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Published on: December 27, 2016
Synergistic effect of antibiotic combinations on Staphylococcus aureus biofilms and their persister cell populations
Ekta Kamble1, Purva Sanghvi1, Karishma Pardesi1
1Department of Microbiology, Savitribai Phule Pune University, Ganeshkhind Road, Pune, 411 007, Maharashtra, India.
Abstract:
Treatment of staphylococcal infections is difficult due to multidrug resistance with their persister forms posing an added threat of recalcitrant infections. Antibiotic combinations are widely studied as an alternative strategy to combat them; therefore, they merit further investigation into their effect on the number of persister cells. In the present study, the fractional inhibitory concentrations of antibiotic combinations ciprofloxacin-daptomycin, ciprofloxacin-vancomycin, daptomycin-tobramycin, and tobramycin-vancomycin (checkerboard assay) were determined against two previously studied clinical (S48 and J6) and one standard (NCIM 5021) isolate of Staphylococcus aureus. They showed synergistic effects with a 2 to 256-fold reduction in MICs. All combinations also resulted in inhibition and disruption of biofilms in a concentration-dependent manner. All antibiotic combinations, except ciprofloxacin-daptomycin, showed total biofilm inhibition at 100X MICs. Similarly, antibiotic combination at 100X MIC showed 77-97% disruption of preformed biofilms. Time-kill assays performed at a 100X MIC combination against stationary-phase cells showed a two to six log10 reduction in CFU followed by a plateau indicating the presence of persisters. Significant differences were observed in persister cell fraction remaining after treatment with antibiotic combinations compared to monotherapies (p < 0.05) and therefore merit further investigation in clinical use for treatment against persisters.
Insights
Antibiotic combinations effectively reduce Staphylococcus aureus biofilms and persister cells, offering a promising strategy against multidrug-resistant infections. Further clinical investigation is warranted for these synergistic treatments.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Multidrug resistance in Staphylococcus aureus, particularly persister cells, complicates treatment.
- Antibiotic combinations are a potential strategy to overcome resistance and eradicate persistent bacterial populations.
Purpose of the Study:
- To evaluate the efficacy of antibiotic combinations against Staphylococcus aureus persister cells and biofilms.
- To determine synergistic effects and minimum inhibitory concentrations (MICs) of various antibiotic pairings.
Main Methods:
- Checkerboard assays were used to determine fractional inhibitory concentrations of ciprofloxacin-daptomycin, ciprofloxacin-vancomycin, daptomycin-tobramycin, and tobramycin-vancomycin.
- Biofilm inhibition and disruption assays were performed.
- Time-kill assays assessed the reduction of persister cells.
Main Results:
- All tested antibiotic combinations exhibited synergistic effects, reducing MICs significantly (2 to 256-fold).
- Combinations demonstrated concentration-dependent inhibition and disruption of Staphylococcus aureus biofilms.
- Time-kill assays revealed a significant reduction in persister cells (2-6 log10 CFU) with antibiotic combinations compared to monotherapies.
Conclusions:
- Antibiotic combinations show significant potential in combating multidrug-resistant Staphylococcus aureus, including persister cells and biofilms.
- These synergistic combinations warrant further investigation for clinical application against recalcitrant staphylococcal infections.
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