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Antimicrobial resistance (AMR) is a global health problem with the environment being an important compartment for the evolution, selection and transmission of AMR. These processes are impacted by pollution with antibiotics. However, biocides used as disinfectants and material preservatives are major pollutants by far excceding the market for antibiotics in terms of mass. Our work shows that biocides have the potential to affect evolutionary processes towards AMR by increasing the rates of de-novo mutation and conjugation. These effects depend on the species and biocidal substance. Importantly, chlorhexidine and quaternary ammonium compounds (QACs) affect rates of mutation and conjugation at environmentally relevant concentrations in E. coli. Moreover, our results show a connection between the RpoS-mediated general stress and the RecA-linked SOS response with increased rates of mutation and conjugation, but not for all biocides. Furthermore, our work highlights the potential of biocides to contribute to selection and transmission of AMR. We show that the application of biocides, especially QAC disinfectants, leads to the rapid evolution of tolerance (i.e. increased survival) in adaptive laboratory evolution (ALE) experiments. The evolved tolerant strains have a selective advantage in the presence of environmentally-relevant concentrations of antibiotics, which could lead to the stabilization of biocide tolerance in environments where biocides and antibiotics co-occur (e.g. wastewater, animal stables). ALE experiments with biocide tolerant strains indicate a decreased evolvability of resistance to antibiotics. Taken together, our work shows the importance of assessing the contribution of biocides on evolution, selection and transmission of AMR in the environment.
BIOCIDE
(2022)
Antimicrobial surfaces have broad use in multiple settings including touch surfaces in hospitals, implanted devices, or consumer products. Their aim is to support existing hygiene procedures, and to help combat the increasing threat of antimicrobial resistance. However, concerns have been raised over the potential selection pressure exerted by such surfaces, which might drive the evolution and spread of antimicrobial resistance. In my presentation, I will highlight the risks and knowledge gaps associated with resistance on antimicrobial surfaces by different processes including evolution by de novo mutations and horizontal gene transfer, and species sorting of inherently resistant bacteria dispersed onto antimicrobial surfaces. The latter process has the potential to select for antibiotic resistance via cross-resistance between traits that confer resistance to both the antimicrobial surface coating and antibiotics. Conditions in which antibiotics and antimicrobial coatings are present simultaneously (e.g. implants) will lead to more complex interactions that can either result in the selection for or against antibiotic resistance. We mapped these interactions between several antimicrobials and antibiotics on growth and selection of Pseudomonas aeruginosa. We find prevalent physiological (i.e. synergy and antagonism) and evolutionary (i.e. cross-resistance and collateral sensitivity) combination effects. Understanding these interactions opens the door to tailor therapeutic interventions to select against resistance. In additions, we need new methods and translational studies that investigate resistance development to antimicrobial surfaces under realistic conditions. Therefore, I will present recent developments in our lab on the development of such a method based on existing efficacy standards.
Antimicrobials can exert specific physiological effects when used in combination that are different from those when applied alone. These effects include physiological effects (i.e. synergy, antagonism and suppression) as well as evolutionary effects on the selection of resistant strains (i.e. cross-resistance and collateral sensitivity). While combination effects have been extensively mapped for antibiotic-antibiotic combinations, the combination effects of antibiotics with antimicrobials used as biocides or antiseptics have not been systematically investigated.
Here, we investigated the physiological and evolutionary consequences of combinations of antibiotics (meropenem, gentamicin and ciprofloxacin) and substances used as biocides or antiseptics (octenidine, benzalkonium chloride, cetrimonium bromide, chlorhexidine, povidone-iodine, silver) on growth and selection of Pseudomonas aeruginosa. We find prevalent physiological combination effects with synergy occurring 6 times and antagonism occurring 10 times. The effects are specific to the antibiotic-biocide combination with meropenem showing a tendency for antagonism with biocides (6 of 7), while gentamicin has a tendency for synergy (5 of 7). A particular strong antagonism is apparent for the meropenem-chlorhexidine combination, for which we conducted an in-depth study on the underlying molecular mechanism using RNASeq. Moreover, we find widespread effects of the biocide-antibiotic combinations on selection of P. aeruginosa strains resistant to the antibiotics, including cross-resistance and collateral sensitivity.
