Polymicrobial Ventilator-Associated Pneumonia: Fighting In Vitro Candida albicans-Pseudomonas aeruginosa Biofilms with Antifungal-Antibacterial Combination Therapy

PLoS One. 2017 Jan 23;12(1):e0170433. doi: 10.1371/journal.pone.0170433. eCollection 2017.

Abstract

The polymicrobial nature of ventilator-associated pneumonia (VAP) is now evident, with mixed bacterial-fungal biofilms colonizing the VAP endotracheal tube (ETT) surface. The microbial interplay within this infection may contribute for enhanced pathogenesis and exert impact towards antimicrobial therapy. Consequently, the high mortality/morbidity rates associated to VAP and the worldwide increase in antibiotic resistance has promoted the search for novel therapeutic strategies to fight VAP polymicrobial infections. Under this scope, this work aimed to assess the activity of mono- vs combinational antimicrobial therapy using one antibiotic (Polymyxin B; PolyB) and one antifungal (Amphotericin B; AmB) agent against polymicrobial biofilms of Pseudomonas aeruginosa and Candida albicans. The action of isolated antimicrobials was firstly evaluated in single- and polymicrobial cultures, with AmB being more effective against C. albicans and PolyB against P. aeruginosa. Mixed planktonic cultures required equal or higher antimicrobial concentrations. In biofilms, only PolyB at relatively high concentrations could reduce P. aeruginosa in both monospecies and polymicrobial populations, with C. albicans displaying only punctual disturbances. PolyB and AmB exhibited a synergistic effect against P. aeruginosa and C. albicans mixed planktonic cultures, but only high doses (256 mg L-1) of PolyB were able to eradicate polymicrobial biofilms, with P. aeruginosa showing loss of cultivability (but not viability) at 2 h post-treatment, whilst C. albicans only started to be inhibited after 14 h. In conclusion, combination therapy involving an antibiotic and an antifungal agent holds an attractive therapeutic option to treat severe bacterial-fungal polymicrobial infections. Nevertheless, optimization of antimicrobial doses and further clinical pharmacokinetics/pharmacodynamics and toxicodynamics studies underpinning the optimal use of these drugs are urgently required to improve therapy effectiveness and avoid reinfection.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / pharmacology
  • Antifungal Agents / administration & dosage*
  • Antifungal Agents / pharmacology
  • Biofilms / drug effects*
  • Candida albicans / drug effects*
  • Candida albicans / pathogenicity
  • Drug Therapy, Combination
  • Humans
  • Microbial Sensitivity Tests
  • Pneumonia, Ventilator-Associated / microbiology*
  • Pseudomonas aeruginosa / drug effects*
  • Pseudomonas aeruginosa / pathogenicity

Substances

  • Anti-Bacterial Agents
  • Antifungal Agents

Grants and funding

Support was provided by: ESCMID Research Grant 2014, named "Reconstruction of polymicrobial interactions in infections: the case of Pseudomonas aeruginosa and Candida albicans cross talk in ventilator-associated pneumonia" and funded by European Society of Clinical Microbiology and Infectious Diseases (ESCMID) [https://www.escmid.org/profession_career/awards_grants/research_grants/previous_awardees/awardees_2014/] (to AL); Portuguese Foundation for Science and Technology (FCT), COMPETE2020, FEDER and P2020, under the scope of the strategic funding of UID/BIO/04469/2013 (URL: http://www.ceb.uminho.pt/Projects/Details/2590) (CEB, UMinho) and UID/EQU/00511/2013 units. (URL:https://sigarra.up.pt/spup/pt/noticias_geral.ver_noticia?p_nr=17725) (LEPABE, FEUP); Project POCI-01-0145-FEDER-006684 (URL: http://www.ceb.uminho.pt/Projects/Details/2590) (CEB, Uminho) and POCI-01-0145-FEDER-006939 (URL: https://sigarra.up.pt/feup/pt/noticias_geral.ver_noticia?p_nr=50509) (LEPABE, FEUP), financed by COMPETE2020, FEDER and National Funds; FCT and the European Community fund FEDER, through Program COMPETE, under the scope of project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) (URL: http://www.ceb.uminho.pt/Projects/Details/1505) (Manuel Mota, CEB, Uminho); and Post-doc grants of the author SPL (SFRH/BPD/95616/2013) and MER (SFRH/BPD/95401/2013). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.