Efficacy of combined vancomycin and fosfomycin against methicillin-resistant Staphylococcus aureus in biofilms in vivo

PLoS One. 2014 Dec 31;9(12):e113133. doi: 10.1371/journal.pone.0113133. eCollection 2014.

Abstract

Infection by methicillin-resistant Staphylococcus aureus (MRSA) is a life-threatening condition, and formation of biofilms can lead to treatment failure in a clinical setting. The aim of this study was to demonstrate the in vivo bactericidal effects of a combination of vancomycin (VAN) and fosfomycin (FOS) against MRSA in a rat carboxymethyl cellulose-pouch biofilm model. The results of the time-kill assay showed that the combination therapy was capable of killing at low minimal inhibitory concentrations (MIC) (½ × MIC VAN +1 × MIC FOS and 1 × MIC VAN + 1 × MIC FOS). In the in vivo study, a synergistically bactericidal effect was observed when using the combination therapy on MRSA embedded in the mature biofilm model. In comparison with the untreated control group and the groups receiving either VAN or FOS alone, the rats treated with combination therapy had lower MRSA colony counts in exudates from the pouch, lower white blood cell and neutrophil counts, and C-reactive protein (CRP) in peripheral blood. Furthermore, histological analysis of the pouch wall indicated combination therapy resulted in disappearance of biofilm-like structures, marked decrease in necrosis, and formation of granular tissue. In conclusion, the combination of VAN with FOS had a synergistic bactericidal effect on chronic MRSA infection embedded in biofilm, providing an alternative approach to treating this condition.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Biofilms / drug effects*
  • C-Reactive Protein / metabolism
  • Drug Synergism
  • Fosfomycin / pharmacology*
  • Fosfomycin / therapeutic use
  • Leukocyte Count
  • Male
  • Methicillin-Resistant Staphylococcus aureus / drug effects*
  • Methicillin-Resistant Staphylococcus aureus / physiology*
  • Microbial Sensitivity Tests
  • Rats
  • Rats, Sprague-Dawley
  • Staphylococcal Infections / blood
  • Staphylococcal Infections / drug therapy
  • Vancomycin / pharmacology*
  • Vancomycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Fosfomycin
  • Vancomycin
  • C-Reactive Protein

Grants and funding

This study was supported by a research grant from National Natural Science Foundation of China (No. 81171734).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.