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Microorganisms 2016, 4(3), 36;

Streptokinase Treatment Reverses Biofilm-Associated Antibiotic Resistance in Staphylococcus aureus

Interdisciplinary Nanoscience Center, Aarhus University, 8000 Aarhus C, Denmark
Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark
Department of Veterinary Disease Biology, University of Copenhagen, 1870 Frederiksberg C, Denmark
Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark
Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark
Author to whom correspondence should be addressed.
Academic Editor: John E. Gustafson
Received: 7 July 2016 / Revised: 7 September 2016 / Accepted: 14 September 2016 / Published: 20 September 2016
(This article belongs to the Special Issue The Biofilm Matrix)
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Biofilms formed by Staphylococcus aureus is a serious complication to the use of medical implants. A central part of the pathogenesis relies on S. aureus’ ability to adhere to host extracellular matrix proteins, which adsorb to medical implants and stimulate biofilm formation. Being coagulase positive, S. aureus furthermore induces formation of fibrin fibers from fibrinogen in the blood. Consequently, we hypothesized that fibrin is a key component of the extracellular matrix of S. aureus biofilms under in vivo conditions, and that the recalcitrance of biofilm infections can be overcome by combining antibiotic treatment with a fibrinolytic drug. We quantified S. aureus USA300 biofilms grown on peg-lids in brain heart infusion (BHI) broth with 0%–50% human plasma. Young (2 h) and mature (24 h) biofilms were then treated with streptokinase to determine if this lead to dispersal. Then, the minimal biofilm eradication concentration (MBEC) of 24 h old biofilms was measured for vancomycin and daptomycin alone or in combination with 10 µg/mL rifampicin in the presence or absence of streptokinase in the antibiotic treatment step. Finally, biofilms were visualized by confocal laser scanning microscopy. Addition of human plasma stimulated biofilm formation in BHI in a dose-dependent manner, and biofilms could be partially dispersed by streptokinase. The biofilms could be eradicated with physiologically relevant concentrations of streptokinase in combination with rifampicin and vancomycin or daptomycin, which are commonly used antibiotics for treatment of S. aureus infections. Fibronolytic drugs have been used to treat thromboembolic events for decades, and our findings suggest that their use against biofilm infections has the potential to improve the efficacy of antibiotics in treatment of S. aureus biofilm infections. View Full-Text
Keywords: USA300; biofilm; human plasma; fibrinolysis; MBEC USA300; biofilm; human plasma; fibrinolysis; MBEC

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Jørgensen, N.P.; Zobek, N.; Dreier, C.; Haaber, J.; Ingmer, H.; Larsen, O.H.; Meyer, R.L. Streptokinase Treatment Reverses Biofilm-Associated Antibiotic Resistance in Staphylococcus aureus. Microorganisms 2016, 4, 36.

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