Role of extracellular polymeric substances in polymicrobial biofilm infections of Staphylococcus epidermidis and Candida albicans modelled in the nematode Caenorhabditis elegans.

Biofilms are formed by communities of microorganisms living in a self-produced extracellular polymeric matrix attached to a surface. When living in a biofilm microorganisms change phenotype and thus are less susceptible to antibiotic treatment and biofilm infections can become severe. The aim of this study was to determine if the presence of multikingdom microorganisms alters the virulence of a biofilm infection in a host organism. The coexistence of Candida albicans and Staphylococcus epidermidis in biofilm was examined in the nematode model Caenorhabditis elegans. It was evaluated if the hyphal form of C. albicans and extracellular polymeric substances (EPS) formed by S. epidermidis increases biofilm virulence. Survival assays were performed, where C. elegans nematodes were exposed to S. epidermidis and C. albicans. Single inoculation assays showed a decreased survival rate after 2 days following exposure, while dual inoculation assays showed that a clinical S. epidermidis strain together with C. albicans significantly increased the virulence and decreased nematode survival. EPS seem to interfere with the bacterial attachment to hyphae, since the EPS overproducing S. epidermidis strain was most virulent. The clinical S. epidermidis paired with C. albicans led to a severe infection in the nematodes resulting in reduced survival.