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Applied and Environmental Microbiology, July 2006, p. 5013-5019, Vol. 72, No. 7
0099-2240/06/$08.00+0 doi:10.1128/AEM.02474-05
Copyright © 2006, American Society for Microbiology. All Rights Reserved.
Department of Biology, Georgia State University, Atlanta, Georgia 30303
Received 19 October 2005/ Accepted 2 May 2006
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In a polymicrobial infection exhibiting IP, the efficiency of antibiotic inactivation by a resistant microorganism should determine the extent of the commensal protection provided to the sensitive microorganism. To investigate the role of antibiotic detoxification mechanisms in IP development in biofilms, a two-member model consortium based on Escherichia coli ATCC 33456 was established. Two strains of E. coli ATCC 33456 were constructed, each with different mechanisms of antibiotic resistance. One strain harbored a plasmid encoding beta-lactamase, conferring resistance to the beta-lactam antibiotic ampicillin. The other strain had a plasmid carrying spectinomycin adenyltransferase, encoding resistance to the aminocyclitol spectinomycin (13). Ampicillin and spectinomycin were selected for use in the model because of (i) the sensitivity of E. coli ATCC 33456 to both in the absence of a heterologous resistance gene, (ii) the ability of these antibiotics to be permanently inactivated by the protein product of their respective resistance genes, and (iii) differences in the energetics of the resistance mechanisms. The two plasmids belonged to the same incompatibility group, preventing their exchange between the two populations. Additionally, the ampicillin-resistant strain expressed green fluorescent protein, allowing it to be distinguished from the other strain following counterstaining with a red dye. The use of two subpopulations derived from a single parent strain was intended to reduce the number of variables in the system that could influence biofilm structure and organization.
To shed light on the role of biofilm structure in IP, the two-member consortium was cultivated in the presence of steady-state antibiotic concentrations in flow cells (biofilm growth) and in chemostats (planktonic growth). The extent of commensal protection conferred by each antibiotic resistance mechanism for each cultivation mode was determined by comparing the growth of the sensitive organism alone with its growth in the presence of the resistant strain. By considering both types of cultivation, it was possible to determine whether the biofilm environment contributed to commensal interactions affecting the survival and activity of antibiotic-sensitive bacteria.
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Chemicals.
Ampicillin and spectinomycin were obtained from Sigma (St. Louis, MO). Antibiotics were dissolved in ultrapure water, sterilized with 0.20-µm-pore filters to create stock solutions, and stored at 20°C. Nitrocefin was obtained from Calbiochem (San Diego, CA). SYTO 59 was purchased from Molecular Probes, Inc. (Eugene, OR).
Biofilm cultivation.
Biofilms were cultivated using parallel-plate flow cells according to a previously described technique (10). Briefly, cells were inoculated into medium reservoirs containing 200 ml LB broth to an optical density at 600 nm (OD600) of 0.03 (0.015 of each strain in mixed-population biofilms) and were recirculated through the flow cell at 0.84 ml min1 for 2 h to allow surface colonization. Antibiotics were present during recirculation at the same concentrations that were used for continuous (steady-state) flow, described below. After recirculation, the system was switched to continuous flow for 46 h (medium flow rate of 0.35 ml min1), introducing LB broth with antibiotics as required to the flow cell. The selected medium flow rate replaced the volume of the flow cell approximately once per minute and was chosen such that the antibiotic concentration in the bulk fluid approximated steady-state conditions. Biofilms were grown for 48 h in order to allow GFP fluorescence to develop and the biofilm structure to mature and also to permit the cultivation of a large number of biofilms. Each growth condition was repeated at least in triplicate. Biofilms were imaged by confocal laser scanning microscopy (CLSM) as described below. Following CLSM imaging, biofilm cells were displaced from flow cells by introducing air into the channels and were resuspended in 1 ml sterile 50 mM phosphate buffer (pH = 7.2) using a pipette. Visual inspection of flow cells by microscopy following biofilm displacement indicated that greater than 99 percent of the cells not directly adhered to the glass substratum were recovered.
Confocal laser scanning microscopy.
Prior to imaging, biofilms were rinsed with sterile 50 mM potassium phosphate buffer (pH = 7.2; no autofluorescence detected) for 10 min and then stained with 20 µM SYTO 59 for 15 min and subsequently rinsed with sterile 50 mM potassium phosphate buffer for another 10 min. Intact biofilms were imaged nondestructively using a Zeiss LSM 510 confocal laser scanning microscope (Zeiss, Thornwood, NY) equipped with a Fluor 40x oil immersion lens. Samples were excited simultaneously at wavelengths of 488 nm and 523 nm. Four image stacks of each biofilm were taken at different locations throughout the flow cell, using a 1-µm z-step increment.
