StepWise USMLE
Microbiology

Bacterial genetics & antimicrobial resistance

Genetic elements, gene transfer, resistance and susceptibility testing

🧬 Genetic Elements

Chromosome

  • Usually one copy-type circular molecule
    • Covalently closed
    • Often several copies per cell
  • Supercoiled into loops around a protein core
  • Single-strand nick relaxes only one loop
  • About 2,000 genes
  • Carries every essential gene

Plasmid

  • Extrachromosomal, circular, small (1.5–400 kb)
  • Replicates independently
  • Carries nonessential genes
    • Fertility (tra) genes
    • Antibiotic resistance genes
    • Most exotoxin genes
  • Episome = plasmid able to integrate into the chromosome
    • Needs matching insertion sequences

Prophage

  • Repressed temperate phage DNA inside the chromosome
  • May encode virulence proteins
  • Virulence gain by prophage = lysogenic conversion
High-yield
  • Essential genes live on the chromosome, never on plasmids.
  • Toxin and resistance genes commonly ride on plasmids or prophages.

πŸ”€ Recombination Types

Why recombination is needed

  • Binary fission gives identical daughters
    • Only de novo mutation changes them
  • Incoming DNA must be stabilized
    • Linear fragment (exogenote) is degraded by exonucleases
    • Stabilized by integration or by re-forming a circular plasmid
FeatureHomologousSite-specific
Sequence matchExtensive homology requiredOnly a short attachment site
OutcomeExchange of segmentsWhole molecule inserted (sum of both)
Key factorsrecA (essential), recB, recC, recDSpecific integration enzymes at sites
Fate of leftoverDisplaced linear piece is lostNothing lost
ExamplesStabilizing transformed or transduced DNAHfr formation, prophage insertion, transposition
Exam trap
  • recA-deficient cells cannot stabilize linear exogenotes.
  • Transposition is a form of site-specific integration.

🧫 Transformation & Conjugation

Transformation Uptake of naked DNA

Cell dies→Free DNA released→Competent cell binds fragment→Uptake→recA integration
  • Naturally competent genera
    • Haemophilus influenzae
    • Streptococcus pneumoniae
    • Bacillus
    • Neisseria
  • Classic outcome: rough, unencapsulated pneumococcus becomes smooth and virulent

Conjugation Direct contact, one strand moves

  • Donor carries fertility (F) factor
    • tra region: sex pilus, pair stabilization, DNA transfer genes
    • oriT: site of the nick where transfer starts
  • Recipient (Fβˆ’) lacks the F factor
  • Transfer is one-way, donor to recipient
  • Donor copy is re-synthesized, so donor genotype is unchanged
CrossF factor stateWhat movesRecipient result
F+ Γ— Fβˆ’Free plasmidWhole plasmid (oriT first, tra last)Becomes F+; no chromosomal genes; no recombination needed
Hfr Γ— Fβˆ’Integrated (episome)oriT, part of F, then adjacent chromosome genesStays Fβˆ’; gains a few chromosomal genes; needs recombination

Hfr details

  • Genes nearest the integration site transfer most often
  • Full chromosome transfer takes about 2 hours
  • Mating bridge usually breaks early
    • tra end is almost never transferred
  • So recipient does not become Hfr
High-yield
  • F+ Γ— Fβˆ’ converts the recipient; Hfr Γ— Fβˆ’ does not.
  • Gene transfer order maps linear gene position.

🦠 Phages & Transduction

Virulent

  • Lytic cycle only
  • Attach β†’ inject DNA β†’ make early proteins β†’ copy DNA β†’ make structural proteins β†’ assemble β†’ lyse

Temperate

  • Can choose lysis or lysogeny
  • Repressor wins early β†’ prophage
  • Repressor loss β†’ lytic cycle

Lysogeny

  • Prophage copies with each host division
  • Persists while repressor is functional
  • Defective prophage needs a helper phage to replicate
  • Lambda phage in E. coli
    • Single insertion site, between gal and bio
    • att sites mediate integration
  • Model for retroviral provirus

Induction

UV / alkylating damage→Repressor damaged→Prophage excised→Lytic cycle
  • Usually precise excision gives normal phage
  • Rare imprecise excision gives a transducing phage

Transduction types

GeneralizedSpecialized
Phage typeLytic cycle (virulent or temperate)Temperate, lysogenic
ErrorBacterial DNA packaged by mistakeFaulty excision takes neighboring genes
Genes movedAny bacterial geneOnly genes beside the insertion site (gal or bio for lambda)
Prophage neededNoYes
StabilizationHomologous recombinationHomologous recombination

