In vitro study on the effect of antibiotic combinations on Staphylococcus epidermidis biofilms

  • Bhupinder Pal Kaur Junior resident ,M.S ,Ophthalmology
  • Shamim Ahmad
  • Humayoun Ashraf
  • Giby Thachil
Keywords: biofilms, ceftazidime, cefuroxime, endophthalmitis, moxifloxacin, Staphylococcus epidermidis, vancomycin


Purpose: Effect of combination of various antibiotics on Staphylococcus epidermidis biofilm.

Study design: Experimental study.

Methods: The biofilm-producing strains of S. epidermidis were isolated from 100 patients undergoing cataract surgery before instillation of any antibiotic. The strains were subjected to sensitivity test to various antibiotic combinations. The most effective agent was selected and its minimum inhibitory concentration was determined by broth dilution method. The statistics wereperformed using SPSS Version 23 (IBM Corp.) and Chi square test.

Results: A total of 22 biofilm-positive samples were obtained. The combinations of vancomycin with ceftazidime (p < 0.05) followed by moxifloxacin with cefuroxime (p < 0.05) were found to be the most effective. Antibiofilm activity was also shown by other antibiotic combination. The minimum inhibitory concentration of vancomycin and ceftazidime in 11 samples was 2.5 and 2.8 mg/ml, while in the rest of the samples, it was 2.5 and 5.6 mg/ml, respectively. The minimum inhibitory concentration of moxifloxacin and cefuroxime was 0.125 and 2.81 mg/ml, respectively.

Conclusion: In our study, we conclude that antibiotics are effective in eradicating biofilms.


Endophthalmitis Vitrectomy Study Group. Results of the Endophthalmitis Vitrectomy Study; a randomized trial of immediate vitrectomy and of intravenous antibiotics for the treatment of postoperative bacterial endophthalmitis. Arch Ophthalmol. 1995;113:1479-1496.

Rupp ME, Ulphani JS, Fey PD, Bartscht K, Mack D. Characterization of the importance of polysaccharide intercellular adhesin/hemagglutinin of Staphylococcus epidermidis in the pathogenesis of biomaterial-based infection in a mouse foreign body infection model. Infect Immun. 1999;67(5):2627-2632.

Prosser BL, Taylor D, Dix BA, Cleeland R. Method of evaluating effects of antibiotics on bacterial biofilm. Antimicrob Agents Chemother. 1987;31(10):1502-1506.

Nichols WW, Evans MJ, Slack MP, Walmsley HL. The penetration of antibiotics into aggregates of mucoid and non-mucoid Pseudomonas aeruginosa. J Gen Microbiol. 1989;135(5):1291-1303.

Dreeszen PH. Biofilm Key to Understanding and Controlling Bacterial Growth in Automated Drinking Water Systems. Edstrom Industries, Inc. 1997; 2008.

Kaiser TD, Pereira EM, Dos Santos KR, Maciel EL, Schuenck RP, Nunes AP. Modification of the Congo red agar method to detect biofilm production by Staphylococcus epidermidis. Diagn Microbiol Infect Dis. 2013;75:235-239.

Ahmad S, Ashraf H, Akram SM. Adhesion of biofilm forming Staphylococcus epidermidis strains on intraocular lenses – an update. In: The Battles Against Microbial Pathogens: Basic Science, Technological Advances and Educational Programs. ISBN-13 Vol 1:978-84942134-6-5, ISBN-13 Collection: 978-84942134-5-8; 2015:357-363.

Akram SM. An in vitro study to compare biofilm formation and adhesion on different intraocular lens materials by Staphylococcus epidermidis isolates obtained from cataract surgery patients (Thesis submitted in JNMCH, AMU, Aligarh); 2013.

Olson R, Donnenfeld E, Bucci FA, et al. Methicillin resistance of Staphylococcus species among health care and nonhealth care workers undergoing cataract surgery. Clin Ophthalmol. 2010;4:1505-1514.

