In-host evolution of Staphylococcus epidermidis in a pacemaker-associated 
endocarditis resulting in increased antibiotic tolerance

Dengler Haunreiter, Vanina; Boumasmoud, Mathilde; Häffner, Nicola; Wipfli, Dennis; Leimer, Nadja; Rachmühl, Carole; Kühnert, Denise; Achermann, Yvonne; Zbinden, Reinhard; Benussi, Stefano; Vulin, Clement; Zinkernagel, Annelies S.

doi:10.1038/s41467-019-09053-9

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In-host evolution of Staphylococcus epidermidis in a pacemaker-associated endocarditis resulting in increased antibiotic tolerance

MPS-Authors

Dengler Haunreiter, Vanina
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Boumasmoud, Mathilde
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Häffner, Nicola
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Wipfli, Dennis
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Leimer, Nadja
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Rachmühl, Carole
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

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Kühnert, Denise
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Achermann, Yvonne
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Zbinden, Reinhard
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Benussi, Stefano
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Vulin, Clement
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

Zinkernagel, Annelies S.
tide, Max Planck Institute for the Science of Human History, Max Planck Society;

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Citation

Dengler Haunreiter, V., Boumasmoud, M., Häffner, N., Wipfli, D., Leimer, N., Rachmühl, C., et al. (2019). In-host evolution of Staphylococcus epidermidis in a pacemaker-associated endocarditis resulting in increased antibiotic tolerance. Nature Communications, 10: 1149. doi:10.1038/s41467-019-09053-9.

Cite as: https://hdl.handle.net/21.11116/0000-0003-27DC-A

Abstract

Treatment failure in biofilm-associated bacterial infections is an important healthcare issue. In vitro studies and mouse models suggest that bacteria enter a slow-growing/non-growing state that results in transient tolerance to antibiotics in the absence of a specific resistance mechanism. However, little clinical confirmation of antibiotic tolerant bacteria in patients exists. In this study we investigate a Staphylococcus epidermidis pacemaker-associated endocarditis, in a patient who developed a break-through bacteremia despite taking antibiotics to which the S. epidermidis isolate is fully susceptible in vitro. Characterization of the clinical S. epidermidis isolates reveals in-host evolution over the 16-week infection period, resulting in increased antibiotic tolerance of the entire population due to a prolonged lag time until growth resumption and a reduced growth rate. Furthermore, we observe adaptation towards an increased biofilm formation capacity and genetic diversification of the S. epidermidis isolates within the patient.