Staphylococcus aureus biofilms are extremely difficult to treat. They provide a protected niche for the bacteria, rendering them highly recalcitrant toward host defenses as well as antibiotic treatment. Bacteria within a biofilm are shielded from the immune system by the formation of an extracellular polymeric matrix, composed of polysaccharides, extracellular DNA (eDNA), and proteins. Many antibiotics do not readily penetrate biofilms, resulting in the presence of subinhibitory concentrations of antibiotics. Here, we show that subinhibitory concentrations of clindamycin triggered a transcriptional stress response in S. aureus via the alternative sigma factor B ( B ) and upregulated the expression of the major biofilm-associated genes atlA, lrgA, agrA, the psm genes, fnbA, and fnbB. Our data suggest that subinhibitory concentrations of clindamycin alter the ability of S. aureus to form biofilms and shift the composition of the biofilm matrix toward higher eDNA content. An understanding of the molecular mechanisms underlying biofilm assembly and dispersal in response to subinhibitory concentrations of clinically relevant antibiotics such as clindamycin is critical to further optimize antibiotic treatment strategies of biofilm-associated S. aureus infections.
Staphylococcus aureus is a major cause of both health care-related and community-associated (CA) infections. The Grampositive human-pathogenic bacterium produces and secretes a range of toxins and enzymes leading to acute infections such as bacteremia and skin abscesses (1, 2). In addition, most S. aureus strains are capable of biofilm formation and can persist in host tissues such as the bone, leading to chronic osteomyelitis, or on implanted medical devices such as vascular catheters, vascular grafts, heart valves, and prosthetic joints (3-5). Biofilm-associated infections are extremely difficult to treat, and these chronic or relapsing infections typically require prolonged antibiotic treatment or removal of the device (6-8). Antibiotic resistance of bacteria within a biofilm may result from slow growth, phenotypic heterogeneity, persister cell formation, and inactivation or reduced penetration of the antibiotic (9, 10). Diffusion of the antibiotic through biofilm cell clusters is dependent on the thickness and the composition of the extracellular polymeric matrix (9, 11). The slow transport within biofilms suggests that the bacteria may encounter subinhibitory concentrations of antibiotics. Previous studies have shown that low doses of different antibiotics trigger biofilm formation (12, 13) and lead to dramatic alterations in bacterial gene expression in S. aureus (14).Biofilm formation proceeds in at least three phases: initial attachment, biofilm maturation, and dispersal (15, 16). Initial surface attachment is dependent on bacterial surface molecules such as the S. aureus murein hydrolase AtlA, teichoic acids, and fibronectin-binding proteins (FnBPs) (17)(18)(19)(20). After attachment to the surface, the bacteria multiply and produce the extracellular...