Staphylococcus epidermidis Phages Transduce Antimicrobial Resistance Plasmids and Mobilize Chromosomal Islands.

Staphylococcus epidermidis is a leading opportunistic pathogen causing nosocomial infections that is notable for its ability to form a biofilm and for its high rates of antibiotic resistance. It serves as a reservoir of multiple antimicrobial resistance genes that spread among the staphylococcal population by horizontal gene transfer such as transduction. While phage-mediated transduction is well studied in Staphylococcus aureus, S. epidermidis transducing phages have not been described in detail yet. Here, we report the characteristics of four phages, 27, 48, 456, and 459, previously used for S. epidermidis phage typing, and the newly isolated phage E72, from a clinical S. epidermidis strain. The phages, classified in the family Siphoviridae and genus Phietavirus, exhibited an S. epidermidis-specific host range, and together they infected 49% of the 35 strains tested. A whole-genome comparison revealed evolutionary relatedness to transducing S. aureus phietaviruses. In accordance with this, all the tested phages were capable of transduction with high frequencies up to 10-4 among S. epidermidis strains from different clonal complexes. Plasmids with sizes from 4 to 19 kb encoding resistance to streptomycin, tetracycline, and chloramphenicol were transferred. We provide here the first evidence of a phage-inducible chromosomal island transfer in S. epidermidis Similarly to S. aureus pathogenicity islands, the transfer was accompanied by phage capsid remodeling; however, the interfering protein encoded by the island was distinct. Our findings underline the role of S. epidermidis temperate phages in the evolution of S. epidermidis strains by horizontal gene transfer, which can also be utilized for S. epidermidis genetic studies.IMPORTANCE Multidrug-resistant strains of S. epidermidis emerge in both nosocomial and livestock environments as the most important pathogens among coagulase-negative staphylococcal species. The study of transduction by phages is essential to understanding how virulence and antimicrobial resistance genes spread in originally commensal bacterial populations. In this work, we provide a detailed description of transducing S. epidermidis phages. The high transduction frequencies of antimicrobial resistance plasmids and the first evidence of chromosomal island transfer emphasize the decisive role of S. epidermidis phages in attaining a higher pathogenic potential of host strains. To date, such importance has been attributed only to S. aureus phages, not to those of coagulase-negative staphylococci. This study also proved that the described transducing bacteriophages represent valuable genetic modification tools in S. epidermidis strains where other methods for gene transfer fail.

Study of the Interactions Between Bacteriophage phiIPLA-RODI and Four Chemical Disinfectants for the Elimination of Staphylococcus aureus Contamination.

Bacteriophages are currently considered as a promising alternative to antibiotics and disinfectants. However, the use of phages in different clinical and industrial settings will involve their exposure to other disinfectants. As a result, the outcome of the phage treatment will depend on two aspects derived from such interactions. On the one hand, the susceptibility of the phage to disinfectants at the concentrations used for disinfection and at lower residual concentrations needs to be determined. Additionally, the existence of synergistic or antagonistic interactions between phages and disinfectants would also affect the potential success of phage biocontrol applications. Here, we tested these effects for the antistaphylococcal phage phiIPLA-RODI by using four different disinfectants: benzalkonium chloride, triclosan, chlorhexidine and hydrogen peroxide. Our results highlight the differences between disinfectants regarding their effect on phage survival and antimicrobial properties. For instance, our data suggests that, out of the four disinfectants used, benzalkonium chloride would be the most adequate to use in settings where phages are to be applied. Nonetheless, this preliminary analysis grants the need for further studies with a larger number of disinfectants for the development of a phiIPLA-RODI-based product.

LysGH15 kills Staphylococcus aureus without being affected by the humoral immune response or inducing inflammation.