Lin Y-H, Kang Y-C, Hou C-H, et al. Antibiotic susceptibility profiles of ocular and nasal flora in patients undergoing cataract surgery in Taiwan: an observational and cross-sectional study. BMJ Open. 2017;7(8):e017352.

Keshav BR, Basu S. Normal conjunctival flora and their antibiotic sensitivity in Omanis undergoing cataract surgery. Oman J Ophthalmol. 2012;5:16-18.

Trinavarat A, Atchaneeyasakul LO. Surgical techniques of cataract surgery and subsequent postoperative endophthalmitis. J Med Assoc Thai. 2005;88:1-5.

Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbial Rev. 2002;15:167-193.

Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. 2001;358:135-138.

Özkan B, Karabas VL, Gundes S, Altintaş O, Etiler N, Cağlar Y. Effect of vancomycin, teicoplanin and cefuroxime on Staphylococcus epidermidis adherence to intraocular lenses. J Cataract Refract Surg. 2005;31:1814-1820.

Drago L, DeVecchi E, Nicola L, Gismondo MR. Antimicrobial activity and interference of tobramycin and chloramphenicol on bacterial adhesion to intraocular lenses. Drugs Exp Clin Res. 2003;29:25-35.

Das T, Sharma S, Muralidhar AV. Effect of vancomycin on adherence to polymethyl methacrylate intraocular lenses; Endophthalmitis Research Group. J Cataract Refract Surg. 2002;28:703-708.

Koul S, Philipson A, Philipson BT, Kock E, Nylén P. Intraocular levels of cefuroxime in uninflamed rabbit eyes. Acta Ophthalmol. 1990;68:455-465.

Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978-988.

Kamalarajah S, Ling R, Silvestri G, et al. Presumed infectious endophthalmitis following cataract surgery in the UK: a case-control study of risk factors. Eye. 2007;21:580-586.

Ong-Tone L. Aqueous humor penetration of gatifloxacin and moxifloxacin eyedrops given by different methods before cataract surgery. Cataract Refract Surg. 2007;33:59-62.

Barreau G, Mounier M, Marin B, et al. Intracameral cefuroxime injection at the end of cataract surgery to reduce the incidence of endophthalmitis. J Cataract Refract Surg. 2012;38:1370-1375.

Pascual A, Ramirez de Arenello E, Perea EJ. Activity of glycopeptides in combination with amikacin or rifampicin against Staphylococcus epidermidis biofilms on plastic catheters. Eur J Clin Microbial Infect Dis. 1994;13:515-517.

Palazzo ICV, Araujo MLC, Darini ALC. First report of vancomycin-resistant staphylococci isolated from healthy carriers in Brazil. J Clin Microbiol. 2005;43:179-185.

Singh R, Ray P, Das A, Sharma M. Role of persisters and small-colony variants in antibiotic resistance of planktonic and biofilm-associated Staphylococcus aureus: an in vitro study. J Med Microbiol. 2009;58:1067-1073.

Karadag S, Ozkan B, Karabas L, Alintaş O, Yumuk Z, Cağlar Y. Effect of cefuroxime and moxifloxacin on Staphylococcus epidermidis adherence to intraocular lenses. Can J Ophthal. 2009;44:663-667.

Benbouzid F, Kodjikian L, Hartmann D, Renaud F, Baillif S. Moxifloxacin superior to cefuroxime in reducing bacterial adhesion of Staphylococcus epidermidis on hydrophobic intraocular lenses. Acta Ophthalmol. 2016;94:11-15.

Haripriya A, Chang F, Ravindran RD. Endophthalmitis reduction with intracameral moxifloxacin prophylaxis. Am Acad Ophthalmol. 2017;124:768-775.

How to Cite
Kaur, B., Ahmad, S., Ashraf, H., & Thachil, G. (2020). In vitro study on the effect of antibiotic combinations on Staphylococcus epidermidis biofilms. Asian Journal of Ophthalmology, 17(2), 147-155.