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Kang Y, Chen S, Zheng B, Du X, Li Z, Tan Z, Zhou H, Huang J, Tian L, Zhong J, Ma X, Li F, Yao J, Wang Y, Zheng M, Li Z. Epidemiological Investigation of Hospital Transmission of Corynebacterium striatum Infection by Core Genome Multilocus Sequence Typing Approach. Microbiol Spectr 2023; 11:e0149022. [PMID: 36537812 PMCID: PMC9927548 DOI: 10.1128/spectrum.01490-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
Corynebacterium striatum has recently received increasing attention due to its multiple antimicrobial resistances and its role as an invasive infection/outbreak agent. Recently, whole-genome sequencing (WGS)-based core genome multilocus sequence typing (cgMLST) has been used in epidemiological studies of specific human pathogens. However, this method has not been reported in studies of C. striatum. In this work, we aim to propose a cgMLST scheme for C. striatum. All publicly available C. striatum genomes, 30 C. striatum strains isolated from the same hospital, and 1 epidemiologically unrelated outgroup C. striatum strain were used to establish a cgMLST scheme targeting 1,795 genes (hereinafter referred to as 1,795-cgMLST). The genotyping results of cgMLST showed good congruence with core genome-based single-nucleotide polymorphism typing in terms of tree topology. In addition, the cgMLST provided a greater discrimination than the MLST method based on 6 housekeeping genes (gyrA, gyrB, hsp65, rpoB, secA1, and sodA). We established a clonal group (CG) threshold based on 104 allelic differences; a total of 56 CGs were identified from among 263 C. striatum strains. We also defined an outbreak threshold based on seven allelic differences that is capable of identifying closely related isolates that could give clues on hospital transmission. According to the results of analysis of drug-resistant genes and virulence genes, we identified CG4, CG5, CG26, CG28, and CG55 as potentially hypervirulent and multidrug-resistant CGs of C. striatum. This study provides valuable genomic epidemiological data on the diversity, resistance, and virulence profiles of this potentially pathogenic microorganism. IMPORTANCE Recently, WGS of many human and animal pathogens has been successfully used to investigate microbial outbreaks. The cgMLST schema are powerful genotyping tools that can be used to investigate potential epidemics and provide classification of the strains precise and reliable. In this study, we proposed the development of a cgMLST typing scheme for C. striatum, and then we evaluated this scheme for its applicability to hospital transmission investigations. This report describes the first cgMLST schema for C. striatum. The analysis of hospital transmission of C. striatum based on cgMLST methods has important clinical epidemiological significance for improving nosocomial infection monitoring of C. striatum and in-depth understanding of its nosocomial transmission routes.
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Affiliation(s)
- Yutong Kang
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shenglin Chen
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Beijia Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Clinical Laboratory, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Xiaoli Du
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenpeng Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhizhou Tan
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jia Huang
- Institute for the Prevention and Control of Infectious Diseases, Xinjiang Center for Disease Control and Prevention, Urumqi, Xinjiang, China
| | - Leihao Tian
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiaxin Zhong
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xueli Ma
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Fang Li
- Department of Medicine, Tibet University, Lhasa, Tibet, China
| | - Jiang Yao
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Wang
- Department of Clinical Laboratory Medicine, Shanxi Bethune Hospital & Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Meiqin Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Jesus HNR, Ramos JN, Rocha DJPG, Alves DA, Silva CS, Cruz JVO, Vieira VV, Souza C, Santos LS, Navas J, Ramos RTJ, Azevedo V, Aguiar ERGR, Mattos-Guaraldi AL, Pacheco LGC. The pan-genome of the emerging multidrug-resistant pathogen Corynebacterium striatum. Funct Integr Genomics 2022; 23:5. [PMID: 36534203 DOI: 10.1007/s10142-022-00932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/06/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Corynebacterium striatum, a common constituent of the human skin microbiome, is now considered an emerging multidrug-resistant pathogen of immunocompromised and chronically ill patients. However, little is known about the molecular mechanisms in the transition from colonization to the multidrug-resistant (MDR) invasive phenotype in clinical isolates. This study performed a comprehensive pan-genomic analysis of C. striatum, including isolates from "normal skin microbiome" and from MDR infections, to gain insights into genetic factors contributing to pathogenicity and multidrug resistance in this species. For this, three novel genome sequences were obtained from clinical isolates of C. striatum of patients from Brazil, and other 24 complete or draft C. striatum genomes were retrieved from GenBank, including the ATCC6940 isolate from the Human Microbiome Project. Analysis of C. striatum strains demonstrated the presence of an open pan-genome (α = 0.852803) containing 3816 gene families, including 15 antimicrobial resistance (AMR) genes and 32 putative virulence factors. The core and accessory genomes included 1297 and 1307 genes, respectively. The identified AMR genes are primarily associated with resistance to aminoglycosides and tetracyclines. Of these, 66.6% are present in genomic islands, and four AMR genes, including aac(6')-ib7, are located in a class 1-integron. In conclusion, our data indicated that C. striatum possesses genomic characteristics favorable to the invasive phenotype, with high genomic plasticity, a robust genetic arsenal for iron acquisition, and important virulence determinants and AMR genes present in mobile genetic elements.
