Sivori Francesca, Cavallo Ilaria, Truglio Mauro, Pelagalli Lorella, Mariani Valerio, Fabrizio Giorgia, Abril Elva, Santino Iolanda, Fradiani Piera Assunta, Solmone Mariacarmela, Pimpinelli Fulvia, Toma Luigi, Arcioni Roberto, De Blasi Roberto Alberto, Di Domenico Enea Gino
Microbiology and Virology Unit, San Gallicano Dermatological Institute, IRCCS, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy.
Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCR), Mascate, Oman.
Microbiol Spectr. 2024 Oct 29;12(12):e0168324. doi: 10.1128/spectrum.01683-24.
is a predominant cause of infections in individuals with spinal cord stimulation (SCS) devices. Biofilm formation complicates these infections, commonly requiring both surgical and antibiotic treatments. This study explored the biofilm matrix composition and antimicrobial susceptibility of planktonic and biofilm-growing isolates from individuals with SCS-related infections. Whole-genome sequencing (WGS) examined genotypes, virulome, resistome, and the pan-genome structure. The study also analyzed biofilm matrix composition, early surface adhesion, hemolytic activity, and antibiotic-susceptibility testing. WGS revealed genetic diversity among isolates. One isolate, though oxacillin susceptible, contained the A gene. The median number of virulence factor genes per isolate was 58. All isolates harbored the biofilm-related A/D genes. When assessing phenotypic characteristics, all strains demonstrated the ability to form biofilms . The antimicrobial susceptibility profile indicated that oxacillin, rifampin, and teicoplanin showed the highest efficacy against biofilm. Conversely, high biofilm tolerance was observed for vancomycin, trimethoprim/sulfamethoxazole, and levofloxacin. These findings suggest that isolates are highly virulent and produce robust biofilms. In cases of suspected biofilm infections caused by , vancomycin should not be the primary choice due to its low activity against biofilm. Instead, oxacillin, rifampin, and teicoplanin appear to be more effective options to manage SCS infections.IMPORTANCESCS devices are increasingly used to manage chronic pain, but infections associated with these devices, particularly those caused by , present significant clinical challenges. These infections are often complicated by biofilm formation, which protects bacteria from immune responses and antibiotic treatments, making them difficult to eradicate. Understanding the genetic diversity, virulence, and biofilm characteristics of isolates from SCS infections is critical to improving treatment strategies. Our study highlights the need to reconsider commonly used antibiotics like vancomycin, which shows reduced activity against biofilm-growing cells. Identifying more effective alternatives, such as oxacillin, rifampin, and teicoplanin, provides valuable insight for clinicians when managing biofilm-related infections in patients with SCS implants. This research contributes to the growing evidence that biofilm formation is crucial in treating device-related infections, emphasizing the importance of tailoring antimicrobial strategies to the biofilm phenotype.
是脊髓刺激（SCS）装置使用者感染的主要原因。生物膜形成使这些感染变得复杂，通常需要手术和抗生素治疗。本研究探讨了来自SCS相关感染患者的浮游菌和生物膜生长菌分离株的生物膜基质组成和抗菌药敏性。全基因组测序（WGS）检测了基因型、毒力组、耐药组和泛基因组结构。该研究还分析了生物膜基质组成、早期表面黏附、溶血活性和抗生素药敏试验。WGS揭示了分离株之间的遗传多样性。一株分离株虽然对苯唑西林敏感，但含有A基因。每个分离株毒力因子基因的中位数为58。所有分离株都含有与生物膜相关的A/D基因。在评估表型特征时，所有菌株都表现出形成生物膜的能力。抗菌药敏谱表明，苯唑西林、利福平和替考拉宁对生物膜的疗效最高。相反，观察到万古霉素、甲氧苄啶/磺胺甲恶唑和左氧氟沙星对生物膜的耐受性较高。这些发现表明，分离株具有高毒力并能产生强大的生物膜。在由……引起的疑似生物膜感染病例中，由于万古霉素对生物膜的活性较低，不应将其作为首选药物。相反，苯唑西林、利福平和替考拉宁似乎是治疗SCS感染更有效的选择。重要性SCS装置越来越多地用于治疗慢性疼痛，但与这些装置相关的感染，特别是由……引起的感染，带来了重大的临床挑战。这些感染常常因生物膜形成而变得复杂，生物膜形成可保护细菌免受免疫反应和抗生素治疗的影响，使其难以根除。了解SCS感染分离株的遗传多样性、毒力和生物膜特征对于改进治疗策略至关重要。我们的研究强调需要重新考虑常用抗生素，如万古霉素，其对生物膜生长细胞的活性降低。确定更有效的替代药物，如苯唑西林、利福平和替考拉宁，为临床医生在治疗SCS植入患者的生物膜相关……感染时提供了有价值的见解。这项研究为越来越多的证据做出了贡献，即生物膜形成在治疗装置相关感染中至关重要，强调了根据生物膜表型调整抗菌策略的重要性。
