Staphylococcus epidermidis Biofilms Have a High Tolerance to Antibiotics in Periprosthetic Joint Infection.

John A Koch,Kenneth L Urish,Jonathan B Mandell,Taylor M Pust,Dongzhu Ma,Alex J Cappellini,Kimberly M Brothers,Neel B Shah

doi:10.3390/life10110253

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.

Highlights

Staphylococcus epidermidis and Staphylococcus aureus are the two most commonly found microorganisms associated with periprosthetic joint infection (PJI) [1,2]
S. epidermidis Antibiotic Sensitivity is Lower in Planktonic Cultures in Comparison to Mature Biofilms
PJI provide provide treatment treatment dosages dosages that that are are based based on on antibiotic antibiotic susceptibility of bacteria in its planktonic state alone. These dosages, may not be representative susceptibility of bacteria in its planktonic state alone. These dosages, may not be of the biofilm state these infections exist in, and this in turn could lead to suboptimal clinical outcomes [11,20]

Summary

Introduction

Staphylococcus epidermidis and Staphylococcus aureus are the two most commonly found microorganisms associated with periprosthetic joint infection (PJI) [1,2]. S. aureus will rapidly form biofilms in implant infections [3,4,5]. S. epidermidis has been demonstrated to rapidly form a biofilm on surgical material in less than 12 h of growth [6]. These infections are challenging to treat due to the fact that bacterial cells in biofilms have a higher tolerance to antibiotic therapy [2]. Life 2020, 10, 253 endocarditis, have been with coagulase-negative staphylococci species like S. epidermidis [7].

Objectives

Methods

Results

Conclusion