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Staphylococcus epidermidis Biofilms Have a High Tolerance to Antibiotics in Periprosthetic Joint Infection
John A Koch1, Taylor M Pust1, Alex J Cappellini1
1Arthritis and Arthroplasty Design Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Abstract:
Both Staphylococcus aureus and Staphylococcus epidermidis are commonly associated with periprosthetic joint infections (PJIs). The treatment of PJI can be challenging because biofilms are assumed to have an increased intolerance to antibiotics. This makes the treatment of PJI challenging from a clinical perspective. Although S. aureus has been previously demonstrated to have increased biofilm antibiotic tolerance, this has not been well established with Staphylococcus epidermidis. A prospective registry of PJI S. epidermidis isolates was developed. The efficacy of clinically relevant antibiotics was quantified against these isolates. S. epidermidis planktonic minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were collected using clinical laboratory standard index (CLSI) assays for eight antibiotics (doxycycline, vancomycin, daptomycin, clindamycin, rifampin, nafcillin, and trimethoprim/sulfamethoxazole). Mature biofilms were grown in vitro, after which minimum biofilm inhibitory concentration (MBIC) and minimum biofilm bactericidal concentration (MBBC) were quantified. Only rifampin and doxycycline had a measurable MBIC across all tested isolates. Based on MBBC, 64% of S. epidermidis biofilms could be eliminated by rifampin, whereas only 18% by doxycycline. S. epidermidis biofilm was observed to have a high tolerance to antibiotics as compared to planktonic culture. Isolate biofilm antibiotic tolerance varied to a larger degree than was seen in planktonic cultures.
Insights
Staphylococcus epidermidis biofilms show high antibiotic tolerance, complicating periprosthetic joint infection treatment. Rifampin effectively eliminated most biofilms, unlike doxycycline, highlighting treatment challenges.
Area of Science:
- Microbiology
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic joint infections (PJIs) are often caused by Staphylococcus aureus and Staphylococcus epidermidis.
- Biofilms formed by these bacteria exhibit increased antibiotic tolerance, complicating PJI treatment.
- While S. aureus biofilm tolerance is known, S. epidermidis tolerance is less understood.
Purpose of the Study:
- To quantify the antibiotic tolerance of Staphylococcus epidermidis biofilms.
- To evaluate the efficacy of clinically relevant antibiotics against S. epidermidis biofilms in vitro.
- To compare biofilm antibiotic tolerance with planktonic S. epidermidis.
Main Methods:
- A prospective registry of PJI S. epidermidis isolates was established.
- Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) were determined for planktonic bacteria.
- Minimum Biofilm Inhibitory Concentration (MBIC) and Minimum Biofilm Bactericidal Concentration (MBBC) were quantified for mature biofilms.
Main Results:
- Only rifampin and doxycycline demonstrated measurable MBIC against all S. epidermidis isolates.
- Rifampin eliminated 64% of biofilms (MBBC), while doxycycline eliminated 18%.
- S. epidermidis biofilms exhibited significantly higher antibiotic tolerance than planktonic cultures, with greater isolate variability.
Conclusions:
- Staphylococcus epidermidis biofilms possess substantial antibiotic tolerance, posing clinical challenges for PJI treatment.
- Rifampin shows superior efficacy in eradicating S. epidermidis biofilms compared to doxycycline.
- Understanding and overcoming biofilm antibiotic tolerance is crucial for effective PJI management.
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