The lysin LysGH15, derived from the staphylococcal phage GH15, exhibits a wide lytic spectrum and highly efficient lytic activity against methicillin-resistant Staphylococcus aureus (MRSA). Here, we found that LysGH15 did not induce resistance in MRSA or methicillin-sensitive S. aureus (MSSA) strains after repeated treatment. Although LysGH15 triggered the generation of LysGH15-specific antibodies in mice, these antibodies did not block lytic activity in vitro (nor the binding capacity of LysGH15). More importantly, when the antibody titre was highest in mice immunized with LysGH15, a single intravenous injection of LysGH15 was sufficient to protect mice against lethal infection with MRSA. These results indicated that LysGH15-specific antibodies did not affect the killing efficiency of LysGH15 against MRSA in vitro or in vivo. LysGH15 also reduced pro-inflammatory cytokines in mice with lethal infections. Furthermore, a high-dose LysGH15 injection did not cause significant adverse effects or pathological changes in the main organs of treated animals. These results provide further evidence for the administration of LysGH15 as an alternative strategy for the treatment of infections caused by MRSA.

Effective removal of staphylococcal biofilms by the endolysin LysH5.

Staphylococcal biofilms are a major concern in both clinical and food settings because they are an important source of contamination. The efficacy of established cleaning procedures is often hindered due to the ability of some antimicrobial compounds to induce biofilm formation, and to the presence of persister cells, a small bacterial subpopulation that exhibits multidrug tolerance. Phage lytic enzymes have demonstrated antimicrobial activity against planktonic and sessile bacteria. However, their ability to lyse and/or select persister cells remains largely unexplored so far. In this work, the lytic activity of the endolysin LysH5 against Staphylococcus aureus and Staphylococcus epidermidis biofilms was confirmed. LysH5 reduced staphylococcal sessile cell counts by 1-3 log units, compared with the untreated control, and sub-inhibitory concentrations of this protein did not induce biofilm formation. LysH5-surviving cells were not resistant to the lytic activity of this protein, suggesting that no persister cells were selected. Moreover, to prove the lytic ability of LysH5 against this subpopulation, both S. aureus exponential cultures and persister cells obtained after treatment with rifampicin and ciprofloxacin were subsequently treated with LysH5. The results demonstrated that besides the notable activity of endolysin LysH5 against staphylococcal biofilms, persister cells were also inhibited, which raises new opportunities as an adjuvant for some antibiotics.

Stability of Staphylococcus aureus phage ISP after freeze-drying (lyophilization).

Staphylococcus aureus phage ISP was lyophilized, using an Amsco-Finn Aqua GT4 freeze dryer, in the presence of six different stabilizers at different concentrations. Stability of the lyophilized phage at 4 °C was monitored up to 37 months and compared to stability in Luria Bertani broth and physiological saline at 4 °C. Sucrose and trehalose were shown to be the best stabilizing additives, causing a decrease of only 1 log immediately after the lyophilization procedure and showing high stability during a 27 month storage period.

Methicillin-resistant Staphylococcus aureus phage plaque size enhancement using sublethal concentrations of antibiotics.

Phage therapy presents an alternative approach against the emerging methicillin-resistant Staphylococcus aureus (MRSA) threat. Some of the problems encountered during isolation of MRSA phages include the high prevalence of enteric phages in natural sources, nonspecific absorption of viable phage, and the formation of pinpoint or tiny plaques. The phage isolated in this study, MR-5, also formed tiny plaques against its host S. aureus ATCC 43300 (MRSA), making its detection and enumeration difficult. An improved method of increasing the plaque size of MRSA phage by incorporating sublethal concentrations of three different classes of antibiotics (inhibitors of protein synthesis) in the classical double-layer agar (DLA) method was investigated. The ß-lactam and quinolone antibiotics commonly employed in earlier studies for increasing the plaque size did not show any significant effect on the plaque size of isolated MR-5 phage. Linezolid (oxazolidinone class), tetracycline, and ketolide antibiotics brought significant enhancements (3 times the original size) in the plaque size of MR-5 phage. Prior treatment with these antibiotics resulted in significant reductions in the time of adsorption and the latent period of MR-5 phage. To rule out whether the action of linezolid (which brought the maximum increase in plaque size) was specific for a single phage only, its effect on the plaque size of seven other S. aureus-specific phages was also assessed. Significant enhancements in the plaque size of these phages were observed. These results indicate that this modification can therefore safely be incorporated in the traditional DLA overlay method to search for new MRSA-virulent phages.

