Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis
Posted on 2019-10-22 - 19:04
Abstract Background Infective endocarditis (IE) is associated with high rates of mortality. Prolonged treatments with high-dose intravenous antibiotics often fail to eradicate the infection, frequently leading to high-risk surgical intervention. By providing a mechanism of antibiotic tolerance, which escapes conventional antibiotic susceptibility profiling, microbial biofilm represents a key diagnostic and therapeutic challenge for clinicians. This study aims at assessing a rapid biofilm identification assay and a targeted antimicrobial susceptibility profile of biofilm-growing bacteria in patients with IE, which were unresponsive to antibiotic therapy. Results Staphylococcus aureus was the most common isolate (50%), followed by Enterococcus faecalis (25%) and Streptococcus gallolyticus (25%). All microbial isolates were found to be capable of producing large, structured biofilms in vitro. As expected, antibiotic treatment either administered on the basis of antibiogram or chosen empirically among those considered first-line antibiotics for IE, including ceftriaxone, daptomycin, tigecycline and vancomycin, was not effective at eradicating biofilm-growing bacteria. Conversely, antimicrobial susceptibility profile of biofilm-growing bacteria indicated that teicoplanin, oxacillin and fusidic acid were most effective against S. aureus biofilm, while ampicillin was the most active against S. gallolyticus and E. faecalis biofilm, respectively. Conclusions This study indicates that biofilm-producing bacteria, from surgically treated IE, display a high tolerance to antibiotics, which is undetected by conventional antibiograms. The rapid identification and antimicrobial tolerance profiling of biofilm-growing bacteria in IE can provide key information for both antimicrobial therapy and prevention strategies.
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Di Domenico, Enea; Rimoldi, Sara; Cavallo, Ilaria; DâAgosto, Giovanna; Trento, Elisabetta; Cagnoni, Giovanni; et al. (2019). Microbial biofilm correlates with an increased antibiotic tolerance and poor therapeutic outcome in infective endocarditis. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4707767.v1
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AUTHORS (21)
ED
Enea Di Domenico
SR
Sara Rimoldi
IC
Ilaria Cavallo
GD
Giovanna DâAgosto
ET
Elisabetta Trento
GC
Giovanni Cagnoni
AP
Alessandro Palazzin
CP
Cristina Pagani
FR
Francesca Romeri
ED
Elena De Vecchi
MS
Monica Schiavini
DS
Daniela Secchi
CA
Carlo Antona
GR
Giuliano Rizzardini
RD
Rita Dichirico
LT
Luigi Toma
DK
Daniela Kovacs
GC
Giorgia Cardinali
MG
Maria Gallo
MG
Maria Gismondo