Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/2579 |
Resumo: | BACKGROUND: Foot infections are a major cause of morbidity in people with diabetes and the most common cause of diabetes-related hospitalization and lower extremity amputation. Staphylococcus aureus is by far the most frequent species isolated from these infections. In particular, methicillin-resistant S. aureus (MRSA) has emerged as a major clinical and epidemiological problem in hospitals. MRSA strains have the ability to be resistant to most β-lactam antibiotics, but also to a wide range of other antimicrobials, making infections difficult to manage and very costly to treat. To date, there are two fifth-generation cephalosporins generally efficacious against MRSA, ceftaroline and ceftobripole, sharing a similar spectrum. Biofilm formation is one of the most important virulence traits of S. aureus. Biofilm growth plays an important role during infection by providing defence against several antagonistic mechanisms. In this study, we analysed the antimicrobial susceptibility patterns of biofilm-producing S. aureus strains isolated from diabetic foot infections. The antibiotic minimum inhibitory concentration (MIC) was determined for ten antimicrobial compounds, along with the minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC), followed by PCR identification of genetic determinants of biofilm production and antimicrobial resistance. RESULTS: Results demonstrate that very high concentrations of the most used antibiotics in treating diabetic foot infections (DFI) are required to inhibit S. aureus biofilms in vitro, which may explain why monotherapy with these agents frequently fails to eradicate biofilm infections. In fact, biofilms were resistant to antibiotics at concentrations 10-1000 times greater than the ones required to kill free-living or planktonic cells. The only antibiotics able to inhibit biofilm eradication on 50 % of isolates were ceftaroline and gentamicin. CONCLUSIONS: The results suggest that the antibiotic susceptibility patterns cannot be applied to biofilm established infections. Selection of antimicrobial therapy is a critical step in DFI and should aim at overcoming biofilm disease in order to optimize the outcomes of this complex pathology. |
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Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot InfectionsHSM MEDAnti-Bacterial Agents/pharmacologyBiofilms/drug effectsBiofilms/growth & developmentCephalosporins/pharmacologyDiabetic Foot/drug therapyDiabetic Foot/microbiologyGentamicins/pharmacologyMethicillin-Resistant Staphylococcus aureus/drug effectsMethicillin-Resistant Staphylococcus aureus/geneticsMethicillin-Resistant Staphylococcus aureus/physiologyMicrobial Sensitivity TestsPolymerase Chain Reaction/methodsStaphylococcal Infections/drug therapyStaphylococcal Infections/microbiologyStaphylococcus aureus/drug effectsStaphylococcus aureus/geneticsStaphylococcus aureus/isolation & purificationStaphylococcus aureus/physiologybeta-Lactams/pharmacologyBACKGROUND: Foot infections are a major cause of morbidity in people with diabetes and the most common cause of diabetes-related hospitalization and lower extremity amputation. Staphylococcus aureus is by far the most frequent species isolated from these infections. In particular, methicillin-resistant S. aureus (MRSA) has emerged as a major clinical and epidemiological problem in hospitals. MRSA strains have the ability to be resistant to most β-lactam antibiotics, but also to a wide range of other antimicrobials, making infections difficult to manage and very costly to treat. To date, there are two fifth-generation cephalosporins generally efficacious against MRSA, ceftaroline and ceftobripole, sharing a similar spectrum. Biofilm formation is one of the most important virulence traits of S. aureus. Biofilm growth plays an important role during infection by providing defence against several antagonistic mechanisms. In this study, we analysed the antimicrobial susceptibility patterns of biofilm-producing S. aureus strains isolated from diabetic foot infections. The antibiotic minimum inhibitory concentration (MIC) was determined for ten antimicrobial compounds, along with the minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC), followed by PCR identification of genetic determinants of biofilm production and antimicrobial resistance. RESULTS: Results demonstrate that very high concentrations of the most used antibiotics in treating diabetic foot infections (DFI) are required to inhibit S. aureus biofilms in vitro, which may explain why monotherapy with these agents frequently fails to eradicate biofilm infections. In fact, biofilms were resistant to antibiotics at concentrations 10-1000 times greater than the ones required to kill free-living or planktonic cells. The only antibiotics able to inhibit biofilm eradication on 50 % of isolates were ceftaroline and gentamicin. CONCLUSIONS: The results suggest that the antibiotic susceptibility patterns cannot be applied to biofilm established infections. Selection of antimicrobial therapy is a critical step in DFI and should aim at overcoming biofilm disease in order to optimize the outcomes of this complex pathology.BioMed CentralRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEMottola, CMatias, CMendes, JJMelo-Cristino, JTavares, LCavaco-Silva, POliveira, M2016-11-10T16:07:24Z2016-06-232016-06-23T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/2579engBMC Microbiol. 2016 Jun 23;16(1):11910.1186/s12866-016-0737-0info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:38:28Zoai:repositorio.chlc.min-saude.pt:10400.17/2579Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:19:55.657157Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
