Virulence Factors Support Voriconazole Effects on .

and are pathogens that are associated with deterioration of lung function, e.g., in persons with cystic fibrosis (CF). There is evidence that co-infections with these pathogens cause airway inflammation and aggravate pathology in CF lungs. Intermicrobial competition of and has been described, but it is unknown how anti-fungal therapy is affected. The anti-fungal azole voriconazole (VCZ), supernatants of laboratory isolates PA14 or PAO1, or clinical isolate Pa10 independently inhibited biofilm metabolism of isolates 10AF and AF13073. When VCZ and supernatants were combined at their ICs, synergistic effects on were found. Synergistic effects were no longer observed when supernatants were prepared in the presence of iron, or when mutants were lacking the ability to produce pyoverdine and pyochelin. Combination of pure products pyoverdine, pyochelin, and pyocyanin with VCZ showed synergistic anti-fungal effects. Combining VCZ with supernatants also improved its MIC and MFC against planktonic . In summary, in the case of - co-infections, it appeared that the co-infection facilitated therapy of the ; lower concentrations of VCZ might be sufficient to control fungal growth.