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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.
The global rise of antibiotic resistance has made the proper use of disinfectants more important than ever. Their application in clinical l settings is an integral part of antibiotics stewardship by preventing the occurrence and spread of infections. However, improper use of disinfectants also harbours the risk for the evolution of tolerance and resistance to disinfectants, but also to antibiotics. It is therefore crucial to understand whether and how bacteria can survive chemical disinfection and which conditions facilitate the evolution of tolerance and resistance.
Here, we study the heterogeneity in the response of isogenic E. coli populations exposed to different levels of commonly used disinfectants. At concentrations below the minimal inhibitory concentration (MIC), we find that certain disinfectants induce prolonged lag times in individual cells, a phenotype that has been associated with persistence against antibiotics. At concentrations above the MIC, we find heterogeneous killing for a range of the tested substances. Interestingly, for the three cationic surfactants that were tested, we find kill kinetics revealing the presence of a tolerant subpopulation that can withstand disinfection longer than most of the population. We will present results from an ongoing evolution experiment in which we test the potential for evolution of population-wide tolerance and resistance through intermittent exposure to lethal doses of a cationic surfactant.