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Affiliation(s)
- Hendor N R Jesus
- Multicenter Post-Graduate Program in Biochemistry and Molecular Biology (PMBqBM), Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Juliana N Ramos
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Danilo J P G Rocha
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Daniele A Alves
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil.,Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina S Silva
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - João V O Cruz
- Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil
| | - Verônica V Vieira
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brazil
| | - Cassius Souza
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Louisy S Santos
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Jesus Navas
- Cantabria University, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Rommel T J Ramos
- Institute of Biological Sciences, Federal University of Para, Belem, PA, Brazil.,Biological Engineering Laboratory, Science and Technology Park Guama, Belem, PA, Brazil
| | - Vasco Azevedo
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Eric R G R Aguiar
- Department of Biological Sciences, State University of Santa Cruz, Ilhéus, BA, Brazil
| | - Ana L Mattos-Guaraldi
- Laboratory of Diphtheria and Corinebacteria of Clinical Relevance, School of Medical Sciences, Rio de Janeiro State University - LDCIC/FCM/UERJ, Rio de Janeiro, RJ, Brazil
| | - Luis G C Pacheco
- Multicenter Post-Graduate Program in Biochemistry and Molecular Biology (PMBqBM), Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil. .,Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil.
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Fujikawa T, Tanimoto K, Kawashima Y, Ito T, Honda K, Takeda T, Sonobe A, Aoki N, Bai J, Tsutsumi T. Cholesteatoma has an altered microbiota with a higher abundance of Staphylococcus species. Laryngoscope Investig Otolaryngol 2022; 7:2011-2019. [PMID: 36544934 PMCID: PMC9764795 DOI: 10.1002/lio2.934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To compare the microbiota between cholesteatoma and chronic suppurative otitis media (COM) and to identify potential pathogens that explain the relevant phenotypes of cholesteatoma. Study Design Prospective cohort study. Methods Surgical specimens collected from 20 cholesteatomas and nine COMs were treated to dissolve biofilms and subjected to 16S ribosomal RNA (rRNA) gene sequencing and amplicon sequence variant-level analysis for microbiota profiling and quantitative comparison. Correlations between the relative abundance of potential pathogens and the volume of the primary resected cholesteatomas were examined. Results Differences in bacterial composition (beta diversity) were observed between cholesteatomas and COM (p = .002), with a higher abundance of Staphylococcus in cholesteatomas than in COM (p = .005). Common genera in the external auditory canal (EAC) flora, such as Staphylococcus, Corynebacterium, and Cutibacterium, were predominant in both cholesteatoma and COM; Staphylococcus aureus and Pseudomonas aeruginosa were increased in both diseases compared with the EAC flora. Furthermore, coagulase-negative staphylococci (CoNS) were more abundant in cholesteatomas than in COM (p = 0.002). Linear discriminant analysis coupled with effect size measurements (LEfSe) identified four CoNS as potential biomarkers for cholesteatoma. The relative abundance of S. aureus, a potential pathogen, was positively correlated with cholesteatoma volume (r = .60, p = .02). Conclusion The microbiota of cholesteatoma and COM originated from EAC flora, but the bacterial composition was largely altered. Our results suggested that S. aureus infection is involved in cholesteatoma progression. Level of Evidence 3b.
