Effects of low-intensity and low-frequency ultrasound combined with tobramycin on biofilms of extended-spectrum beta-lactamases (ESBLs) Escherichia coli.

Low-intensity and low-frequency ultrasound (LILFU) can enhance the bactericidal action of antibiotics against various sensitive bacterial species. The current study investigated the effects of LILFU combined with tobramycin on extended-spectrum beta-lactamases (ESBLs) Escherichia coli biofilms (a multi-drug resistant bacteria). The biofilms of ESBLs E. coli were established and treated with ultrasound (42 kHz and ISATA of 0.66 W/cm2) continuously for 0.5 h with and without tobramycin. The bacterial viability, the morphology and the antibiotic penetration of ESBLs E. Coli biofilms were investigated. The results demonstrated that the bacterial viability of biofilms significantly declined and the diameter of the inhibition zone was significantly increased after treatment with ultrasound combined with tobramycin compared with the controls (P < 0.05). Confocal laser scanning microscopy showed that the bacterial viability was affected most in the outer layer of ESBLs E. coli biofilms after joint treatment. The morphological structure of the biofilms was altered remarkably after joint treatment based on scanning electron microscopy, especially in regard to reduced thickness and loosened structure. These results suggest that the combination of ultrasound and tobramycin can exert synergistic bactericidal effects against biofilms formed by ESBLs E. coli.