In-host evolution of Staphylococcus epidermidis in a pacemaker-associated endocarditis resulting in increased antibiotic tolerance

Vanina Dengler Haunreiter, Mathilde Boumasmoud, Nicola Häffner, Dennis Wipfli, Nadja Leimer, Carole Rachmühl, Denise Kühnert, Yvonne Achermann, Reinhard Zbinden, Stefano Benussi, Clement Vulin and Annelies S. Zinkernagel ()
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Vanina Dengler Haunreiter: University Hospital Zurich, University of Zurich
Mathilde Boumasmoud: University Hospital Zurich, University of Zurich
Nicola Häffner: University Hospital Zurich, University of Zurich
Dennis Wipfli: University Hospital Zurich, University of Zurich
Nadja Leimer: University Hospital Zurich, University of Zurich
Carole Rachmühl: University Hospital Zurich, University of Zurich
Denise Kühnert: University Hospital Zurich, University of Zurich
Yvonne Achermann: University Hospital Zurich, University of Zurich
Reinhard Zbinden: University of Zurich
Stefano Benussi: University Heart Center, University Hospital Zurich, University of Zurich
Clement Vulin: Institute of Biogeochemistry and Pollutant Dynamics, ETH Zurich
Annelies S. Zinkernagel: University Hospital Zurich, University of Zurich

Nature Communications, 2019, vol. 10, issue 1, 1-14

Abstract: Abstract Treatment failure in biofilm-associated bacterial infections is an important healthcare issue. In vitro studies and mouse models suggest that bacteria enter a slow-growing/non-growing state that results in transient tolerance to antibiotics in the absence of a specific resistance mechanism. However, little clinical confirmation of antibiotic tolerant bacteria in patients exists. In this study we investigate a Staphylococcus epidermidis pacemaker-associated endocarditis, in a patient who developed a break-through bacteremia despite taking antibiotics to which the S. epidermidis isolate is fully susceptible in vitro. Characterization of the clinical S. epidermidis isolates reveals in-host evolution over the 16-week infection period, resulting in increased antibiotic tolerance of the entire population due to a prolonged lag time until growth resumption and a reduced growth rate. Furthermore, we observe adaptation towards an increased biofilm formation capacity and genetic diversification of the S. epidermidis isolates within the patient.

Date: 2019
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DOI: 10.1038/s41467-019-09053-9

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