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Affiliation(s)
- Taro Fujikawa
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Kousuke Tanimoto
- Genome Laboratory, Medical Research InstituteTokyo Medical and Dental UniversityTokyoJapan
| | | | - Taku Ito
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Keiji Honda
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takamori Takeda
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Akane Sonobe
- Genome Laboratory, Medical Research InstituteTokyo Medical and Dental UniversityTokyoJapan
| | - Natsuki Aoki
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Jing Bai
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
| | - Takeshi Tsutsumi
- Department of OtolaryngologyTokyo Medical and Dental UniversityTokyoJapan
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Marino A, Campanella E, Stracquadanio S, Ceccarelli M, Zagami A, Nunnari G, Cacopardo B. Corynebacterium striatum Bacteremia during SARS-CoV2 Infection: Case Report, Literature Review, and Clinical Considerations. Infect Dis Rep 2022; 14:383-390. [PMID: 35645221 PMCID: PMC9149851 DOI: 10.3390/idr14030042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
Bacterial infections, especially those in hospital settings, represent a major complication of COVID-19 patients, complicating management and worsening clinical outcomes. Corynebacterium striatum is a non-diphtheric actinobacterium that has been reported as being the causative agent of several different infections, affecting both immunocompetent and immunocompromised patients. Recently, C. striatum has been recognized as a nosocomial pathogen that is responsible for severe infection in critical patients, as well as in fragile and immunocompromised subjects. C. striatum has been described as the etiological agent of bacteremia, central line infections, and endocarditis. We report a case of a 91-year-old woman who was hospitalized due to SARS-CoV-2 infection, who developed C. striatum bacteremia and died despite antimicrobial therapy and clinical efforts. Furthermore, we discuss C. striatum diagnosis and treatment based on evidence from the scientific literature.
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Affiliation(s)
- Andrea Marino
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
| | - Edoardo Campanella
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, 98124 Messina, Italy; (E.C.); (G.N.)
| | - Stefano Stracquadanio
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
| | - Aldo Zagami
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, 98124 Messina, Italy; (E.C.); (G.N.)
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, 95122 Catani, Italy; (M.C.); (A.Z.); (B.C.)
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Kharseeva GG, Mangutov EO, Alutina EL, But OM, Pakhomova AE. Etiological significance of Corynebacterium spp. in the development of diseases of the respiratory tract. Klin Lab Diagn 2021; 66:673-677. [PMID: 34882352 DOI: 10.51620/0869-2084-2021-66-11-673-677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Corynebacterium spp. It is associated with inflammatory diseases of the respiratory tract (tracheitis, pharyngitis, rhinosinusitis, bronchitis, pneumonia, etc.). C. pseudodiphtheriticum can be the causative agent of bacterial coinfection in patients with a new coronavirus infection (COVID-19). The aim is to determine the pathogenic properties and resistance to antimicrobial drugs of Corynebacterium spp. strains to establish their etiological significance in the development of inflammatory diseases of the respiratory tract. Strains of Corynebacterium spp. isolated from patients with inflammatory diseases of the respiratory tract (43 pcs.) and practically healthy individuals (29 pcs.). Isolates were identified by mass spectrometric method (MALDI-TOF MS), their cytopathic effect in CHO-K1 cell culture, hemolytic, urease activity, antimicrobial drug resistance were determined. Strains of Corynebacterium spp. isolated from patients in the amount of 105 CFU/ml or more, practically healthy - 104 CFU/ml or less. Isolates of Corynebacterium spp. patients had a more pronounced cytopathic effect (83.7±11.1%) and were more often resistant to antimicrobial drugs than those isolated from practically healthy. To establish the etiological significance of Corynebacterium spp. isolates. in the development of inflammatory diseases of the respiratory tract, it is advisable to determine their amount in biological material (105 CFU/ml or more), the cytopathic effect on CHO-K1 cell culture, as well as the presence of multiple resistance to antimicrobial drugs. Differences in the characteristics of Corynebacterium spp. isolates. from patients with respiratory tract pathology and practically healthy individuals are associated with the strain, not the species, of corynebacteria.
