In two pairs of clinical colistin-susceptible/colistin-resistant (Cst s /Cst r ) Acinetobacter baumannii strains, the Cst r strains showed significantly decreased biofilm formation in static and dynamic assays (P < 0.001) and lower relative fitness (P < 0.05) compared with those of the Cst s counterparts. The whole-genome sequencing comparison of strain pairs identified a mutation converting a stop codon to lysine (*241K) in LpsB (involved in lipopolysaccharide [LPS] synthesis) in one Cst r strain and a frameshift mutation in CarO and the loss of a 47,969-bp element containing multiple genes associated with biofilm production in the other.
Colistin-resistant (Cst r ) Acinetobacter baumannii clinical isolates are increasingly recovered worldwide (1), which is causing major clinical concerns. Thus far, two primary colistin resistance mechanisms have been described in A. baumannii, (i) modification of the lipid A moiety of lipopolysaccharide (LPS) mediated by mutations and/or overexpression in the two-component regulatory system pmrAB and (ii) loss of LPS caused by either mutations or insertional inactivation of lipid A biosynthesis genes (2).The development of colistin resistance in clinical and laboratory-derived Cst r A. baumannii due to changes in the PmrAB system has been correlated with impaired fitness and virulence (3, 4) and lower infectivity (5, 6). Also, reduced biofilm formation has been observed in laboratory-generated Cst r A. baumannii (7,8). We previously reported the characteristics of two pairs of colistin-susceptible (Cst s )/Cst r A. baumannii clinical strains (Ab248/ Ab249 and Ab299/Ab347; colistin MICs of 0.5/128 and 0.5/32 g/ml, respectively) sequentially obtained from two patients after prolonged colistin exposure (6). Briefly, compared to Cst s strains, Cst r strains harbored a single pmrB mutation (P233S for Ab249 and P170L for Ab347) and had significantly slower growth. Strains within each pair had identical pulsed-field gel electrophoresis (PFGE) profiles, and all were assigned to the international clone 2. Important differences in the antibiotic resistance phenotypes other than colistin were not observed (6). One Cst r strain underexpressed the CsuA/B and CsuC proteins, which are involved in biofilm formation (6). In the present follow-up study, we compared these strain pairs in terms of fitness, biofilm-forming ability, and whole-genome sequencing (WGS) focusing specifically on genes involved in virulence and biofilm formation.In vitro competition assays were performed in triplicate at 5 h and 20 h (4), and relative fitness was calculated as previously described (9). To study adhesion (6 h) and biofilm formation (24 h) under static conditions, the crystal violet method was used (10) with some modifications. Briefly, inoculum was prepared by adjusting exponential cultures grown in Luria-Bertani (LB) broth to a 0.5 McFarland standard, and this was followed by a 1:10 dilution in LB broth. Then, 200-l aliquots (approximately 2 ϫ 10 6 CFU) were loaded into a 96-well polystyrene microplate (...