Phage-linked virulence (lysogenic conversion)

BacteriumPhage-encoded factor
Corynebacterium diphtheriaeDiphtheria toxin
Clostridium botulinumBotulinum toxin
Vibrio choleraeCholera toxin
Streptococcus pyogenesPyrogenic (erythrogenic) toxins
E. coli (EHEC) / ShigellaShiga-type toxin
SalmonellaAltered O antigen

βš–οΈ Transfer Mechanisms Compared

QuestionTransformationConjugationTransduction
Cell contact neededNoYesNo
Phage involvedNoNoYes
Competence neededYesNoNo
Naked DNAYesNoNo
Recombination to stabilizeYesF+: no; Hfr: yesYes
Exam traps
  • Only conjugation needs pili and oriT.
  • Only transduction needs a phage vector.
  • Only transformation needs free DNA and competence.

πŸ’Š Drug Resistance

TypeGenetic locationTypical mechanismLevel
IntrinsicInherent biologyTarget absent or unreachableβ€”
ChromosomalChromosomeAltered drug targetUsually low
Plasmid-mediatedR plasmidDrug-modifying enzymes, efflux, target changeOften high; transferable

Intrinsic examples

  • No mycolic acid β†’ isoniazid ineffective
  • No peptidoglycan (Mycoplasma) β†’ penicillin ineffective

R plasmids

  • R factor = RTF + R determinant
    • RTF: oriT and tra genes, conjugation machinery
    • R determinant: resistance genes
  • Multidrug plasmids assemble through transposons and gene cassettes
    • Mobile DNA, encodes transposase
    • Insertion can disrupt unrelated genes
    • Found in bacteria, eukaryotes, viruses

Mechanisms by drug class

DrugResistance mechanism
Penicillins, cephalosporinsΞ²-lactamase cleaves ring (plasmid); altered PBPs (chromosome)
Methicillin (MRSA)Mutated penicillin-binding protein
AminoglycosidesAcetyl-, adenylyl-, phosphotransferases; reduced uptake
ChloramphenicolAcetyltransferase
TetracyclinesEfflux; ribosome-protecting protein
SulfonamidesExport; low-affinity enzyme
VancomycinCell wall precursor ends in D-Ala–D-lactate (vanA, vanB); thicker wall in VISA
Macrolides, lincosamides23S rRNA methylation; efflux; esterases
FluoroquinolonesMutant topoisomerase; efflux
RifampinMutant RNA polymerase
IsoniazidLoss of catalase-peroxidase activation
EthambutolMutant arabinosyl transferase
Trimethoprim / sulfonamideAltered DHFR / altered dihydropteroate synthase
High-yield
  • vanA and vanB moved from Enterococcus to Staphylococcus aureus (VRSA).
  • ESBLs can be missed by routine susceptibility tests.
  • Gram-negative Ξ²-lactamases act in the periplasm.

πŸ”¬ Susceptibility Testing

Disk diffusion

Lawn of isolate→Drug disks placed→Diffusion gradient→Measure inhibition zone
  • Result: susceptible, intermediate, or resistant
  • Pros: cheap, simple, many drugs per plate
  • Con: qualitative only

MIC vs MBC

MICMBC
MeasuresGrowth inhibitionKilling
MethodSerial drug dilutions plus fixed inoculumSubculture MIC tubes onto drug-free agar
EndpointLowest concentration with no visible growthLowest concentration with no regrowth
ControlDrug-free tube confirms viable inoculumβ€”
UseRoutineOrdered selectively
  • MBC matters when host immunity cannot clear inhibited bacteria
    • Immunocompromised patients
  • MBC is equal to or above MIC
Exam trap
  • A lower MIC does not by itself prove bactericidal action.

⭐ Rapid Review

Conjugation

  • Needs pilus and oriT
  • Donor genotype unchanged
  • F+ cross makes new F+
  • Hfr cross leaves Fβˆ’

Transformation

  • Free DNA, competent cells
  • Pneumococcus, Haemophilus, Neisseria, Bacillus

Transduction

  • Phage is the vehicle
  • Generalized: any gene
  • Specialized: neighbors of prophage

Resistance

  • Plasmids spread it horizontally
  • Transposons assemble multidrug plasmids
  • Chromosomal changes mostly alter targets
Clinical pearl
  • Phage-encoded toxins explain why only some strains of a species cause toxin disease.