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Affiliation(s)
- Galina G Kharseeva
- Federal State Educational Institution of Higher Education «Rostov State Medical University» Ministry of Health of Russia
| | - E O Mangutov
- Federal State Educational Institution of Higher Education «Rostov State Medical University» Ministry of Health of Russia
| | - E L Alutina
- Federal State Educational Institution of Higher Education «Rostov State Medical University» Ministry of Health of Russia
| | - O M But
- Municipal budgetary health care institution, «City hospital № 20 of Rostov-on-Don»
| | - A E Pakhomova
- Federal State Educational Institution of Higher Education «Rostov State Medical University» Ministry of Health of Russia
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Yamamuro R, Hosokawa N, Otsuka Y, Osawa R. Clinical Characteristics of Corynebacterium Bacteremia Caused by Different Species, Japan, 2014-2020. Emerg Infect Dis 2021; 27. [PMID: 34812137 PMCID: PMC8632174 DOI: 10.3201/eid2712.210473] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Corynebacterium bacteremia is most commonly caused by C. striatum or C. jeikeium. To determine differences in clinical characteristics of patients with bacteremia caused by Corynebacterium striatum, C. jeikeium, and other species of Corynebacterium, we retrospectively reviewed medical records of patients in Japan who had Corynebacterium bacteremia during January 2014–May 2020. Of the 115 records evaluated, 60 (52%) were cases of true bacteremia and 55 (48%) were cases of contamination. Proportions of true bacteremia cases caused by C. striatum (70%) and by C. jeikeium (71%) were significantly higher than those caused by other species of Corynebacterium (9%). These 2 organisms were commonly detected in blood cultures of patients with hematologic malignancies and neutropenia. The mortality rates at 90 days were 34% (C. striatum), 30% (C. jeikeium), and 0 (other species). Given the high mortality rates, assessing true bacteremia when C. striatum or C. jeikeium is detected in blood cultures, especially in patients with hematologic malignancy, is warranted.
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Wang Y, Shi X, Zhang J, Wang Y, Lv Y, Du X, ChaoLuMen Q, Wang J. Wide spread and diversity of mutation in the gyrA gene of quinolone-resistant Corynebacterium striatum strains isolated from three tertiary hospitals in China. Ann Clin Microbiol Antimicrob 2021; 20:71. [PMID: 34598679 PMCID: PMC8487134 DOI: 10.1186/s12941-021-00477-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Corynebacterium striatum was confirmed to be an important opportunistic pathogen, which could lead to multiple-site infections and presented high prevalence of multidrug resistance, particularly to quinolone antibiotics. This study aimed to investigate the mechanism underlying resistance to quinolones and the epidemiological features of 410 quinolone-resistant C. striatum clinical strains isolated from three tertiary hospitals in China. METHODS A total of 410 C. striatum clinical strains were isolated from different clinical samples of patients admitted to three tertiary teaching hospitals in China. Antibiotic susceptibility testing was performed using the microdilution broth method and pulsed-field gel electrophoresis (PFGE) was used for genotyping. Gene sequencing was used to identify possible mutations in the quinolone resistance-determining regions (QRDRs) of gyrA. RESULTS In total, 410 C. striatum isolates were sensitive to vancomycin, linezolid, and daptomycin but resistant to ciprofloxacin. Depending on the antibiotic susceptibility testing results of 12 antimicrobial agents, the 410 C. striatum strains were classified into 12 resistant biotypes; of these, the three biotypes R1, R2, and R3 were dominant and accounted for 47.3% (194/410), 21.0% (86/410), and 23.2% (95/410) of the resistant biotypes, respectively. Mutations in the QRDRs ofgyrA were detected in all quinolone-resistant C. striatum isolates, and 97.3% of the isolates (399/410) showed double mutations in codons 87 and 91 of the QRDRs of gyrA. Ser-87 to Phe-87 and Asp-91 to Ala-91 double mutation in C. striatum was the most prevalent and accounted for 72.2% (296/410) of all mutations. Four new mutations in gyrA were identified in this study; these included Ser-87 to Tyr-87 and Asp-91 to Ala-91 (double mutation, 101 isolates); Ser-87 to Val-87 and Asp-91 toGly-91 (double mutation, one isolate); Ser-87 to Val-87 and Asp-91 to Ala-91 (double mutation, one isolate); and Ser-87 to Ile-87 (single mutation, one isolate). The minimum inhibitory concentration of ciprofloxacin for isolates with double (96.5%; 385/399) and single (72.7%; 8/11) mutations was high (≥ 32 µg/mL). Based on the PFGE typing results, 101 randomly selected C. striatum strains were classified into 50 genotypes (T01-T50), including the three multidrug-resistant epidemic clones T02, T06, and T28; these accounted for 14.9% (15/101), 5.9% (6/101), and 11.9% (12/101) of all genotypes, respectively. The multidrug-resistant T02 clone was identified in hospitals A and C and persisted from 2016 to 2018. Three outbreaks resulting from the T02, T06, and T28 clones were observed among intensive care unit (ICU) patients in hospital C between April and May 2019. CONCLUSIONS Quinolone-resistant C. striatum isolates showed a high prevalence of multidrug resistance. Point mutations in the QRDRs of gyrA conferred quinolone resistance to C. striatum, and several mutations in gyrA were newly found in this study. The great clonal diversity, high-level quinolone resistance and increased prevalence among patients susceptible to C. striatum isolates deserve more attention in the future. Moreover, more thorough investigation of the relationship between quinolone exposure and resistance evolution in C. striatum is necessary.