In conclusion, antibiotics and biocides or antiseptics exert physiological and evolutionary combination effects on the pathogen P. aeruginosa. These effects have consequences for the efficacy of both types of substances and for the selection of antimicrobial resistant strains in clinical applications with combined exposure (e.g. wound care, coated biomaterials).
Antimicrobials can exert specific physiological effects when used in combination that are different from those when applied alone. These effects include physiological effects (i.e. synergy, antagonism and suppression) as well as evolutionary effects on the selection of resistant strains (i.e. cross-resistance and collateral sensitivity). While combination effects have been extensively mapped for antibiotic-antibiotic combinations, the combination effects of antibiotics with antimicrobials used as biocides or antiseptics have not been systematically investigated.
Here, we investigated the physiological and evolutionary consequences of combinations of antibiotics (meropenem, gentamicin and ciprofloxacin) and substances used as biocides or antiseptics (octenidine, benzalkonium chloride, cetrimonium bromide, chlorhexidine, povidone-iodine, silver) on growth and selection of Pseudomonas aeruginosa. We find prevalent physiological combination effects with synergy occurring 6 times and antagonism occurring 10 times. The effects are specific to the antibiotic-biocide combination with meropenem showing a tendency for antagonism with biocides (6 of 7), while gentamicin has a tendency for synergy (5 of 7). A particular strong antagonism is apparent for the meropenem-chlorhexidine combination, for which we conducted an in-depth study on the underlying molecular mechanism using RNASeq. Moreover, we find widespread effects of the biocide-antibiotic combinations on selection of P. aeruginosa strains resistant to the antibiotics, including cross-resistance and collateral sensitivity.
In conclusion, antibiotics and biocides or antiseptics exert physiological and evolutionary combination effects on the pathogen P. aeruginosa. These effects have consequences for the efficacy of both types of substances and for the selection of antimicrobial resistant strains in clinical applications with combined exposure (e.g. wound care, coated biomaterials).
Biocides, including disinfectants and antimicrobial surfaces (AMCs), are important to prevent the spread of pathogens and antimicrobial resistant bacteria via surfaces. However, concerns have been raised about the evolution and selection of resistance against disinfectants and AMCs. In turn, resistance against disinfectants and AMCs can be associated to antibiotic resistance due to cross-resistance and co-resistance. We need to understand the mechanisms and risks of disinfectants and AMCs for resistance and cross-resistance evolution to optimize their application and safeguard their long-term efficacy. We used adaptive laboratory evolution (ALE) experiments based on repeated exposure of bacteria to disinfectants. Our results show that repeated disinfection of E. coli with benzalkonium chloride in suspension results in a 2000-fold increase in survival within 5 exposure cycles. Adaption is linked to the initial presence of persister cells highly tolerant to benzalkonium chloride. We used the same approach to develop standardizable ALE experiments to determine resistance evolution to AMCs. The results highlight rapid adaptation of E. coli and P. aeruginosa towards copper surfaces. Moreover, there are multiple situations in the clinic or in the environment in which biocides and antibiotics co-occur and in which combination effects can shape their antimicrobial activity or their selective effects. Our work with P. aeruginosa shows prevalent combination effects of biocides and antibiotics, ranging from synergy to antagonism and resulting in the selection for or against antibiotic resistant strains. The combination effects are dependent on the biofilm mode-of-growth, manifesting in apparent differences in the structural arrangement of antibiotic sensitive and resistant strains in biofilms exposed to combinations. Furthermore, biocides affect rates of mutation and horizontal gene transfer, thereby having a potential facilitating effect on resistance evolution. Taken together, our work shows that the role of biocides as potential drivers of resistance evolution and selection deserves further study and regulative action.
Here, we introduce the BEAT-AMR consortium, which is recommended for funding within the 3rd call of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR).
The aim of the consortium is to investigate fundamental mechanisms that shape antimicrobial resistance in biofilms in relation to the surface and then translate those findings into clinical practice. We thereby aim to generate clinical recommendations on the combinatorial use of biomaterials coated with antimicrobials and antibiotics that avoid the occurrence and transmission of nosocomial biofilm infections with bacteria insusceptible to antibiotics. We established a Europe-wide network of experts in biofilm research, antimicrobial resistance, material sciences, and translational medicine that allows us to investigate those aspects in a coherent framework.
