 and 260:
� Kagan, B.L., Ganz, T. and Lehre
Page 261 and 262:
esistant Staphylococcus aureus (CA-
Page 263 and 264:
� Murray, P. R., Baron, E. J., Jo
Page 265 and 266:
� Scholar, E. M. and Pratt, W. B.
Page 267 and 268:
� Subrahmanyam, M. (1998) A prosp
Page 269 and 270:
� Wadi, M., Al-Amin, H., Farouq,
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