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Affiliation(s)
- Yingjun Wang
- Department of Laboratory Medicine, Affiliated Hospital of Inner Mongolian Medical University, 010050 Hohhot, People’s Republic of China
| | - Xiaohong Shi
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Laboratory Medicine, 250014 Jinan, People’s Republic of China
| | - Jian Zhang
- Department of Laboratory Medicine, Bayannur People’s Hospital, 015000 Bayannur, People’s Republic of China
| | - Yanyan Wang
- Department of Laboratory Medicine, Affiliated Hospital of Inner Mongolian Medical University, 010050 Hohhot, People’s Republic of China
| | - Yingying Lv
- Department of Laboratory Medicine, Affiliated Hospital of Inner Mongolian Medical University, 010050 Hohhot, People’s Republic of China
| | - Xiaoli Du
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 102206 Beijing, People’s Republic of China
| | - QiQiGe ChaoLuMen
- Pediatric Ward, Affiliated Hospital of Inner Mongolian Medical University, 010050 Hohhot, People’s Republic of China
| | - Junrui Wang
- Department of Laboratory Medicine, Affiliated Hospital of Inner Mongolian Medical University, 010050 Hohhot, People’s Republic of China
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Leyton B, Ramos JN, Baio PVP, Veras JFC, Souza C, Burkovski A, Mattos-Guaraldi AL, Vieira VV, Abanto Marin M. Treat Me Well or Will Resist: Uptake of Mobile Genetic Elements Determine the Resistome of Corynebacterium striatum. Int J Mol Sci 2021; 22:7499. [PMID: 34299116 PMCID: PMC8304765 DOI: 10.3390/ijms22147499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
Corynebacterium striatum, a bacterium that is part of the normal skin microbiota, is also an opportunistic pathogen. In recent years, reports of infections and in-hospital and nosocomial outbreaks caused by antimicrobial multidrug-resistant C. striatum strains have been increasing worldwide. However, there are no studies about the genomic determinants related to antimicrobial resistance in C. striatum. This review updates global information related to antimicrobial resistance found in C. striatum and highlights the essential genomic aspects in its persistence and dissemination. The resistome of C. striatum comprises chromosomal and acquired elements. Resistance to fluoroquinolones and daptomycin are due to mutations in chromosomal genes. Conversely, resistance to macrolides, tetracyclines, phenicols, beta-lactams, and aminoglycosides are associated with mobile genomic elements such as plasmids and transposons. The presence and diversity of insertion sequences suggest an essential role in the expression of antimicrobial resistance genes (ARGs) in genomic rearrangements and their potential to transfer these elements to other pathogens. The present study underlines that the resistome of C. striatum is dynamic; it is in evident expansion and could be acting as a reservoir for ARGs.
