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  • Title: Effect of Haemophilus influenzae exposure on Staphylococcus aureus tympanostomy tube attachment and biofilm formation.
    Author: Esin L, Antonelli PJ, Ojano-Dirain C.
    Journal: JAMA Otolaryngol Head Neck Surg; 2015 Feb; 141(2):148-53. PubMed ID: 25522126.
    Abstract:
    IMPORTANCE: Tympanostomy tube (TT) biofilm formation may lead to sequelae. OBJECTIVE: To determine whether the acute pathogen Haemophilus influenzae promotes TT attachment and biofilm formation by the chronic pathogen Staphylococcus aureus. DESIGN AND SETTING: Controlled, in vitro microbiological study at an academic research laboratory using TTs treated with 0 (untreated), 10, or 3000 µg/mL ciprofloxacin or ethylene oxide and TTs with and without prior H influenzae exposure. INTERVENTIONS: Fluoroplastic TTs (18 per treatment) were cultured with H influenzae. The TTs were gas-sterilized or exposed to 0, 10, or 3000 µg/mL ciprofloxacin. One-third of the TTs from each treatment group underwent H influenzae counts or scanning electron microscopy (SEM). Another one-third were used for an S aureus attachment assay. The remainder, as well as TTs not exposed to H influenzae, were cultured with S aureus and then treated with oxacillin to kill planktonic S aureus. S aureus counts and SEM were performed. MAIN OUTCOMES AND MEASURES: Attachment and biofilm formation of S aureus on TTs assessed by quantitative bacterial counts and SEM. RESULTS: Mean (SD) H influenzae counts were lower on TTs treated with 3 mg/mL than with 10 µg/mL ciprofloxacin (2.06 × 103 [1.00 × 103] vs 4.21 × 105 [1.67 × 105]; P < .001). Mean (SD) S aureus attachment was higher on TTs with untreated preexisting H influenzae (8.88 × 105 [3.20 × 105]; P < .001) and lower on TTs with prior exposure to H influenzae treated with 10 (3.43 × 104 [2.10 × 104]; P = .006) or 3000 µg/mL ciprofloxacin (6.41 × 102 [3.59 × 102]; P < .001). S aureus biofilm formation was similar across groups, except TTs with prior exposure to H influenzae treated with ciprofloxacin 3 mg/mL, which had significantly less (9.30 × 101 [3.51 × 102]; P < .001). CONCLUSIONS AND RELEVANCE: Exposure to live H influenzae may promote S aureus attachment on TTs. Treatment of H influenzae on TTs with ciprofloxacin, 3 mg/mL, as found in ototopical therapy, may reduce subsequent S aureus attachment and biofilm formation.
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