The prevalence of Staphylococcus aureus with mucoid phenotype in the airways of patients with cystic fibrosis—A prospective study

• Published in: International journal of medical microbiology 2019-07, Vol.309 (5), p.283-287
• Main Authors: Lennartz, Farina E., Schwartbeck, Bianca, Dübbers, Angelika, Große-Onnebrink, Jörg, Kessler, Christina, Küster, Peter, Schültingkemper, Holger, Peters, Georg, Kahl, Barbara C.
• Format: Article
• Language: English
• Subjects: Biofilm; Cystic fibrosis; Ica; Mucoid phenotype; S. aureus
• ISSN: 1438-4221; 1618-0607
• DOI: 10.1016/j.ijmm.2019.05.002

Background: Staphylococcus aureus is one of the most frequently isolated pathogens in the respiratory tract of CF patients. Recently, we characterized peculiar mucoid S. aureus isolates, which are excessive biofilm formers and which carried a 5bp-deletion within the intergenic region of the ica operon. In this prospective study, we determined the prevalence of mucoid S. aureus-isolates in the airways of CF-patients during a 3-months period. Methods: We analyzed specimens (sputa, throat swabs) from 81 CF patients who attended two CF centers in Münster, Germany. Ten S. aureus isolates were randomly picked from every S. aureus-positive airway specimen and evaluated for mucoidy using Congo Red agar and phenotypic tests. Mucoid isolates were characterized by spa sequence typing, biofilm production and sequencing of the intergenic region of the ica operon to screen for the 5bp-deletion. Results: In 7 of 81 examined patients (8.6%), we detected mucoid S. aureus phenotypes (37 out of 1050 isolates; 3.5%). Twenty-five mucoid isolates carried the 5bp-deletion. Mucoid isolates produced excessive biofilm and were significantly more resistant to certain antibiotics. Conclusions: In our prospective study, mucoid S. aureus was present in 8.6% of S. aureus–positive CF-patients. In 6 of 7 patients, mucoid isolates carried the 5bp-deletion, indicating that also other so far not identified mechanisms cause excessive biofilm formation. Further studies are necessary to ascertain the clinical impact of mucoid S. aureus phenotypes on the severity of the CF disease.