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Affiliation(s)
- Benjamin Leyton
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile;
- Carrera de Bioquímica, Departamento de Ciencias Químicas y Recursos Naturales, Universidad de La Frontera, Temuco 4811230, Chile
| | - Juliana Nunes Ramos
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro—LDCIC/FCM/UERJ, Rio de Janeiro 20550-170, Brazil; (C.S.); (A.L.M.-G.)
| | - Paulo Victor Pereira Baio
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
| | - João Flávio Carneiro Veras
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
| | - Cassius Souza
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro—LDCIC/FCM/UERJ, Rio de Janeiro 20550-170, Brazil; (C.S.); (A.L.M.-G.)
| | - Andreas Burkovski
- Department of Biology, Professur für Mikrobiologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Staudtstrasse 5, 91058 Erlangen, Germany;
| | - Ana Luíza Mattos-Guaraldi
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro—LDCIC/FCM/UERJ, Rio de Janeiro 20550-170, Brazil; (C.S.); (A.L.M.-G.)
| | - Verônica Viana Vieira
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz—Fiocruz, Rio de Janeiro 21040-361, Brazil; (J.N.R.); (P.V.P.B.); (J.F.C.V.); (V.V.V.)
| | - Michel Abanto Marin
- Scientific and Technological Bioresource Nucleus (BIOREN), Universidad de La Frontera, Temuco 4811230, Chile;
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9
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Virulence of clinically relevant multidrug resistant Corynebacterium striatum strains and their ability to adhere to human epithelial cells and inert surfaces. Microb Pathog 2021; 155:104887. [PMID: 33894290 DOI: 10.1016/j.micpath.2021.104887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/13/2023]
Abstract
Corynebacterium striatum is a nosocomial pathogen which is increasingly associated with serious infections in both immunocompetent and immunocompromised patients. However, little is known about virulence factors and mechanisms that may enhance the establishment and long-term survival of Corynebacterium striatum. in the hospital environment. In this study, we investigated the ability of 22 multidrug-resistant C. striatum clinical isolates to adhere to human epithelial cells and to produce biofilm on polystyrene plates, glass and various tracheostomy tubes. We also tested the virulence of these strains on the nematode Caenorhabditis elegans. They showed good adhesion to epithelial human cells after 180 min of infection. The 22 C. striatum were able to produce biofilms on positively and negatively charged abiotic surfaces at 37 °C. They were also able to infect and to kill Caenorhabditis elegans after 5 days of infection. The virulence condition was associated with the presence of SpaDEF operon encoding pili in all strains. This study provides new insights on virulence mechanisms that may contribute to the persistence of C. striatum in the hospital environment, increasing the probability of causing nosocomial infections.
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10
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Chauvelot P, Ferry T, Tafani V, Diot A, Tasse J, Conrad A, Chidiac C, Braun E, Lustig S, Laurent F, Valour F. Bone and Joint Infection Involving Corynebacterium spp.: From Clinical Features to Pathophysiological Pathways. Front Med (Lausanne) 2021; 7:539501. [PMID: 33585497 PMCID: PMC7873945 DOI: 10.3389/fmed.2020.539501] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Corynebacteria represent often-neglected etiological agents of post-traumatic and/or post-operative bone and joint infection (BJI). We describe here clinical characteristics and bacteriological determinants of this condition. Methods: A retrospective cohort study described characteristics, outcome and determinants of treatment failure of all patients with proven Corynebacterium spp. BJI (i.e., ≥2 culture-positive gold-standard samples). Available strains were further characterized regarding their antibiotic susceptibilies, abilities to form early (BioFilm Ring Test®) and mature (crystal violet staining method) biofilms and to invade osteoblasts (gentamicin protection assay). Results: The 51 included BJI were mostly chronic (88.2%), orthopedic device-related (74.5%) and polymicrobial (78.4%). After a follow-up of 60.7 weeks (IQR, 30.1-115.1), 20 (39.2%) treatment failures were observed, including 4 Corynebacterium-documented relapses, mostly associated with non-optimal surgical management (OR 7.291; p = 0.039). Internalization rate within MG63 human osteoblasts was higher for strains isolated from delayed (>3 months) BJI (p < 0.001). Infection of murine osteoblasts deleted for the β1-integrin resulted in a drastic reduction in the internalization rate. No difference was observed regarding biofilm formation. Conclusions: Surgical management plays a crucial role in outcome of BJI involving corynebacteria, as often chronic and device-associated infections. Sanctuarisation within osteoblasts, implicating the β1 cellular integrin, may represent a pivotal virulence factor associated with BJI chronicity.
