title: Staphylococcus epidermidis originating from titanium implants infects surrounding tissue and immune cells.
abstract: Infection is a major cause of failure of inserted or implanted biomedical devices (biomaterials). During surgery, bacteria may adhere to the implant, initiating biofilm formation. Bacteria are also observed in and recultured from the tissue surrounding implants, and may even reside inside host cells. Whether these bacteria originate from biofilms is not known. Therefore, we investigated the fate of Staphylococcus epidermidis inoculated on the surface of implants as adherent planktonic cells or as a biofilm in mouse experimental biomaterial-associated infection. In order to discriminate the challenge strain from potential contaminating mouse microflora, we constructed a fully virulent green fluorescent S. epidermidis strain. S. epidermidis injected along subcutaneous titanium implants, pre-seeded on the implants or pre-grown as biofilm, were retrieved from the implants as well as the surrounding tissue in all cases after 4days, and in histology bacteria were observed in the tissue co-localizing with macrophages. Thus, bacteria adherent to or in a biofilm on the implant are a potential source of infection of the surrounding tissue, and antimicrobial strategies should prevent both biofilm formation and tissue colonization.
authors.affiliation: Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Riool
authors.affiliation: Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Leonie
authors.initials: L
authors.lastname: de Boer
authors.affiliation: Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Valery
authors.initials: V
authors.lastname: Jaspers
authors.affiliation: Department of Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Chris M
authors.initials: CM
authors.lastname: van der Loos
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
authors.forename: Willem J B
authors.initials: WJB
authors.lastname: van Wamel
authors.affiliation: Department of Oral Implantology and Prosthetic Dentistry, Academic Center for Dentistry Amsterdam, VU University and University of Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands.
authors.forename: Gang
authors.initials: G
authors.lastname: Wu
authors.affiliation: Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Paulus H S
authors.initials: PHS
authors.lastname: Kwakman
authors.affiliation: Department of Medical Microbiology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. Electronic address: s.a.zaat@amc.uva.nl.
authors.forename: Sebastian A J
authors.initials: SAJ
authors.lastname: Zaat
mesh_terms: D000818:Animals; D001422:Bacterial Adhesion; D018441:Biofilms / Q000254:growth & development*; D005260:Female; D051379:Mice; D008810:Mice, Inbred C57BL; D016459:Prosthesis-Related Infections / Q000276:immunology* / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000276:immunology* / Q000382:microbiology* / Q000473:pathology; D013212:Staphylococcus epidermidis / Q000276:immunology*; D014025:Titanium
chemical_list: D014025:Titanium
keywords: Biofilm; Biomaterial-associated infection; Intracellular survival; Staphylococcus epidermidis; Titanium