Cryptic susceptibility to penicillin/β-lactamase inhibitor combinations in emerging multidrug-resistant, hospital-adapted Staphylococcus epidermidis lineages

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  • Xiaoliang Ba
  • Claire L. Raisen
  • Olivier Restif
  • Lina Maria Cavaco
  • Carina Vingsbo Lundberg
  • Jean Y.H. Lee
  • Benjamin P. Howden
  • Bartels, Mette Damkjær
  • Birgit Strommenger
  • Ewan M. Harrison
  • Anders Rhod Larsen
  • Mark A. Holmes
  • Jesper Larsen

Global spread of multidrug-resistant, hospital-adapted Staphylococcus epidermidis lineages underscores the need for new therapeutic strategies. Here we show that many S. epidermidis isolates belonging to these lineages display cryptic susceptibility to penicillin/β-lactamase inhibitor combinations under in vitro conditions, despite carrying the methicillin resistance gene mecA. Using a mouse thigh model of S. epidermidis infection, we demonstrate that single-dose treatment with amoxicillin/clavulanic acid significantly reduces methicillin-resistant S. epidermidis loads without leading to detectable resistance development. On the other hand, we also show that methicillin-resistant S. epidermidis is capable of developing increased resistance to amoxicillin/clavulanic acid during long-term in vitro exposure to these drugs. These findings suggest that penicillin/β-lactamase inhibitor combinations could be a promising therapeutic candidate for treatment of a high proportion of methicillin-resistant S. epidermidis infections, although the in vivo risk of resistance development needs to be further addressed before they can be incorporated into clinical trials.

Original languageEnglish
Article number6479
JournalNature Communications
Volume14
Issue number1
Number of pages12
ISSN2041-1723
DOIs
Publication statusPublished - 2023

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