13Enterococcus faecalis is a Gram-positive opportunistic pathogen that inhabits the human 14 gastrointestinal tract. Because of the high frequency of antibiotic resistance among 15 Enterococcus clinical isolates, interest in using phage to treat enterococcal infections and to 16 decolonize high-risk patients for antibiotic-resistant Enterococcus is rising. Bacteria can evolve 17 phage resistance, but there is little published information on these mechanisms in E. faecalis. In 18 this report, we identified genetic determinants of E. faecalis resistance to ϕNPV1. We found that 19 loss-of-function mutations in epaR confer ϕNPV1 resistance by blocking phage adsorption. We 20 attribute the inability of the phage to adsorb to the modification or loss of an extracellular 21 polymer in strains with inactivated epaR. Phage-resistant epaR mutants exhibited increased 22 daptomycin and osmotic stress susceptibilities. Our results demonstrate that in vitro 23 spontaneous resistance to ϕNPV1 comes at a cost in E. faecalis OG1RF.
25Introduction 26 Enterococcus faecalis is a Gram-positive bacterium that inhabits the human gastrointestinal 27 tract and is associated with nosocomial infections (1). Infections caused by E. faecalis can be 28 difficult to treat because of the high frequency of resistance to multiple antibiotics among E. 29 faecalis clinical isolates (2). The antibiotic daptomycin can be used to treat certain infections 30 caused by multidrug-resistant enterococci. Daptomycin is a lipopeptide antibiotic that interacts 31 with the enterococcal cell surface and disrupts membrane structure and function (3).
33Bacteriophages (phages) are bacterial viruses and natural predators of bacteria. It is reasonable 34 to expect that phages can be employed to treat bacterial infections. However, phages have not 35 been extensively studied in the Western world in the context of therapeutic application until 36 recently due to the availability of antibiotics (4). In recent years, interest in using phages to treat 37 bacterial infections (phage therapy) has reemerged because of the emergence of multidrug-38 resistant bacteria. For E. faecalis, promising studies include the use of phage to eliminate 39 biofilm, a major barrier to antibiotic treatment, and to increase survival rates in mouse models of 40 enterococcal infection (5, 6).
42One advantage of phage therapy is limited damage to the native microbiome because of the 43 specificity of the phage to its host (7). Typically, lytic phage have narrow host ranges and are 44 species-specific or target a range of strains within a species. The first step to a successful 45 phage infection is the attachment of the phage particle to the proper receptor present on the 46 surface of the host cell. Phage receptors have been extensively studied in certain phage the ϕSPP-1 receptor, and PIP, the phage c2 receptor, are orthologs and are required for irreversible phage adsorption (12). Enterococcal phage receptors have not been well-52 characterized. Previously, we and collaborators identified PI...