COMSTAT analysis.
Quantitative analysis of CLSM images of biofilms was conducted using the digital image analysis program COMSTAT (12). For COMSTAT analysis, the following settings were used: pixel intensity threshold of 30; minimum colony size of 100 pixels, representing a cluster of five cells.
Chemostat experiments.
Chemostats were made from 250-ml sidearm flasks. Flasks were sealed with a rubber stopper containing a 3.2-mm-inside-diameter Pharmed tube that extended to the bottom of the flask for influent media and another tube for the intake of air, which passed through a 0.20-µm-pore-size filter. Sterile LB broth with antibiotics as required was contained in 2-liter Pyrex bottles incubated in a 37°C water bath and pumped into the chemostat using a peristaltic pump (Cole Parmer) through autoclaved 3.2-mm-inside-diameter Pharmed tubing. The sidearm flask was located on a heated magnetic stir plate at a setting that maintained a temperature of 37°C ± 0.5°C. A magnetic stir bar kept the flask contents well mixed, and effluent flowed out of the sidearm into a sterile, hooded funnel leading to a waste vessel. Samples were collected by extending a sterile microcentrifuge tube held by flame-sterilized tweezers into the sterile hood to collect effluent. A Bunsen burner was stationed next to the chemostat to maintain aseptic conditions. At each time point, a sample was collected to measure turbidity and a second sample was collected, centrifuged, resuspended in 10% glycerol, and stored at 82°C for analysis by plate count. The cell densities of cultures that were stored frozen at 82°C prior to dilution plate counting were 83% ± 6% of those of cultures that were not frozen prior to plating. Freezer storage did not alter the specific fluorescence of GFP-containing cells. Dilution rates were set to maintain the sensitive strain at 55 percent (Sptr strain) or 60 percent (Ampr strain) of its maximum growth rate in LB medium. With ampicillin in the medium, the pump flow was maintained at 4.5 ml min1, corresponding to a complete reactor displacement every 64 min. With spectinomycin in the medium, the pump flow was maintained at 3.8 ml min1, corresponding to a complete reactor displacement every 76 min. The inoculum concentration of the resistant strain was always an OD600 of 0.40, corresponding to 2 x 108 CFU ml1. The inoculum concentration of the sensitive strain was always 0.04. Preliminary work with ampicillin-containing medium indicated that when the sensitive strain was inoculated at higher initial optical densities, the population size declined and stabilized at an OD600 of approximately 0.04. Chemostats were run in at least duplicate for each condition.
Determination of MIC and MBPC.
Antibiotic MIC determinations were performed as described by Jorgensen and Turnidge (14). The concentration of antibiotic required to prevent the formation of biofilm by viable cells adhering to the flow cell substratum during the recirculation phase was designated the minimum biofilm preventative concentration (MBPC). MBPCs were determined by measuring the concentration at which biofilm biomass as calculated by COMSTAT equaled 0 µm3 µm2, indicating that only cells which adhered to the flow cell substratum during its inoculation were present. At the MBPC, the areal cell density was 3.5 x 103 CFU mm2.
Nitrocefin assay.
The beta-lactamase potential of the Ampr strain during growth in biofilms and chemostats was measured using the chromogenic substrate nitrocefin (22). Briefly, Ampr cells were resuspended in sterile 50 mM phosphate buffer, adjusted to an OD600 of 0.40, and incubated with 0.1 mM nitrocefin for 5 min at 37°C. Activity was measured by using a spectrophotometer (486 nm, as per the manufacturer's recommendation) at 0 and 5 min. All assays were carried out in at least triplicate, and statistical significance was determined using Student's t test.
Flow cytometry.
Flow cytometry was performed with a Becton-Dickinson FACSCalibur flow cytometer (BD Biosciences, San Jose, CA). Cells were washed and resuspended in sterile 50 mM phosphate buffer to an OD600 of 0.03 prior to analysis. Samples were excited at a wavelength of 488 nm with an argon laser, and 10,000 events were collected. Fluorescence was measured using logarithmic gain, and side scatter (SSC) was measured using linear gain. Six-micrometer-diameter beads (BD Biosciences, San Jose, CA) were used as size controls.
Plate counts.