title |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
spellingShingle |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections Mottola, C HSM MED Anti-Bacterial Agents/pharmacology Biofilms/drug effects Biofilms/growth & development Cephalosporins/pharmacology Diabetic Foot/drug therapy Diabetic Foot/microbiology Gentamicins/pharmacology Methicillin-Resistant Staphylococcus aureus/drug effects Methicillin-Resistant Staphylococcus aureus/genetics Methicillin-Resistant Staphylococcus aureus/physiology Microbial Sensitivity Tests Polymerase Chain Reaction/methods Staphylococcal Infections/drug therapy Staphylococcal Infections/microbiology Staphylococcus aureus/drug effects Staphylococcus aureus/genetics Staphylococcus aureus/isolation & purification Staphylococcus aureus/physiology beta-Lactams/pharmacology |
title_short |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
title_full |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
title_fullStr |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
title_full_unstemmed |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
title_sort |
Susceptibility Patterns of Staphylococcus Aureus Biofilms in Diabetic Foot Infections |
author |
Mottola, C |
author_facet |
Mottola, C Matias, C Mendes, JJ Melo-Cristino, J Tavares, L Cavaco-Silva, P Oliveira, M |
author_role |
author |
author2 |
Matias, C Mendes, JJ Melo-Cristino, J Tavares, L Cavaco-Silva, P Oliveira, M |
author2_role |
author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Mottola, C Matias, C Mendes, JJ Melo-Cristino, J Tavares, L Cavaco-Silva, P Oliveira, M |
dc.subject.por.fl_str_mv |
HSM MED Anti-Bacterial Agents/pharmacology Biofilms/drug effects Biofilms/growth & development Cephalosporins/pharmacology Diabetic Foot/drug therapy Diabetic Foot/microbiology Gentamicins/pharmacology Methicillin-Resistant Staphylococcus aureus/drug effects Methicillin-Resistant Staphylococcus aureus/genetics Methicillin-Resistant Staphylococcus aureus/physiology Microbial Sensitivity Tests Polymerase Chain Reaction/methods Staphylococcal Infections/drug therapy Staphylococcal Infections/microbiology Staphylococcus aureus/drug effects Staphylococcus aureus/genetics Staphylococcus aureus/isolation & purification Staphylococcus aureus/physiology beta-Lactams/pharmacology |
topic |
HSM MED Anti-Bacterial Agents/pharmacology Biofilms/drug effects Biofilms/growth & development Cephalosporins/pharmacology Diabetic Foot/drug therapy Diabetic Foot/microbiology Gentamicins/pharmacology Methicillin-Resistant Staphylococcus aureus/drug effects Methicillin-Resistant Staphylococcus aureus/genetics Methicillin-Resistant Staphylococcus aureus/physiology Microbial Sensitivity Tests Polymerase Chain Reaction/methods Staphylococcal Infections/drug therapy Staphylococcal Infections/microbiology Staphylococcus aureus/drug effects Staphylococcus aureus/genetics Staphylococcus aureus/isolation & purification Staphylococcus aureus/physiology beta-Lactams/pharmacology |
description |
BACKGROUND: Foot infections are a major cause of morbidity in people with diabetes and the most common cause of diabetes-related hospitalization and lower extremity amputation. Staphylococcus aureus is by far the most frequent species isolated from these infections. In particular, methicillin-resistant S. aureus (MRSA) has emerged as a major clinical and epidemiological problem in hospitals. MRSA strains have the ability to be resistant to most β-lactam antibiotics, but also to a wide range of other antimicrobials, making infections difficult to manage and very costly to treat. To date, there are two fifth-generation cephalosporins generally efficacious against MRSA, ceftaroline and ceftobripole, sharing a similar spectrum. Biofilm formation is one of the most important virulence traits of S. aureus. Biofilm growth plays an important role during infection by providing defence against several antagonistic mechanisms. In this study, we analysed the antimicrobial susceptibility patterns of biofilm-producing S. aureus strains isolated from diabetic foot infections. The antibiotic minimum inhibitory concentration (MIC) was determined for ten antimicrobial compounds, along with the minimum biofilm inhibitory concentration (MBIC) and minimum biofilm eradication concentration (MBEC), followed by PCR identification of genetic determinants of biofilm production and antimicrobial resistance. RESULTS: Results demonstrate that very high concentrations of the most used antibiotics in treating diabetic foot infections (DFI) are required to inhibit S. aureus biofilms in vitro, which may explain why monotherapy with these agents frequently fails to eradicate biofilm infections. In fact, biofilms were resistant to antibiotics at concentrations 10-1000 times greater than the ones required to kill free-living or planktonic cells. The only antibiotics able to inhibit biofilm eradication on 50 % of isolates were ceftaroline and gentamicin. CONCLUSIONS: The results suggest that the antibiotic susceptibility patterns cannot be applied to biofilm established infections. Selection of antimicrobial therapy is a critical step in DFI and should aim at overcoming biofilm disease in order to optimize the outcomes of this complex pathology. |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016-11-10T16:07:24Z 2016-06-23 2016-06-23T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/2579 |
url |
http://hdl.handle.net/10400.17/2579 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
BMC Microbiol. 2016 Jun 23;16(1):119 10.1186/s12866-016-0737-0 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
BioMed Central |
publisher.none.fl_str_mv |
BioMed Central |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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