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Sharafi T, Ghaemi EA, Rafiee M, Ardebili A. Combination antimicrobial therapy: in vitro synergistic effect of anti-staphylococcal drug oxacillin with antimicrobial peptide nisin against Staphylococcus epidermidis clinical isolates and Staphylococcus aureus biofilms. Ann Clin Microbiol Antimicrob 2024; 23:7. [PMID: 38245727 PMCID: PMC10800071 DOI: 10.1186/s12941-024-00667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
The ability of Staphylococcus epidermidis and S. aureus to form strong biofilm on plastic devices makes them the major pathogens associated with device-related infections (DRIs). Biofilm-embedded bacteria are more resistant to antibiotics, making biofilm infections very difficult to effectively treat. Here, we evaluate the in vitro activities of anti-staphylococcal drug oxacillin and antimicrobial peptide nisin, alone and in combination, against methicillin-resistant S. epidermidis (MRSE) clinical isolates and the methicillin-resistant S. aureus ATCC 43,300. The minimum inhibitory concentrations (MIC) and minimum biofilm eradication concentrations (MBEC) of oxacillin and nisin were determined using the microbroth dilution method. The anti-biofilm activities of oxacillin and nisin, alone or in combination, were evaluated. In addition, the effects of antimicrobial agents on the expression of icaA gene were examined by quantitative real-time PCR. MIC values for oxacillin and nisin ranged 4-8 µg/mL and 64-128 µg/mL, respectively. Oxacillin and nisin reduced biofilm biomass in all bacteria in a dose-dependent manner and this inhibitory effect was enhanced with combinatorial treatment. MBEC ranges for oxacillin and nisin were 2048-8192 µg/mL and 2048-4096 µg/mL, respectively. The addition of nisin significantly decreased the oxacillin MBECs from 8- to 32-fold in all bacteria. At the 1× MIC and 1/2× MIC, both oxacillin and nisin decreased significantly the expression of icaA gene in comparison with untreated control. When two antimicrobial agents were combined at 1/2× MIC concentration, the expression of icaA were significantly lower than when were used alone. Nisin/conventional oxacillin combination showed considerable anti-biofilm effects, including inhibition of biofilm formation, eradication of mature biofilm, and down-regulation of biofilm-related genes, proposing its applications for treating or preventing staphylococcal biofilm-associated infections, including device-related infections.
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Affiliation(s)
- Toktam Sharafi
- Infectious Disease Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ezzat Allah Ghaemi
- Infectious Disease Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Maryam Rafiee
- Infectious Disease Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Ardebili
- Infectious Disease Research Center, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
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Kim S, Choi JP, Oh DH, Ahn MY, Yang E. Increased incidence of teicoplanin-non-susceptible Staphylococcus epidermidis strains: a 6-year retrospective study. Sci Rep 2023; 13:12582. [PMID: 37537250 PMCID: PMC10400644 DOI: 10.1038/s41598-023-39666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023] Open
Abstract
Glycopeptide antibiotics (vancomycin and teicoplanin) are usually used for the treatment of Staphylococcus epidermidis infections owing to their increased oxacillin resistance. However, S. epidermidis strains with decreased susceptibility to teicoplanin have become increasingly incident in recent years. We aimed to identify the characteristics of teicoplanin-non-susceptible (Teico-NS) S. epidermidis isolated at our hospital and analyze its relationship with teicoplanin usage. We retrospectively evaluated 328 S. epidermidis strains isolated from clinical isolates between January 2016 and December 2021. All strains were susceptible to vancomycin (minimal inhibitory concentration (MIC) ≤ 4 mg/L). The annual incidence for S. epidermidis strains with an elevated teicoplanin MIC of 8 mg/L ranged from 22.2 to 28.9%. In addition, in 2021, the number of S. epidermidis strains with teicoplanin MIC ≥ 16 mg/L rapidly increased (n = 13, 32.5%). Furthermore, teicoplanin use increased annually until 2019; however, in 2020, it decreased abruptly due to the COVID 19 pandemic. Thus, we could not confirm the existence of a clear correlation between teicoplanin usage and increased incidence of S. epidermidis with reduced teicoplanin-susceptibility. We showed the increased incidence of Teico-NS S. epidermidis in recent years. Further studies are needed to identify the mechanisms and risk factors for teicoplanin-resistance in S. epidermidis.
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Affiliation(s)
- Subin Kim
- Division of Infectious Disease, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 05505, Republic of Korea
| | - Jae-Phil Choi
- Division of Infectious Disease, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 05505, Republic of Korea
| | - Dong Hyun Oh
- Division of Infectious Disease, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 05505, Republic of Korea
| | - Mi Young Ahn
- Division of Infectious Disease, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 05505, Republic of Korea
| | - Eunmi Yang
- Division of Infectious Disease, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, Seoul, 05505, Republic of Korea.
