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Infect Dis (Lond). 2019 Jun;51(6):446-451. doi: 10.1080/23744235.2019.1593499. Epub 2019 Apr 15.

Biofilm formation by Staphylococcus aureus clinical isolates correlates with the infection type.

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a Department of Rheumatology and Inflammation Research , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
b Department of Immunology and Microbiology , University of Colorado School of Medicine , Aurora , CO , USA.
c Department of Infectious Diseases , Skaraborg Hospital , Skövde , Sweden.
d Department of Veterans Affairs Eastern Colorado Healthcare System , Denver , CO , USA.
e Department of Rheumatology , Sahlgrenska University Hospital , Gothenburg , Sweden.



Biofilms are involved in many Staphylococcus aureus infections, but relation of biofilm formation and the infection types or the clinical outcomes remain unclear.


We measured biofilm formation, with a microtiter plate assay, of a collection of methicillin-sensitive clinical isolates from 159 invasive S. aureus infections, encompassing all cases occurring within a hospital catchment area during two years, and from additional 49 non-invasive skin infections from the same region. Results were related to available clinical and microbiological documentation.


Isolates from medical device infections (intravenous line-associated and prosthetic joint infections), as well as isolates from superficial skin infections, were particularly proficient in forming biofilms. No increased biofilm-forming capacity was seen in isolates from endocarditis, osteomyelitis, or other infections. There was also a correlation of biofilm formation with the agr type of the isolates. Thicker biofilms were more resistant to antibiotic treatment in vitro. No correlation between biofilm formation and clinical outcomes was noted.


S. aureus isolates from 'classical' biofilm-related infections, but also from superficial skin infections, are especially proficient in forming biofilms. There is, however, no obvious relation of biofilm-forming capacity of isolates and the clinical outcome of the infection, and more studies on this issue are needed.


; Biofilm; antibiotic sensitivity; clinical outcome; skin

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