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Introduction: Biofilms are regarded as a common cause of chronic infections on medical devices. Preventive and therapeutic strategies against biofilm infections commonly involve applications of multiple antimicrobial substances: antimicrobial coatings on the implanted biomaterials in combination with systemically administered antibiotics. While this practice of combination therapy harbours the risk of developing cross-resistance, it might also provide the possibility to implement specific antimicrobial-antibiotic combinations (AACs) that can slow down the selection of antibiotic resistant strains.
Hypothesis and aims: Specific AACs can exert combinatorial effects on the growth of susceptible and antibiotic-resistant Pseudomonas aeruginosa that either suppress or increase their individual effects.
Our aim is to identify AACs with antagonistic or synergistic effects on pseudomonal biofilms and to understand their impact on selection of resistant strains. Specifically, we want to identify AACs that select for and against antibiotic resistance during biofilm formation.
Methodology: We screened for AACs that cause antagonistic or synergistic effects on planktonic P. aeruginosa.
To study the effect of antimicrobial-antibiotic exposure on resistance selection in bacterial biofilms, we will grow resistant and sensitive strains on PDMS surfaces with and without antimicrobial coatings and expose them to antibiotics.
Results: Several combinations with synergistic or antagonistic interaction on the growth rate of P. aeruginosa were detected. We observed a strong antagonism when combining the antimicrobial substance chlorhexidine with the carbapenem drug meropenem. A meropenem-resistant mutant showed a selection advantage in low concentrations of chlorhexidine combined with a sub-inhibitory concentration of meropenem over the wild-type. No antagonistic effect was observed for the same combination when E. coli was exposed to chlorhexidine and meropenem, suggesting a non-chemical basis for the observed effect on P. aeruginosa.
Conclusion: Gaining a better understanding about resistance selection during biofilm formation on biomedical surfaces will enable us to mitigate against biofilm-associated antimicrobial resistance.
Antimicrobials can exert specific physiological effects when used in combination that are different from those when applied alone. 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 effects of combinations of antibiotics (meropenem, gentamicin, and ciprofloxacin) and substances used as biocides or antiseptics [octenidine, benzalkonium chloride, cetrimonium bromide, chlorhexidine, Povidone-iodine, silver nitrate (AgNO3), and Ag-nanoparticles] on the planktonic growth rate of Pseudomonas aeruginosa. Combination effects were investigated in growth experiments in microtiter plates at different concentrations and the Bliss interaction scores were calculated. Among the 21 screened combinations, we find prevalent combination effects with synergy occurring six 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). In conclusion, antibiotics and biocides or antiseptics exert physiological combination effects on the pathogen P. aeruginosa. These effects have consequences for the efficacy of both types of substances and potentially for the selection of antimicrobial resistant strains in clinical applications with combined exposure (e.g., wound care and coated biomaterials).