Oxygen Restriction Generates Difficult-To-Culture Pathogens

Abstract

Induction of a non-culturable state has been demonstrated for many bacteria. In a clinical perspective, the lack of growth due to these non-culturable bacteria can have major consequences for the diagnosis and treatment of patients. Here we show how anoxic conditioning (restriction of molecular oxygen, O2) generates difficult-to-culture (DTC) bacteria during biofilm growth. A significant subpopulation of Pseudomonas aeruginosa entered a DTC state after anoxic conditioning, ranging from five to 90 % of the total culturable population, in both planktonic and biofilm models. Anoxic conditioning also generated DTC subpopulations of Staphylococcus aureus and Staphylococcus epidermidis. Growth of the DTC populations were achieved by substituting O2 with 10 mM NO3- as an alternative electron acceptor for anaerobic respiration or, in the case of P. aeruginosa, by adding sodium pyruvate or catalase as scavengers against reactive oxygen species (ROS) during aerobic respiration. An increase in normoxic plating due to addition of catalase suggests the molecule hydrogen peroxide as a possible mechanism for induction of DTC P. aeruginosa. Anoxic conditioning also generated a true viable but non-culturable (VBNC) population of P. aeruginosa that was not resurrected by substituting O2 with NO3- during anaerobic respiration. Moreover, bacterial detection in clinical samples was improved significantly by supplementing 10 mM NO3- to LB plates and incubating under anoxic conditions. These results demonstrate that habituation to an infectious anoxic micro-environment complicates diagnostic culturing of bacteria, especially in the case of chronic infections where oxygen is restricted due to the host immune response. ImportanceDiagnostics of bacteria from chronic infections by standard culture-based methods is challenging. Bacteria in a non-culturable state may contribute to the lack of culturing from these infections. Many stressors are known to induce a non-culturable state, among others the absence of molecular oxygen, which is evident in chronic infections due to high rates of oxygen consumption by the host response. In this study, we have shown that Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis can enter a difficult-to-culture state after oxygen restriction. Regrowth was not possible using conventional normoxic plating where oxygen served as electron acceptor. Instead, regrowth was enabled during anoxic conditions with added nitrate as alternative electron acceptor. Our findings show that bacteria can habituate to their environment and that it has to be taken into consideration especially when culturing clinical samples e.g. from chronic infections.