Resistance is notoriously high in Asia but may not entirely explain therapeutic failures. Specific modes of bacterial life, such as biofilm or intracellular survival, may also contribute to the persistent and/or recurrent character of infections. Most Staphylococcus aureus isolates form biofilm and many survive and even thrive intracellularly. We collected 36 nonduplicate S. aureus isolates (including 18 methicillin-resistant S. aureus) from patients with clinical evidence of persistent or recurrent infections in a large tertiary Vietnamese hospital. We examined their antibiotic resistance profile (minimal inhibitory concentration determination) and clonal relatedness (spa and agr typing, pulsed field gel electrophoresis profiles). We then assessed the activity of moxifloxacin in both biofilms and infected phagocytes (moxifloxacin previously proved to be one of the most active antibiotics against reference strains in these models). spa-types t189 and t437 and agr group I were the most frequent. Among the 36 isolates, 30 were multidrug resistant but 30 were recovered from patients having received an active drug. All tested isolates produced biofilm and survived inside phagocytes. At its human C_max, moxifloxacin was inactive on biofilms made by moxifloxacin-susceptible as well as moxifloxacin-resistant isolates. It caused only a modest intracellular colony-forming unit decrease against moxifloxacin-susceptible isolates and was inactive against those resistant to moxifloxacin. While our data confirm for this collection the high resistance levels and prevalence of endemic spa- or agr- types in Asia, they show that tolerance in both biofilm and phagocytes are correlated and markedly limit moxifloxacin activity, which goes in line with the suggested role of these modes of life in persistence or recurrence of infections.

中文翻译：

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抗生素耐药性，生物被膜形成和细胞内存活是越南三级医院持续或反复感染金黄色葡萄球菌的可能决定因素：重点是对莫西沙星的细菌反应。

在亚洲，耐药性很高，但可能不能完全解释治疗失败的原因。细菌生命的特定模式，例如生物膜或细胞内存活，也可能有助于感染的持续性和/或复发性。大多数金黄色葡萄球菌分离物形成生物膜，许多在细胞内存活，甚至壮成长。我们从一家大型越南三级医院的有持续或反复感染的临床证据的患者中收集了36份非重复的金黄色葡萄球菌分离株（包括18株耐甲氧西林的金黄色葡萄球菌）。我们检查了它们的抗生素耐药性（最小抑菌浓度的测定）和克隆相关性（spa和agr打字，脉冲场凝胶电泳图）。然后，我们评估了莫西沙星在生物膜和感染的吞噬细胞中的活性（以前证明莫西沙星是这些模型中针对参考菌株的活性最高的抗生素之一）。水疗中心-类型T189和t437和AGR I组是最常见的。在这36株分离株中，有30株具有多重耐药性，但从接受活性药物的患者中回收了30株。所有测试的分离物均产生生物膜并在吞噬细胞内存活。达到人类的C _max，莫西沙星对易受莫西沙星和耐莫西沙星的分离物制成的生物膜无活性。它仅对莫西沙星敏感分离株引起适度的细胞内集落形成单位减少，而对耐莫西沙星的分离株无效。虽然我们对这个系列的高阻力水平，地方病流行的数据证实了水疗中心-或者agr-类型在亚洲，它们显示了两个生物膜容忍和吞噬细胞是相关的，并且显着限制莫西沙星的活动，它出现在符合的建议角色这些生活方式会持续存在或复发。