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Clinical Infections, Antibiotic Resistance, and Pathogenesis of Staphylococcus haemolyticus. Microorganisms 2022; 10:microorganisms10061130. [PMID: 35744647 PMCID: PMC9231169 DOI: 10.3390/microorganisms10061130] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Staphylococcus haemolyticus (S. haemolyticus) constitutes the main part of the human skin microbiota. It is widespread in hospitals and among medical staff, resulting in being an emerging microbe causing nosocomial infections. S. haemolyticus, especially strains that cause nosocomial infections, are more resistant to antibiotics than other coagulase-negative Staphylococci. There is clear evidence that the resistance genes can be acquired by other Staphylococcus species through S. haemolyticus. Severe infections are recorded with S. haemolyticus such as meningitis, endocarditis, prosthetic joint infections, bacteremia, septicemia, peritonitis, and otitis, especially in immunocompromised patients. In addition, S. haemolyticus species were detected in dogs, breed kennels, and food animals. The main feature of pathogenic S. haemolyticus isolates is the formation of a biofilm which is involved in catheter-associated infections and other nosocomial infections. Besides the biofilm formation, S. haemolyticus secretes other factors for bacterial adherence and invasion such as enterotoxins, hemolysins, and fibronectin-binding proteins. In this review, we give updates on the clinical infections associated with S. haemolyticus, highlighting the antibiotic resistance patterns of these isolates, and the virulence factors associated with the disease development.
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Nicolosi D, Cinà D, Di Naso C, D’Angeli F, Salmeri M, Genovese C. Antimicrobial Resistance Profiling of Coagulase-Negative Staphylococci in a Referral Center in South Italy: A Surveillance Study. Open Microbiol J 2020. [DOI: 10.2174/1874285802014010091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background:
CoNS are part of the normal flora of the skin, upper respiratory tract and human intestine. CoNS are able to colonize host tissues or inert materials such as prosthetics, heart valves, pacemakers, and urinary and venous catheters. They can also internalize in host cells, thus eluding immune defenses and attack by antibiotics.
Objective:
In this study, we collected the epidemiological data and determined the antibiotic susceptibility of 828 CoNS, collected in Garibaldi Hospital (Catania, Italy) between January 2016 and October 2018.
Methods:
Strains were evaluated by determining the Minimum Inhibitory Concentration (MIC) using the broth microdilution method, according to the guidelines of the Clinical and Laboratory Standards Institute. The antibiotic sensitivity pattern of CoNS against eighteen antibiotics was determined.
Results:
For all the 828 clinical isolates, varying resistance rates were observed: ampicillin (87%), penicillin (86%), amoxicillin-clavulanate (71%), oxacillin (70%), erythromycin (69%), azithromycin (68%), levofloxacin (55%), ciprofloxacin (54%), gentamycin (47%), moxifloxacin (42%), trimethoprim-sulfamethoxazole (30%), clindamycin (28%), tetracycline (24%), rifampicin (20%), quinupristin-dalfopristin (synercid) (4%). No strains investigated demonstrated resistance to teicoplanin, vancomycin and linezolid.
Conclusion:
Our results highlight the importance of monitoring the evolution of CoNS resistance in order to implement control measures and reduce the risk of spread in the population.
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Kord M, Ardebili A, Jamalan M, Jahanbakhsh R, Behnampour N, Ghaemi EA. Evaluation of Biofilm Formation and Presence of Ica Genes in Staphylococcus epidermidis Clinical Isolates. Osong Public Health Res Perspect 2018; 9:160-166. [PMID: 30159221 PMCID: PMC6110329 DOI: 10.24171/j.phrp.2018.9.4.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives Biofilm formation is one of the important features of Staphylococcus epidermidis, particularly in nosocomial infections. We aimed to investigate the biofilm production by phenotypic methods and the presence of ica genes in S epidermidis. Methods A total of 41 S epidermidis isolates were recovered from different clinical specimens. Biofilm formation was evaluated by microtiter plate, tube method and Congo red agar method. The presence of icaA and icaD genes was investigated by PCR. Validity of methods (sensitivity and specificity), and metrics for test performance (positive/negative predictive value, and positive/negative likelihood ratio) were determined. Results By both microtiter plate and tube method, 53.6% of S epidermidis isolates were able to produce biofilm, whilst only 24.4% of isolates provided a biofilm phenotype on Congo red agar plates. icaA and icaD genes were found in 100% and 95.1% of isolates, respectively. Biofilm phenotypes accounted for 4.8% by microtiter plate assay, despite the absence of the ica gene. Congo red agar and PCR exhibited a lower sensitivity (18% and 45.5%, respectively) for identifying the biofilm phenotype in comparison to microtiter plate. Conclusion The microtiter plate method remains generally a better tool to screen biofilm production in S epidermidis. In addition, the ability of S epidermidis to form biofilm is not always dependent on the presence of ica genes, highlighting the importance of ica-independent mechanisms of biofilm formation. The use of reliable methods to specifically detect biofilms can be helpful to treat the patients affected by such problematic bacteria.
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Affiliation(s)
- Maryam Kord
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Ardebili
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.,Laboratory Science Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Maryam Jamalan
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghaye Jahanbakhsh
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Naser Behnampour
- School of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ezzat Allah Ghaemi
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.,Laboratory Science Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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