Biofilms are structured communities of bacteria found on surfaces that become embedded within a self-produced extracellular polymeric matrix. Bacteria living in biofilms can tolerate much higher antibiotic concentrations compared to planktonic bacteria and survive long enough to evolve antimicrobial resistance (AMR). They form persistent, hard-to-treat infections and exhibit an intrinsic biology that promotes the development and transmission of AMR. The goal of our consortium is to determine how bacteria adapt to antimicrobials during biofilm formation on surfaces coated with antimicrobials, how AMR mutations are acquired and evolve within mature biofilms, and how population dynamics within biofilms affect the transmission of AMR. Our team provides facilities and clinical research governance for experimental and translational medicine. Our synergy of laboratory, clinical and translational research across Europe will ensure the development of novel and successful interventions and therapeutic outcomes.
Here, we introduce the BEAT-AMR consortium, which is recommended for funding within the 3rd call of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). mechanisms that shape antimicrobial resistance in biofilms.
The aim of the consortium is to investigate fundamental in relation to the surface and then translate those findings into clinical practice. We thereby aim to generate clinical recommendations on the combinatorial use of biomaterials coated with antimicrobials and antibiotics that avoid the occurrence and transmission of nosocomial biofilm infections with bacteria insusceptible to antibiotics. We established a Europe-wide network of experts in biofilm research, antimicrobial resistance, material sciences, and translational medicine that allows us to investigate those aspects in a coherent framework.
Biofilms are structured communities of bacteria found on surfaces that become embedded within a self-produced extracellular polymeric matrix. Bacteria living in biofilms can tolerate much higher antibiotic concentrations compared to planktonic bacteria and survive long enough to evolve antimicrobial resistance (AMR). They form persistent, hard-to-treat infections and exhibit an intrinsic biology that promotes the development and transmission of AMR. The goal of our consortium is to determine how bacteria adapt to antimicrobials during biofilm formation on surfaces coated with antimicrobials, how AMR mutations are acquired and evolve within mature biofilms, and how population dynamics within biofilms affect the transmission of AMR. Our team provides facilities and clinical research governance for experimental and translational medicine. Our synergy of laboratory, clinical and translational research across Europe will ensure the development of novel and successful interventions and therapeutic outcomes.
Here, we introduce the BEAT-AMR consortium, which is recommended for funding within the 3rd call of the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). The aim of the consortium is to investigate fundamental mechanisms that shape antimicrobial resistance in biofilms in relation to the surface and then translate those findings into clinical practice. We thereby aim to generate clinical recommendations on the combinatorial use of biomaterials coated with antimicrobials and antibiotics that avoid the occurrence and transmission of nosocomial biofilm infections with bacteria insusceptible to antibiotics. We established a Europe-wide network of experts in biofilm research, antimicrobial resistance, material sciences, and translational medicine that allows us to investigate those aspects in a coherent framework.
A relatively recent advance in microbiology is the finding that the majority of infections are caused by bacterial biofilms. Biofilms are structured communities of bacteria found on surfaces that become embedded within a self-produced extracellular polymeric matrix. Biofilms can form on tissues or on biomedical surfaces, such as blood catheters or implants, where they act as a reservoir of potential healthcare-associated infection. Bacteria living in biofilms can tolerate much higher antibiotic concentrations compared to planktonic bacteria and survive long enough to evolve antimicrobial resistance (AMR). They form persistent, hard-to-treat infections and exhibit an intrinsic biology that promotes the development and transmission of AMR. The goal of our consortium is to determine how bacteria adapt to antimicrobials during biofilm formation on surfaces coated with antimicrobials, how AMR mutations are acquired and evolve within mature biofilms, and how population dynamics within biofilms affect the transmission of AMR. We address the hypothesis that understanding the contribution of biofilms to AMR acquisition and spread will lead to the development of novel antimicrobial strategies and medical devices that are more effective in preventing biofilm-associated infection and AMR. Our team provides facilities and clinical research governance for experimental and translational medicine. Our synergy of laboratory, clinical and translational research across Europe will ensure the best chance to develop novel and successful interventions and therapeutic outcomes.