Bioprocessing of bacteriophages via rapid drying onto microcrystals.

We present an alternative bioprocess for bacteriophages involving room temperature coprecipitation of an aqueous mixture of phage (Siphoviridae) and a crystallizable carrier (glutamine or glycine) in excess of water miscible organic solvent (isopropanol or isobutanol). The resultant suspension of phage-coated microcrystals can be harvested by filtration and the residual solvent removed rapidly by air-drying at a relative humidity of 75%. Albumin or trehalose added at 5% w/w of the crystalline carrier provide for better stabilization of the phage during co-precipitation. Free-flowing dry powders generated from an aqueous solution of phage (∼13 log(10) pfu/mL) can be reconstituted in the same aqueous volume to a phage titer of almost 10 log(10) pfu/mL; high enough to permit subsequent formulation steps following bioprocessing. The phage-coated microcrystals remain partially stable at room temperature for at least one month, which compares favorably with phage immobilized into polyester microcarriers or lyophilized with excipient (1-5% polyethylene glycol 6000 or 0.1-0.5 M sucrose). We anticipate that this bioprocessing technique will have application to other phage families as required for the development of phage therapies.

Ciprofloxacin and trimethoprim cause phage induction and virulence modulation in Staphylococcus aureus.

In Staphylococcus aureus strains of human origin, phages which integrate into the chromosomal gene coding for beta-hemolysin (hlb) are widely distributed. Most of them encode accessory virulence determinants such as staphylokinase (sak) or enterotoxins. Here, we analyzed the effects of ciprofloxacin and trimethoprim on phage induction and expression of phage-encoded virulence factors by using isolates from patients with cystic fibrosis for which the induction of hlb-converting phages was demonstrated in vivo (C. Goerke, S. Matias y Papenberg, S. Dasbach, K. Dietz, R. Ziebach, B. C. Kahl, and C. Wolz, J. Infect. Dis. 189:724-734, 2004) as well as a phi13 lysogen of phage-cured strain 8325-4. Treatment of lysogens with subinhibitory concentrations of either antibiotic resulted in (i) delysogenization of strains resembling the isolates picked up after chronic lung infection and (ii) replication of phages in the bacterial host in a dose-dependent manner. Ciprofloxacin treatment resulted in enhanced recA transcription, indicating involvement of the SOS response in phage mobilization. Induction of phi13 was linked to elevated expression of the phage-encoded virulence gene sak, chiefly due to the activation of latent phage promoters. In summary, we could show the induction of hlb-converting phages and a subsequent virulence modulation of the host bacterium by ciprofloxacin and trimethoprim.

Antibiotic-induced SOS response promotes horizontal dissemination of pathogenicity island-encoded virulence factors in staphylococci.

Although mobile genetic elements have a crucial role in spreading pathogenicity-determining genes among bacterial populations, environmental and genetic factors involved in the horizontal transfer of these genes are largely unknown. Here we show that SaPIbov1, a Staphylococcus aureus pathogenicity island that belongs to the growing family of these elements that are found in many strains, is induced to excise and replicate after SOS induction of at least three different temperate phages, 80alpha, phi11 and phi147, and is then packaged into phage-like particles and transferred at high frequency. SOS induction by commonly used fluoroquinolone antibiotics, such as ciprofloxacin, also results in replication and high-frequency transfer of this element, as well as of SaPI1, the prototypical island of S. aureus, suggesting that such antibiotics may have the unintended consequence of promoting the spread of bacterial virulence factors. Although the strains containing these prophages do not normally contain SaPIs, we have found that RF122-1, the original SaPIbov1-containing clinical isolate, contains a putative second pathogenicity island that is replicated after SOS induction, by antibiotic treatment, of the prophage(s) present in the strain. Although SaPIbov1 is not induced to replicate after SOS induction in this strain, it is transferred by the antibiotic-activated phages. We conclude that SOS induction by therapeutic agents can promote the spread of staphylococcal virulence genes.