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Affiliation(s)
- Pierre Chauvelot
- Departement of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.,French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
| | - Tristan Ferry
- Departement of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.,French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
| | - Virginie Tafani
- International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
| | - Alan Diot
- International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
| | - Jason Tasse
- International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France.,BioFilm Control, Saint-Beauzire, France
| | - Anne Conrad
- Departement of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.,French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
| | - Christian Chidiac
- Departement of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.,French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
| | - Evelyne Braun
- Departement of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.,French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France
| | - Sébastien Lustig
- French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,Orthopedic Surgery Unit, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France.,Laboratory of bacteriology, French National Reference Centre for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - Florent Valour
- Departement of Infectious Diseases, Hospices Civils de Lyon, Lyon, France.,French Regional Reference Center for Complex Bone and Joint Infection (CRIOAc), Hospices Civils de Lyon, Lyon, France.,International Centre for Research in Infectiology, INSERM U1111, Claude Bernard Lyon 1 University, Lyon, France
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11
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Olender A, Bogut A, Magryś A, Tabarkiewicz J. Cytokine Levels in the In Vitro Response of T Cells to Planktonic and Biofilm Corynebacterium amycolatum. Pol J Microbiol 2019; 68:457-464. [PMID: 31880890 PMCID: PMC7260632 DOI: 10.33073/pjm-2019-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 11/16/2022] Open
Abstract
Unravelling of the interplay between the immune system and non-diphtheria corynebacteria would contribute to understanding their increasing role as medically important microorganisms. We aimed at the analysis of pro- (TNF, IL-1β, IL-6, IL-8, and IL-12p70) and anti-inflammatory (IL-10) cytokines produced by Jurkat T cells in response to planktonic and biofilm Corynebacterium amycolatum. Two reference strains: C. amycolatum ATCC 700207 (R-CA), Staphylococcus aureus ATCC 25923 (R-SA), and ten clinical strains of C. amycolatum (C-CA) were used in the study. Jurkat T cells were stimulated in vitro by the planktonic-conditioned medium (PCM) and biofilm-conditioned medium (BCM) derived from the relevant cultures of the strains tested. The cytokine concentrations were determined in the cell culture supernatants using the flow cytometry. The levels of the cytokines analyzed were lower after stimulation with the BCM when compared to the PCM derived from the cultures of C-CA; statistical significance (p < 0.05) was observed for IL-1β, IL-12 p70, and IL-10. Similarly, planktonic R-CA and R-SA stimulated a higher cytokine production than their biofilm counterparts. The highest levels of pro-inflammatory IL-8, IL-1β, and IL-12p70 were observed after stimulation with planktonic R-SA whereas the strongest stimulation of anti-inflammatory IL-10 was noted for the BCM derived from the mixed culture of both reference species. Our results are indicative of weaker immunostimulatory properties of the biofilm C. amycolatum compared to its planktonic form. It may play a role in the persistence of biofilm-related infections. The extent of the cytokine response can be dependent on the inherent virulence of the infecting microorganism.
