
doi: 10.1093/jac/dkv044
pmid: 25712314
Abstract Objectives Treatment of catheter-related bloodstream infections (CRBSI) is hampered by the characteristic tolerance of bacterial biofilms towards antibiotics. Our objective was to study the effect of the combination of antibiotics and the alkaline amino acid l-arginine or the cation chelator EDTA on the bacterial killing of in vitro biofilms formed by an array of clinical strains responsible for CRBSI and representative of epidemiologically relevant bacterial species. Methods Among 32 strains described in a previous clinical study, we focused on the most antibiotic-tolerant strains including CoNS (n = 4), Staphylococcus aureus (n = 4), Enterococcus faecalis (n = 2), Pseudomonas aeruginosa (n = 4) and Enterobacteriaceae (n = 4). We used an in vitro biofilm model (96-well plate assay) to study biofilm tolerance and tested various combinations of antibiotics and non-antibiotic adjuvants. Gentamicin, amikacin or vancomycin was combined with disodium EDTA or l-arginine for 24 h to reproduce the antibiotic lock therapy (ALT) approach. Killing of biofilm bacteria was measured by cfu quantification after a vigorous step of pipetting up and down in order to detach all biofilm bacteria from the surface of the wells. Results Both of our adjuvant strategies significantly increased the effect of antibiotics against biofilms formed by Gram-positive and Gram-negative bacterial pathogens. The combination of gentamicin + EDTA was active against all tested strains apart from one P. aeruginosa. The combination of gentamicin + l-arginine was active against most of the tested strains with the notable exception of CoNS for which no potentiation was observed. We also demonstrated that amikacin + EDTA was active against Gram-negative bacteria and that vancomycin + EDTA was active against Gram-positive bacteria. Conclusions The addition of EDTA enhanced the activity of gentamicin, amikacin and vancomycin against biofilms formed by a wide spectrum of bacterial strains responsible for CRBSI.
Biofilms/*drug effects, Colony Count, Colony Count, Microbial, Arginine, Microbial, Anti-Infective Agents, Vancomycin, antibiotic lock therapy, Humans, persisters, Disinfection/methods, Amikacin, Edetic Acid, in vitro models, Chelating Agents, aminoglycosides, Microbial Viability, Bacteria, Edetic Acid/pharmacology, Chelating Agents/*pharmacology, Arginine/*pharmacology, Microbial Viability/drug effects, Amikacin/pharmacology, Vancomycin/pharmacology, Bacteria/*drug effects/isolation & purification, Disinfection, Gentamicins/pharmacology, Biofilms, Catheter-Related Infections, adjuvant strategy, Anti-Infective Agents/*pharmacology, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Gentamicins, Catheter-Related Infections/microbiology
Biofilms/*drug effects, Colony Count, Colony Count, Microbial, Arginine, Microbial, Anti-Infective Agents, Vancomycin, antibiotic lock therapy, Humans, persisters, Disinfection/methods, Amikacin, Edetic Acid, in vitro models, Chelating Agents, aminoglycosides, Microbial Viability, Bacteria, Edetic Acid/pharmacology, Chelating Agents/*pharmacology, Arginine/*pharmacology, Microbial Viability/drug effects, Amikacin/pharmacology, Vancomycin/pharmacology, Bacteria/*drug effects/isolation & purification, Disinfection, Gentamicins/pharmacology, Biofilms, Catheter-Related Infections, adjuvant strategy, Anti-Infective Agents/*pharmacology, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Gentamicins, Catheter-Related Infections/microbiology
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