Phenotypic and molecular characterization of community occurring, Western Samoan phage pattern methicillin-resistant Staphylococcus aureus.

In New Zealand, it is estimated that greater than half of the methicillin-resistant Staphylococcus aureus (MRSA) strains recovered from patients belong to what has been termed Western Samoan phage pattern types 1 and 2 (WSPP1, WSPP2). These strains differ from classical MRSA isolates in terms of their lack of multiresistance and community occurrence, suggesting that such strains possess properties and/or characteristics different from those of other MRSA. To address this hypothesis, 10 WSPP1 and WSPP2 isolates from Western Samoa, New Zealand and Australia were compared with common hospital MRSA isolates. All WSPP isolates were identical with regard to pulsed-field gel electrophoretic pattern of SmaI-digested DNA, coagulase gene restriction fragment length polymorphism pattern and localization of mecA to a 194 kb SmaI digestion fragment. The WSPP strains were no more resistant/sensitive to various environmental stresses (e.g. skin fatty acids, UV light, desiccation) compared with hospital epidemic MRSA strains, except for their higher tolerance to salt. In terms of virulence, the WSPP MRSA were quantitatively better at attaching to the epithelial cell line HEp2, were uniformly egg-yolk opacity factor negative and produced higher levels of haemolytic toxins compared with non-WSPP MRSA isolates.

[A comparative analysis of energy process inhibitors on the efficiency of phage infection in staphylococci]. / Sravnitel'nyi analiz vozdeistviia ingibitorov énergeticheskikh protsessov na éffektivnost' fagovoi infektsii u stafilokokkov.

The study of the effect of KCN, DCCD and CCCP as inhibitors of the energy yielding processes showed that the efficacy of phage infection depended on respiration, proton ATPase, and proton electrochemical potential of hydrogen ions. There was a 49.5-68.0% decrease of the efficacy of phage infection after addition of the above mentioned inhibitors at the period of the contact of cells with bacteriophages at the stage of the phage nucleic acid transfer. The Embden-Meyerhof-Parnas route inhibitors NaF and CH2ICOOH less affected the efficacy of phage infection. The same effect was observed during addition of Na3AsO4 as the ATP synthesis inhibitor. This efficacy decrease was probably due the inhibition of the processes of the substrate level phosphorylation and the deplete of the intracellular ATP content.

Molecular and phage typing of Staphylococcus aureus harbouring cryptic conjugative plasmids.

The spread of antibiotic resistant-bacterial pathogens in a hospital could be due to the spread of a resistant strain or the spread of a resistance plasmid among unrelated strains. In this study the relatedness of Staphylococcus aureus isolates carrying identical cryptic conjugative plasmids was determined by a combination of resistance profiles, plasmid patterns, pulsed field gel electrophoresis of SmaI digested chromosomal DNA and phage typing. Results of the different typing techniques were in agreement to one another and demonstrated that the isolates were of three different types. The results suggested that a cryptic conjugative plasmid had spread to different S. aureus isolates in the hospital. This is an example of plasmid spread as opposed to strain spread.

Cure of prophage in Staphylococcus aureus by furocoumarin photoadditions.

In a previous report curing of prophage in Staphylococcus aureus by treatment with 8-methoxypsoralen plus near-UV (365 nm) radiation was described. In the present work the use of angelicin and 4,5',8-trimethylpsoralen and repeated irradiation show that monoadducts and DNA interstrand cross-links formed by furocoumarin photoaddition are involved in the curing of the prophage responsible for the suppression of the lipolytic activity in a putative repair proficient strain of Staphylococcus aureus.