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Affiliation(s)
- Alina Olender
- Chair and Department of Medical Microbiology, Medical University of Lublin , Lublin , Poland
| | - Agnieszka Bogut
- Chair and Department of Medical Microbiology, Medical University of Lublin , Lublin , Poland
| | - Agnieszka Magryś
- Chair and Department of Medical Microbiology, Medical University of Lublin , Lublin , Poland
| | - Jacek Tabarkiewicz
- Department of Human Immunology, Faculty of Medicine, University of Rzeszów , Rzeszów , Poland
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12
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Wang X, Zhou H, Chen D, Du P, Lan R, Qiu X, Hou X, Liu Z, Sun L, Xu S, Ji X, Li H, Li D, Zhang J, Zeng H, Li Z. Whole-Genome Sequencing Reveals a Prolonged and Persistent Intrahospital Transmission of Corynebacterium striatum, an Emerging Multidrug-Resistant Pathogen. J Clin Microbiol 2019; 57:e00683-19. [PMID: 31315959 PMCID: PMC6711910 DOI: 10.1128/jcm.00683-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Corynebacterium striatum is an emerging multidrug-resistant (MDR) pathogen that occurs primarily among immunocompromised and chronically ill patients. However, little is known about the genomic diversity of C. striatum, which contributes to its long-term persistence and transmission in hospitals. In this study, a total of 192 C. striatum isolates obtained from 14 September 2017 to 29 March 2018 in a hospital in Beijing, China, were analyzed by antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE). Whole-genome sequencing was conducted on 91 isolates. Nearly all isolates (96.3%, 183/190) were MDR. The highest resistance rate was observed for ciprofloxacin (99.0%, 190/192), followed by cefotaxime (90.6%, 174/192) and erythromycin (89.1%, 171/192). PFGE separated the 192 isolates into 79 pulsotypes, and differences in core genome single-nucleotide polymorphisms (SNPs) partitioned the 91 isolates sequenced into four clades. Isolates of the same pulsotype were identical or nearly identical at the genome level, with some exceptions. Two dominant subclones, clade 3a, and clade 4a, were responsible for the hospital-wide dissemination. Genomic analysis further revealed nine resistance genes mobilized by eight unique cassettes. PFGE and whole-genome sequencing revealed that the C. striatum isolates studied were the result mainly of predominant clones spreading in the hospital. C. striatum isolates in the hospital progressively acquired resistance to antimicrobial agents, demonstrating that isolates of C. striatum may adapt rapidly through the acquisition and accumulation of resistance genes and thus evolve into dominant and persistent clones. These insights will be useful for the prevention of C. striatum infection in hospitals.
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Affiliation(s)
- Xuebing Wang
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Haijian Zhou
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Dongke Chen
- Department of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Pengcheng Du
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ruiting Lan
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - Xiaotong Qiu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Xuexin Hou
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Zhiguo Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Lina Sun
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Shuai Xu
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Xingzhao Ji
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Heqiao Li
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Dan Li
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Jingshan Zhang
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
| | - Hui Zeng
- Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhenjun Li
- State Key Laboratory of Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Changping, Beijing, China
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13
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Olender A, Bogut A, Magryś A, Król-Turmińska K. A Novel Approach to Study the Effect of Ciprofloxacin on Biofilms of Corynebacterium spp. Using Confocal Laser Scanning Microscopy. Pol J Microbiol 2018; 67:431-440. [PMID: 30550229 PMCID: PMC7256825 DOI: 10.21307/pjm-2018-051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/11/2022] Open
Abstract
Non-diphtherial corynebacteria are Gram-positive rods that cause opportunistic infections, what is supported by their ability to produce biofilm on artificial surfaces. In this study, the characteristic of the biofilm produced on vascular and urological catheters was determined using a confocal microscopy for the most frequently involved in infections diphtheroid species. They were represented by the reference strains of Corynebacterium striatum ATCC 6940 and C. amycolatum ATCC 700207. The effect of ciprofloxacin on the biofilm produced by the antibiotic-susceptible C. striatum strain was evaluated using three concentrations of the antimicrobial agent (2 ×, 4 ×, and 6 × the MIC – the Minimum Inhibitory Concentration). The basis for the interpretation of results was the statistical analysis of maximum points readings from the surface comprising a total of 245 areas of the biofilm image under the confocal microscope. It was observed that ciprofloxacin at a concentration equal to 4 × MIC paradoxically caused an enlargement of areas with live bacteria within the biofilm. Biofilm destruction required the application of ciprofloxacin at a concentration higher than 6 × MIC. This suggests that the use of relatively low doses of antimicrobial agents may increase the number of live bacteria within the biofilm, and further facilitate their detachment from the biofilm’s structure thus leading to the spread of bacteria into the bloodstream or to the neighboring tissues. The method of biofilm analysis presented here provides the original and novel approach to the investigation of the diphtheroid biofilms and their interaction with antimicrobial agents.
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Affiliation(s)
- Alina Olender
- Department of Medical Microbiology, Medical University , Lublin , Poland
| | - Agnieszka Bogut
- Department of Medical Microbiology, Medical University , Lublin , Poland
| | - Agnieszka Magryś
- Department of Medical Microbiology, Medical University , Lublin , Poland
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