Cells recovered from biofilms or chemostats were resuspended in sterile 50 mM phosphate buffer, serially diluted, and plated on LB agar plates supplemented with antibiotics as necessary. Plates were incubated overnight at 37°C. Biofilms resuspended to an OD600 of 1.0 corresponded to an average cell density of 7.7 x 108 CFU ml1 (n = 8), whereas the average cell density of suspensions of chemostat cells with an OD600 of 1.0 corresponded to 6.4 x 108 CFU ml1 (n = 10).
Growth kinetics.
Specific growth rates were determined from hourly measurements of optical densities (600 nm) during growth of each strain in LB broth in batch culture. Triplicate test tubes were inoculated to an initial OD600 of 0.03 from liquid cultures in mid-log-phase growth.
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FIG. 1. Antibiotic concentrations required to prevent planktonic or biofilm growth. MICs for each strain were determined in batch culture. The antibiotic concentration at which attached cells were unable to form a biofilm within 48 h was termed the MBPC. A: Sptr strain in ampicillin-containing medium. B: Ampr strain in spectinomycin-containing medium. Filled symbols, MIC; open symbols, MBPC.
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Exchange of antibiotic resistance determinants in biofilms.
To check if antibiotic resistance determinants were exchanged between the Ampr and Sptr strains during growth in biofilms, cells from resuspended mixed-population biofilms were cultured on plates containing either ampicillin or spectinomycin. Eight biofilms cultivated in ampicillin-containing medium and eight biofilms cultivated in spectinomycin-containing medium were tested. Cells that grew were inoculated into LB broth containing twice the MIC of the reciprocal antibiotic. Out of 16 biofilms that were screened, only 1 spontaneous mutant, originally grown in ampicillin, was found to be resistant to both antibiotics.
Nitrocefin assay of beta-lactamase potential.
The beta-lactamase potential of Ampr cells grown in chemostats or 48-h biofilms were compared. Cells from chemostats showed a greater potential (P < 0.042) to cleave nitrocefin than biofilms cells (per 1 x 108 cells): 0.75 ± 0.17 ppm min1 in the chemostat and 0.49 ± 0.08 ppm min1 in biofilms.
Commensal protection in biofilms.
The MBPC for the Sptr strain was 50 ppm ampicillin (Fig. 1A), and the MBPC for the Ampr strain was 40 ppm spectinomycin (Fig. 1B). In the absence of ampicillin, the Sptr strain developed robust biofilms with an overall spongiform morphology, with individual cells exhibiting the typical coccobacillus shape (Fig. 2A). The average thickness of these biofilms was 50 µm. Exposure to sublethal concentrations of ampicillin caused the formation of filamentous structures (Fig. 2B), and these biofilms had a maximum height of approximately 6 µm at ampicillin concentrations greater than 13 ppm. The Ampr strain formed an extensive biofilm of fluorescent cells in the absence of antibiotics (Fig. 2D). Concentrations of spectinomycin greater than 20 ppm caused deformation of cells into filaments and a reduction in GFP expression (Fig. 2E and 3). Ampr biofilms were approximately 35 µm thick through 35 ppm spectinomycin but then decreased in size until the MBPC of 40 ppm was reached.
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FIG. 2. Prevention of morphological damage to antibiotic-sensitive bacteria during growth with a resistant strain. Biofilms of each strain alone or the two strains grown together were imaged by CLSM. Representative images of the substratum are shown. A: Sptr strain in LB broth. B: Sptr strain in LB broth plus 8 ppm ampicillin. C: Ampr and Sptr strains in LB broth plus 8 ppm ampicillin. D: Ampr strain in LB broth. E: Ampr strain in LB broth plus 20 ppm spectinomycin. F: Ampr and Sptr strains in LB broth plus 20 ppm spectinomycin. Magnification, x400.
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FIG. 3. Flow cytometry scatter plots of Ampr biofilms grown in spectinomycin-containing medium. Representative flow cytometry scatter plots showing the distribution of fluorescent events in Ampr biofilms grown alone in medium containing subinhibitory concentrations of spectinomycin. x axis: SSC. y axis: GFP fluorescence (FL1-H).
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FIG. 4. Commensal protection in biofilms. Antibiotic-sensitive organisms grown in biofilms either alone (filled symbols) or with the resistant strain (open symbols) were enumerated by plate counts. A: Sptr strain in ampicillin-containing medium. B: Ampr strain in spectinomycin-containing medium.
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FIG. 5. Flow cytometry analyses of Ampr populations grown alone or together with the Sptr strain in spectinomycin-containing medium. Ampr strain grown alone, filled circles. Ampr and Sptr strains grown together, open circles.