[Phage-mediated conjugative transfer of plasmids in Staphylococcus aureus]. / Oposredovannyi fagom kon''iugativnyi perenos plazmid u Staphylococcus aureus.

It was shown possible to transfer nonconjugative plasmids during joint cultivation of the donor and recipient cells by transduction and phage-mediated conjugation. In the latter case it was necessary that the phage in the medium was free and the prophage was present in the recipient cells. Differences in the regularities of the transfer of the nonconjugative plasmids mobilized by the conjugative plasmid or phage were observed.

[Differentiation of methicillin-resistant strains of Staphylococcus aureus by prophage specificity]. / Differentsiatsiia metitsillinorezistentnykh Staphylococcus aureus po spetsifichnosti profagov.

By inducing with mitomycin C the following phages were isolated from all the tested 32 methicillin resistant strains of S. aureus: the serogroup B phage was isolated from 2 strains, the serogroup B and F phages were isolated from 5 strains and the serogroup F phage was isolated from 25 strains. The phages were divided into 5 groups by the antiphage immunity. In group 1 of the phages 4 additional phages were specified. By the specificity of the prophages in the cultures all the strains were divided into 5 groups. Group 1 of the cultures was divided into 5 subgroups (A, B, C, D and E).

[Effect of prophages on transfer frequency of conjugative plasmid G 873]. / Vliianie profagov na chastotu peredachi kon''iugativnoi plazmidy G 873.

Transfer of the conjugative plasmid G873 on filters and mixed cultivation of the donor and recipient cells in liquid media is described. In the both systems the use of the lysogenic recipient cells (phages of serogroups B and F) in the crossings increased mor than 100-fold the frequency of plasmid transfer. The conjugative transfer of the plasmid in the mixed cultivation system was proved. The conjugative transfer required the presence (while not obligatory) of calcium chloride and was restricted by the serum factors.

Ciprofloxacin-resistant methicillin-resistant Staphylococcus aureus in New York health care facilities, 1988. The New York MRSA Study Group.

The emergence in 1988 of ciprofloxacin-resistant methicillin-resistant Staphylococcus aureus (MRSA) in New York City was studied in nine hospitals and eight nursing homes. Of the 43 hospitalized patients studied, 21 were admitted from home, while nine of the 12 nursing home patients were transferred from a hospital. Twenty-four of the 55 patients had been treated previously with ciprofloxacin, and 26 had an identifiable risk factor for a nosocomial infection. MRSA was a contributing factor in at least five of the 21 deaths. MRSA resistance to ciprofloxacin was detected within three months of the drug's commercial availability, apparently emerged independently at a number of the health care facilities, and has become widespread. If such resistance is found in a health care facility, ciprofloxacin may not be useful as a first line antibiotic.

[The effect of valinomycin and nigericin on the efficacy of bacteriophage infection of staphylococcal cells]. / Vliianie valinomitsina i nigeritsina na éffektivnost' infektsii kletok stafilokokka bakteriofagom.

The effect of ionophore antibiotics, valinomycin and nigericin, on the generation of the membrane potential, the pH gradient and the efficacy of phage infection in tetracycline-resistant staphylococci has been studied. Valinomycin at a concentration of 0.5 microM induces the dissipation of the membrane potential, and nigericin at a concentration of 12.0 microM decreases the value of the pH gradient on the membrane of staphylococci. The separate use of antibiotics has no essential influence on the efficacy of phage infection. The combined use of valinomycin and nigerimycin produces the maximum inhibition of phage infection (64.5%) at the stage of the introduction of DNA into the bacterial cell, which is indicative of a definite role played by the membrane potential and the pH gradient in the transport of phage DNA into staphylococcal cells.