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. 2017 Jul 18;8(4):e00873-17.
doi: 10.1128/mBio.00873-17.

Pseudomonas aeruginosa Alters Staphylococcus aureus Sensitivity to Vancomycin in a Biofilm Model of Cystic Fibrosis Infection

Affiliations

Pseudomonas aeruginosa Alters Staphylococcus aureus Sensitivity to Vancomycin in a Biofilm Model of Cystic Fibrosis Infection

Giulia Orazi et al. mBio. .

Abstract

The airways of cystic fibrosis (CF) patients have thick mucus, which fosters chronic, polymicrobial infections. Pseudomonas aeruginosa and Staphylococcus aureus are two of the most prevalent respiratory pathogens in CF patients. In this study, we tested whether P. aeruginosa influences the susceptibility of S. aureus to frontline antibiotics used to treat CF lung infections. Using our in vitro coculture model, we observed that addition of P. aeruginosa supernatants to S. aureus biofilms grown either on epithelial cells or on plastic significantly decreased the susceptibility of S. aureus to vancomycin. Mutant analyses showed that 2-n-heptyl-4-hydroxyquinoline N-oxide (HQNO), a component of the P. aeruginosa Pseudomonas quinolone signal (PQS) system, protects S. aureus from the antimicrobial activity of vancomycin. Similarly, the siderophores pyoverdine and pyochelin also contribute to the ability of P. aeruginosa to protect S. aureus from vancomycin, as did growth under anoxia. Under our experimental conditions, HQNO, P. aeruginosa supernatant, and growth under anoxia decreased S. aureus growth, likely explaining why this cell wall-targeting antibiotic is less effective. P. aeruginosa supernatant did not confer additional protection to slow-growing S. aureus small colony variants. Importantly, P. aeruginosa supernatant protects S. aureus from other inhibitors of cell wall synthesis as well as protein synthesis-targeting antibiotics in an HQNO- and siderophore-dependent manner. We propose a model whereby P. aeruginosa causes S. aureus to shift to fermentative growth when these organisms are grown in coculture, leading to reduction in S. aureus growth and decreased susceptibility to antibiotics targeting cell wall and protein synthesis.IMPORTANCE Cystic fibrosis (CF) lung infections are chronic and difficult to eradicate. Pseudomonas aeruginosa and Staphylococcus aureus are two of the most prevalent respiratory pathogens in CF patients and are associated with poor patient outcomes. Both organisms adopt a biofilm mode of growth, which contributes to high tolerance to antibiotic treatment and the recalcitrant nature of these infections. Here, we show that P. aeruginosa exoproducts decrease the sensitivity of S. aureus biofilm and planktonic populations to vancomycin, a frontline antibiotic used to treat methicillin-resistant S. aureus in CF patients. P. aeruginosa also protects S. aureus from other cell wall-active antibiotics as well as various classes of protein synthesis inhibitors. Thus, interspecies interactions can have dramatic and unexpected consequences on antibiotic sensitivity. This study underscores the potential impact of interspecies interactions on antibiotic efficacy in the context of complex, polymicrobial infections.

Keywords: Pseudomonas; Staphylococcus aureus; antibiotic tolerance; biofilms; cystic fibrosis; polymicrobial.

