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[万古霉素和达托霉素对凝固酶阴性葡萄球菌菌株生物膜形成的体外作用]

[In vitro effect of vancomycin and daptomycin on biofilm formation of coagulase-negative staphylococci strains].

作者信息

Öcal Duygu Nilüfer, Dolapçı İştar, Gençtürk Zeynep, Tekeli Alper

机构信息

University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Department of Medical Microbiology, Ankara, Turkey.

出版信息

Mikrobiyol Bul. 2017 Jul;51(3):220-235. doi: 10.5578/mb.57435.

Abstract

Coagulase-negative staphylococci (CNS) are one of the primer agents of blood stream infections (BSI) and catheter-related bloodstream infections (CR-BSI) which are associated mostly with the usage of central venous catheters and, important causes of morbidity and mortality despite the usage of antibacterial and supportive treatment. It is important to determine the properties of these causative microorganisms in order to make appropriate treatment of such infections. The aims of our study were to evaluate the biofilm formation of coagulase negative staphylococci (CNS) which were causative agents of bloodstream (BSI) and catheter related bloodstream infections (CR-BSI), to determine the minimum inhibitory concentration (MIC) of planktonic forms and minimal biofilm eradication concentration (MBEC) of sessile forms for vancomycin and daptomycin and to evaluate the efficacy of these antibiotics in infections with biofilm-forming isolates in vitro. A total of 65 CoNS (n= 26 catheter colonizers, n= 28 CR-BSI, n= 11 BSI agents) were identified by conventional methods and also with BD Phoenix (Becton Dickinson, USA) and Bruker Microflex MS (Bruker Daltonics, Germany) systems. Methicillin resistance was determined by the presence of mecA gene with PCR. MIC values of vancomycin and daptomycin were investigated by broth microdilution, for daptomycin medium containing 25 and 50 μg/ml Ca++ were used. Assessment of biofilm formation and detection of MBEC were determined by microplate method. The clonal relationship was investigated by the PFGE method. A total of 65 isolates; 26 catheter colonizers, 28 CR-BSI agents and 11 BSI agents were evaluated and identified as Staphylococcus epidermidis (n= 33), Staphylococcus haemolyticus (n= 16), Staphylococcus hominis (n= 15), and Staphylococcus capitis (n= 1). 81.5% of the isolates were found to be methicillin resistant and all of them were found to be sensitive to vancomycin (MIC= 0.125-4 μg/ml) and daptomycin (MIC= 0.062-0.25 μg/ml in 25 μg/ml Ca++ and MIC= 0.031-0.50 μg/ml in 50 μg/ml Ca++ containing medium). MIC values were lower in medium containing 50 μg/ml Ca++ for daptomycin. As it is known that the efficacy of daptomycin depends on the physiological levels of Ca++, which causes conformational changes in the structure of these antibacterials. Our findings also suggested that high levels of Ca++ are needed to ensure the efficacy of daptomycin. All of the isolates produced biofilm at different strengths of positivity (n= 12/18.5% weak, n= 35/%53.8 moderate, n= 18/%27.7 strong). MBEC and MBEC/MIC values for vancomycin were found to be higher than daptomycin (p< 0.001). Strong biofilm producers had higher MBEC and MBEC/MIC, MBEC50/MIC50 ve MBEC90/MIC90 values (p< 0.05). Especially in infections with biofilm forming isolates, the detection of only MIC values are not always sufficient in the treatment of biofilm-related infections as they reflect the sensitivity of planktonic bacteria. The inconsistency between the MIC and MBEC values and the high rates of MBEC/MIC found in our study supported this prediction.The lower detection of MBEC and MBEC/MIC values of daptomycin compared to the same values of vancomycin suggested that daptomycin might be effective at lower doses than vancomycin in the treatment of biofilm infections.

摘要

凝固酶阴性葡萄球菌(CNS)是血流感染(BSI)和导管相关血流感染(CR-BSI)的主要病原体之一,这些感染大多与中心静脉导管的使用有关,并且尽管使用了抗菌和支持治疗,仍是发病和死亡的重要原因。确定这些致病微生物的特性对于恰当治疗此类感染很重要。我们研究的目的是评估作为血流感染(BSI)和导管相关血流感染(CR-BSI)病原体的凝固酶阴性葡萄球菌(CNS)的生物膜形成情况,确定浮游形式的万古霉素和达托霉素的最低抑菌浓度(MIC)以及固着形式的最低生物膜清除浓度(MBEC),并评估这些抗生素在体外对形成生物膜分离株感染的疗效。通过传统方法以及BD Phoenix(美国BD公司)和布鲁克Microflex MS(德国布鲁克道尔顿公司)系统共鉴定出65株凝固酶阴性葡萄球菌(n = 26导管定植菌,n = 28 CR-BSI,n = 11 BSI病原体)。通过PCR检测mecA基因来确定耐甲氧西林情况。采用肉汤微量稀释法研究万古霉素和达托霉素的MIC值,对于达托霉素使用含25和50μg/ml Ca++的培养基。通过微孔板法评估生物膜形成并检测MBEC。采用脉冲场凝胶电泳(PFGE)方法研究克隆关系。共评估了65株分离株;26株导管定植菌、28株CR-BSI病原体和11株BSI病原体,并鉴定为表皮葡萄球菌(n = 33)、溶血葡萄球菌(n = 16)、人葡萄球菌(n = 15)和头葡萄球菌(n = 1)。发现81.5%的分离株耐甲氧西林,并且所有分离株对万古霉素(MIC = 0.125 - 4μg/ml)和达托霉素(在含25μg/ml Ca++的培养基中MIC = 0.062 - 0.25μg/ml,在含50μg/ml Ca++的培养基中MIC = 0.031 - 0.50μg/ml)敏感。对于达托霉素,在含50μg/ml Ca++的培养基中MIC值较低。众所周知,达托霉素的疗效取决于Ca++的生理水平,Ca++会导致这些抗菌药物结构发生构象变化。我们的研究结果还表明需要高水平的Ca++来确保达托霉素的疗效。所有分离株均产生不同强度阳性的生物膜(n = 12/18.5%弱,n = 35/53.8%中度,n = 18/27.7%强)。发现万古霉素的MBEC和MBEC/MIC值高于达托霉素(p < 0.001)。强生物膜产生菌具有更高的MBEC和MBEC/MIC、MBEC50/MIC50以及MBEC90/MIC90值(p < 0.05)。特别是在由形成生物膜分离株引起的感染中,仅检测MIC值在治疗生物膜相关感染时并不总是足够的,因为它们反映的是浮游细菌的敏感性。我们研究中发现的MIC和MBEC值之间的不一致以及高比例的MBEC/MIC支持了这一预测。与万古霉素的相同值相比,达托霉素的MBEC和MBEC/MIC值较低,这表明在治疗生物膜感染时,达托霉素可能比万古霉素在更低剂量下有效。

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