Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA.
Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA.
Microbiol Spectr. 2023 Feb 14;11(1):e0288422. doi: 10.1128/spectrum.02884-22. Epub 2022 Dec 12.
Breast implant-associated infections (BIAIs) are the primary complication following placement of breast prostheses in breast cancer reconstruction. Given the prevalence of breast cancer, reconstructive failure due to infection results in significant patient distress and health care expenditures. Thus, effective BIAI prevention strategies are urgently needed. This study tests the efficacy of one infection prevention strategy: the use of a triple antibiotic pocket irrigant (TAPI) against Staphylococcus aureus, the most common cause of BIAIs. TAPI, which consists of 50,000 U bacitracin, 1 g cefazolin, and 80 mg gentamicin diluted in 500 mL of saline, is used to irrigate the breast implant pocket during surgery. We used and assays to test the efficacy of each antibiotic in TAPI, as well as TAPI at the concentration used during surgery. We found that planktonically grown S. aureus BIAI isolates displayed susceptibility to gentamicin, cefazolin, and TAPI. However, TAPI treatment enhanced biofilm formation of BIAI strains. Furthermore, we compared TAPI treatment of a S. aureus reference strain (JE2) to a BIAI isolate (117) in a mouse BIAI model. TAPI significantly reduced infection of JE2 at 1 and 7 days postinfection (dpi). In contrast, BIAI strain 117 displayed high bacterial burdens in tissues and implants, which persisted to 14 dpi despite TAPI treatment. Lastly, we demonstrated that TAPI was effective against Pseudomonas aeruginosa reference (PAO1) and BIAI strains and Together, these data suggest that S. aureus BIAI strains employ unique mechanisms to resist antibiotic prophylaxis treatment and promote chronic infection. The incidence of breast implant associated infections (BIAIs) following reconstructive surgery postmastectomy remains high, despite the use of prophylactic antibiotic strategies. Thus, surgeons have begun using additional antibiotic-based prevention strategies, including triple antibiotic pocket irrigants (TAPIs). However, these strategies fail to reduce BIAI rates for these patients. To understand why these therapies fail, we assessed the antimicrobial resistance patterns of Staphylococcus aureus strains, the most common cause of BIAI, to the antibiotics in TAPI (bacitracin, cefazolin, and gentamicin). We found that while clinically relevant BIAI isolates were more susceptible to the individual antibiotics compared to a reference strain, TAPI was effective at killing all the strains . However, in a mouse model, the BIAI isolates displayed recalcitrance to TAPI, which contrasted with the reference strain, which was susceptible. These data suggest that strains causing BIAI may encode specific recalcitrance mechanisms not present within reference strains.
乳房植入物相关感染(BIAI)是乳腺癌重建后放置乳房假体的主要并发症。鉴于乳腺癌的高发率,感染导致的重建失败会给患者带来极大的痛苦和医疗支出。因此,迫切需要有效的 BIAI 预防策略。本研究测试了一种感染预防策略的效果:使用包含 50,000 U 杆菌肽、1 g 头孢唑林和 80mg 庆大霉素的三重抗生素口袋灌洗液(TAPI)来预防金黄色葡萄球菌(BIAI 最常见的病因)感染。TAPI 在手术过程中用于冲洗乳房植入物口袋。我们使用 和 测定来测试 TAPI 中每种抗生素以及手术中使用的 TAPI 浓度的功效。我们发现,浮游生长的金黄色葡萄球菌 BIAI 分离株对庆大霉素、头孢唑林和 TAPI 敏感。然而,TAPI 处理增强了 BIAI 菌株的生物膜形成。此外,我们比较了 TAPI 处理金黄色葡萄球菌参考株(JE2)和 BIAI 分离株(117)在小鼠 BIAI 模型中的效果。TAPI 显著降低了 JE2 在感染后 1 天和 7 天的感染。相比之下,BIAI 菌株 117 在组织和植入物中仍具有较高的细菌负荷,尽管进行了 TAPI 治疗,但仍持续到 14 天。最后,我们证明 TAPI 对铜绿假单胞菌参考株(PAO1)和 BIAI 株 和 均有效。这些数据表明,金黄色葡萄球菌 BIAI 菌株采用独特的机制来抵抗抗生素预防治疗并促进慢性感染。尽管使用了预防性抗生素策略,乳房植入物相关感染(BIAI)在乳房重建手术后仍然很高。因此,外科医生开始使用额外的抗生素预防策略,包括三重抗生素口袋灌洗液(TAPIs)。然而,这些策略并不能降低这些患者的 BIAI 发生率。为了了解这些治疗方法为何失败,我们评估了引起 BIAI 的金黄色葡萄球菌菌株对抗生素的耐药模式,这些抗生素是 TAPI(杆菌肽、头孢唑林和庆大霉素)的成分。我们发现,与参考株相比,临床相关的 BIAI 分离株对单个抗生素的敏感性更高,但 TAPI 能有效杀死所有菌株。然而,在小鼠模型中,BIAI 分离株对 TAPI 表现出耐药性,而参考株则对 TAPI 敏感。这些数据表明,引起 BIAI 的菌株可能编码了参考株中不存在的特定耐药机制。
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