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Figures

FIG 1
FIG 1
P. aeruginosa protects S. aureus biofilm and planktonic populations from vancomycin. (A to D) Biofilm disruption assays on plastic were performed with S. aureus (Sa) Newman (A) and USA300 (B), P. aeruginosa PA14 supernatant (Pa sup), and vancomycin at 50 μg/ml. S. aureus biofilm (A and B) and planktonic (C and D) CFU were determined. Data in panels A and C and B and D were from the same experiments. Each column displays the average from at least three biological replicates, each with three technical replicates. Error bars indicate standard deviation (SD). **, P < 0.01, and ***, P < 0.001, by ordinary one-way analysis of variance (ANOVA) and Tukey’s multiple comparisons posttest. bd, below detection.
FIG 2
FIG 2
Kinetics of S. aureus biofilm and planktonic populations in the presence of P. aeruginosa supernatant and vancomycin. (A to D) Biofilm disruption assays on plastic were performed with S. aureus (Sa) Newman (A and C) or USA300 (B and D), P. aeruginosa PA14 supernatant (Pa sup), and vancomycin (Vanc) at 50 μg/ml. S. aureus biofilm (A and B) and planktonic (C and D) CFU were determined. Data in panels A and C and B and D were from the same experiments. Each time point displays the average from two biological replicates, each with three technical replicates. Error bars indicate SD.
FIG 3
FIG 3
P. aeruginosa protects S. aureus biofilms from vancomycin on CFBE cells. (A and B) Representative images of S. aureus microcolonies on CFBE cells 6 h p.i. (A) and 21 h p.i. (B). White arrows indicate microcolonies. (C) Representative image of mixed-species microcolonies composed of S. aureus (red, DsRed expressing) and P. aeruginosa (green, green fluorescent protein [GFP] expressing) on CFBE cells 6 h p.i. (D) Cytotoxicity of S. aureus (Sa) Newman and/or P. aeruginosa PA14 supernatants (Pa sup) either undiluted (1×) or diluted 1/16× on CFBE cells. Cytotoxicity is normalized to total LDH release. (E) Biofilm disruption assays on CFBE cells were performed with S. aureus Newman, P. aeruginosa PA14 supernatant diluted 1/16×, and vancomycin (Vanc) at 50 μg/ml. Each column displays the average from at least three biological replicates, each with three technical replicates. Error bars indicate SD. ns, not significant.
FIG 4
FIG 4
HQNO and pyoverdine quantification. (A and B) The amounts of HQNO and pyoverdine in supernatants from wild-type P. aeruginosa PA14 (Pa) grown either on CFBE cells or on plastic were determined. (A) Levels of HQNO were determined using a standard curve relating the HQNO concentration to S. aureus CFU following coculture with a P. aeruginosa PA14 ΔpqsL ΔpvdA ΔpchE deletion mutant. (B) The levels of pyoverdine were determined by measuring absorbance at 405 nm. Each column displays the average from two biological replicates, each with three technical replicates. Error bars indicate SD.
FIG 5
FIG 5
Exogenous HQNO protects S. aureus biofilms from vancomycin. (A and B) Biofilm disruption assays on plastic were performed with S. aureus (Sa) Newman (A) or USA300 (B), vancomycin (Vanc) at 50 μg/ml, and the specified concentrations of HQNO (dissolved in DMSO). Each column displays the average from at least three biological replicates, each with three technical replicates. Error bars indicate SD. ns, not significant; *, P < 0.05, **, P < 0.01, and ***, P < 0.001, by ordinary one-way ANOVA and Tukey’s multiple comparisons posttest.
FIG 6
FIG 6
Anoxia protects S. aureus biofilms from vancomycin. (A and B) Biofilm disruption assays on plastic were performed with S. aureus (Sa) Newman (A) or USA300 (B), P. aeruginosa PA14 (Pa) wild-type (WT) and ΔpqsLΔ pvdA ΔpchE deletion mutant supernatants, and vancomycin at 50 μg/ml under either normoxic or anoxic conditions. Each column displays the average from at least three biological replicates, each with three technical replicates. Error bars indicate SD. ns, not significant; *, P < 0.05, **, P < 0.01, and ***, P < 0.001, by ordinary one-way ANOVA and Tukey’s multiple comparisons posttest.
FIG 7
FIG 7
P. aeruginosa supernatant decreases S. aureus growth. (A and B) Growth curve assays of planktonic populations in shaking flasks were performed with S. aureus (Sa) Newman, HQNO at 100 μg/ml, and P. aeruginosa PA14 (Pa) wild-type (WT) and ΔpqsL ΔpvdA ΔpchE deletion mutant supernatants. Samples were collected either every 2 h from 0 to 10 h p.i. (A) or every 2 h from 12 h to 24 h p.i. (B). Each time point displays the average from at least three biological replicates, each with two technical replicates. Error bars indicate SD. (C) Planktonic susceptibility assays in shaking flasks were performed with S. aureus (Sa) Newman, P. aeruginosa PA14 supernatant (Pa sup), and 50 μg/ml of vancomycin. Each column displays the average from at two biological replicates, each with two technical replicates. Error bars indicate SD. *, P < 0.05 by ordinary one-way ANOVA and Tukey’s multiple comparisons posttest.
FIG 8
FIG 8
S. aureus small-colony variant biofilms are tolerant to vancomycin independent of P. aeruginosa supernatant. (A and B) Biofilm disruption assays on plastic were performed with S. aureus (Sa) Col, P. aeruginosa PA14 supernatant (Pa sup), and vancomycin. (A) The S. aureus Col hemB mutant was exposed to 250 μg/ml of vancomycin. (B) The S. aureus Col parental strain was exposed to 50 μg/ml of vancomycin. Each column displays the average from at least three biological replicates, each with three technical replicates. Error bars indicate SD. ns, not significant; **, P < 0.01, and ***, P < 0.001, by ordinary one-way ANOVA and Tukey’s multiple comparisons posttest.

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