Staphylococcus aureus is one of the most frequent pathogens responsible for biofilm-associated infections (BAI), and the choice of antibiotics to treat these infections remains a challenge for the medical community. In particular, daptomycin has been reported to fail against implant-associated S. aureus infections in clinical practice, while its association with rifampin remains a good candidate for BAI treatment. To improve our understanding of such resistance/tolerance toward daptomycin, we took advantage of the dynamic fluorescence imaging tools (time-lapse imaging and fluorescence recovery after photobleaching [FRAP]) to locally and accurately assess the antibiotic diffusion reaction in methicillin-susceptible and methicillin-resistant S. aureus biofilms. To provide a realistic representation of daptomycin action, we optimized an in vitro model built on the basis of our recently published in vivo mouse model of prosthetic vascular graft infections. We demonstrated that at therapeutic concentrations, daptomycin was inefficient in eradicating biofilms, while the matrix was not a shield to antibiotic diffusion and to its interaction with its bacterial target. In the presence of rifampin, daptomycin was still present in the vicinity of the bacterial cells, allowing prevention of the emergence of rifampin-resistant mutants. Conclusions derived from this study strongly suggest that S. aureus biofilm resistance/tolerance toward daptomycin may be more likely to be related to a physiological change involving structural modifications of the membrane, which is a strain-dependent process.
Staphylococcus aureus is a Gram-positive bacterial species shown to be the most frequent cause of biofilm-associated infections (BAI) (1) and one of the major causes of morbidity and mortality in hospitals and communities (2). Unlike planktonic cells, biofilms exhibit specific phenotypic traits allowing them to resist host defenses and antibiotic treatments (3), which frequently leads to chronic infections such as endocarditis, sinusitis, and osteomyelitis and also to implant-associated infections (4).Among the most recent clinically used antibiotics, daptomycin is a cyclic lipopeptide approved for the treatment of serious staphylococcal infections such as bacteremia and implant-related infections (5). Daptomycin is a calcium-dependent antibiotic that acts by insertion into the Gram-positive cytoplasmic membranes where it forms oligomeric pores, causing potassium ion leakage and subsequent membrane depolarization, leading ultimately to cell death (6). As is the case for many antibiotics, daptomycin has been shown to exhibit a significant bactericidal activity against planktonic cells (7-9). However, the eradication of adherent bacteria is rarely achieved despite the large number of in vitro and animal studies in which daptomycin activity was evaluated (10-16). Besides the results of the literature that appear controversial (17), direct comparison between studies is not directly possible, since the biofilm growth and treatment protocols...