Consistent Biofilm Formation by Streptococcus pyogenes emm 1 Isolated From Patients With Necrotizing Soft Tissue Infections

Abstract

ObjectivesBiofilm formation has been demonstrated in muscle and soft tissue samples from patients with necrotizing soft tissue infection (NSTI) caused by Streptococcus pyogenes, but the clinical importance of this observation is not clear. Although M-protein has been shown to be important for in vitro biofilm formation in S. pyogenes, the evidence for an association between emm type and biofilm forming capacity is conflicting. Here we characterize the biofilm forming capacity in a collection of S. pyogenes isolates causing NSTI, and relate this to emm type of the isolates and clinical characteristics of the patients.MethodsBacterial isolates and clinical data were obtained from NSTI patients enrolled in a multicenter prospective observational study. Biofilm forming capacity was determined using a microtiter plate assay.ResultsAmong 57 cases, the three most frequently encountered emm types were emm1 (n = 22), emm3 (n = 13), and emm28 (n = 7). The distribution of biofilm forming capacity in emm1 was qualitatively (narrow-ranged normal distribution) and quantitatively (21/22 isolates in the intermediate range) different from other emm types (wide ranged, multimodal distribution with 5/35 isolates in the same range as emm1). There were no significant associations between biofilm forming capacity and clinical characteristics of the patients.ConclusionsThe biofilm forming capacity of emm1 isolates was uniform and differed significantly from other emm types. The impact of biofilm formation in NSTI caused by S. pyogenes on clinical outcomes remains uncertain.

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“…S. pyogenes is able to form biofilms which have been associated with diseases such as tonsilitis and cellulitis [ 37 ]. Recently, it was shown that S. pyogenes serotype M1 strains consistently formed biofilms in patients with necrotising fasciitis (‘flesh-eating disease’) [ 38 ].…”

Cutaneous tuberculosis—ambiguous transmission, bacterial diversity with biofilm formation in humoral abnormality: case report illustration

“…167008, Denmark), covered with a lid, and incubated at 37°C under aerobic conditions for 24 h or 48 h (for slower growing strains). The procedure for measuring the biofilm-forming capacity was performed according to Skutlaberg et al ( 15 ) with heat fixing and staining with crystal violet. A BioTek PowerWave XS microplate reader (BioTek, Winooski, VT, United States) was used for the OD600 measurements.…”