Glucose is widely used in the reconstitution of intravenous
medications,
which often include antimicrobials. How glucose affects antimicrobial
activity has not been comprehensively studied. The present work reports
that glucose added to bacteria growing in a rich medium suppresses
the bactericidal but not the bacteriostatic activity of several antimicrobial
classes, thereby revealing a phenomenon called glucose-mediated antimicrobial
tolerance. Glucose, at concentrations corresponding to blood-sugar
levels of humans, increased survival of Escherichia coli treated with quinolones, aminoglycosides, and cephalosporins with
little effect on minimal inhibitory concentration. Glucose suppressed
a ROS surge stimulated by ciprofloxacin. Genes involved in phosphorylated
fructose metabolism contributed to glucose-mediated tolerance, since
a pfkA deficiency, which blocks the formation of
fructose-1,6-bisphosphate, eliminated protection by glucose. Disrupting
the pentose phosphate pathway or the TCA cycle failed to alter glucose-mediated
tolerance, consistent with an upstream involvement of phosphorylated
fructose. Exogenous sodium pyruvate or sodium citrate reversed glucose-mediated
antimicrobial tolerance. Both metabolites bypass the effects of fructose-1,6-bisphosphate,
a compound known to scavenge hydroxyl radical and chelate iron, activities
that suppress ROS accumulation. Treatment with these two compounds
constitutes a novel way to mitigate the glucose-mediated antimicrobial
tolerance that may exist during intravenous antimicrobial therapy,
especially for diabetes patients.