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FIG. 6. Representative scatter plots of biofilms grown in media containing 33.3 to 40 ppm spectinomycin. Top row: Sptr strain alone. Middle row: Ampr strain alone. Bottom row: mixed biofilms, with fluorescent populations indicated by the R1 region. x axis: SSC. y axis: GFP fluorescence (FL1-H).
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FIG. 7. Commensal protection in chemostats. Antibiotic-sensitive organisms grown in chemostats either alone (filled symbols) or with the resistant strain (open symbols) were enumerated by plate counts. A: Sptr strain in ampicillin-containing medium. B: Ampr strain in spectinomycin-containing medium.
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FIG. 8. Comparison of chemostat and biofilm commensalism in ampicillin-containing media. The log scale reduction of ampicillin-sensitive Sptr cells grown in coculture with Ampr cells was compared for chemostats (filled symbols) and biofilms (open symbols). Samples were taken from chemostats after three reactor volumes and from biofilms after 48 h. Cells were enumerated by dilution spread plating.
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In spectinomycin-containing medium, no protection was afforded to the sensitive Ampr strain in the chemostat with respect to population size or GFP expression. Similarly, in terms of population size, the Ampr strain received no benefit from the Sptr strain in biofilms. However, a commensal interaction was evident in biofilms in terms of enhanced GFP expression in the Ampr strain. The commensal interaction likely resulted from the development of microenvironments with reduced spectinomycin concentrations resulting from the enzyme-catalyzed detoxification of spectinomycin by the Sptr strain. The reduction in Ampr cells with abnormal morphology in the commensal environment that was observed by CLSM also supports the concept of spectinomycin-reduced microenvironments within the mixed biofilm. Alternatively, the greater biomass that formed in the mixed biofilms may have also contributed to enhanced Ampr strain resistance to spectinomycin.
Two methods-related aspects of this work warrant discussion. First, the concept of MBPC, the concentration of antibiotic required to prevent biofilm formation, was introduced. Existing parameters emphasize the concentration of chemical required to eliminate biofilms already attached to a surface. For example, the minimum biofilm eradication concentration measures the concentration of antibiotic required to kill an already-established biofilm (7), and the minimum biofilm inhibitory concentration measures the antibiotic concentration required to inhibit growth of individual cells shed from an established biofilm (24). In contrast, the MBPC describes the concentration of an agent required to keep a surface free of biofilm. Second, GFP fluorescence was used to characterize the quality of the biofilm environment for E. coli activity. GFP fluorescence requires low levels of oxygen (11, 27), is pH dependent (23), and may be inhibited when cells are challenged with antibiotics. Thus, a decrease in GFP fluorescence may indicate suboptimal conditions for an aerobic neutrophile like E. coli. Conversely, the persistence of localized GFP fluorescence under inhibitory conditions, as was detected in mixed biofilms exposed to spectinomycin, indicated the presence of microenvironments with suitable conditions for Ampr strain fluorescence.
The mechanism of antibiotic resistance substantially influenced the extent of the commensal interaction between the Ampr and Sptr strains. In the case of ampicillin, detoxification by the TEM-1 beta-lactamase produced by the Ampr strain facilitated the growth of a significant population of sensitive bacteria. TEM-1 beta-lactamase has a high affinity for ampicillin (Km = 14 µM [
5 ppm]) (20) and hydrolyzes ampicillin without an energy input, leading to efficient antibiotic inactivation. In contrast, the inactivation of spectinomycin by the Sptr strain provided a small benefit to spectinomycin-sensitive cells. The spectinomycin adenyltransferase AAD(9) determinant inactivates spectinomycin by adenylation at the 9-OH position in an ATP-consuming reaction (19), and the associated energy cost most likely inhibited extensive antibiotic detoxification. The potential for commensal interactions to cause IP in response to other antibiotics is largely uninvestigated to date. Antibiotics that are enzymatically degraded or modified could potentially be susceptible, including aminoglycosides, macrolides, chloramphenicol, and rifamycin (28). In the case of IP caused by beta-lactamase-producing bacteria, administration of amoxicillin and the beta-lactamase inhibitor clavulanic acid reduced the extent of treatment failure (4) and helped eliminate penicillin-sensitive pneumococci in a model biofilm (5). Understanding the factors that give rise to IP in polymicrobial biofilms could facilitate narrow-spectrum antibiotic therapies and help reduce incidences of treatment failure.
This research was supported by the American Heart Association Southeast Affiliate (grant no. 0160196B).
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