Invasive species drive polymicrobial resistance to amoxicillin in oral biofilms through beta-lactamase release

Since bacterial biofilms often cause refractory infections, antimicrobial susceptibility testing (AST) is highly desirable even for oral peri-implant biofilms. However, characterization of polymicrobial drug resistance is challenging due to high diversity and complexity of these biofilms. In this work, we developed laser-assisted AST and detected polymicrobial amoxicillin resistance in peri-implantitis. TEM-1 {beta}-lactamase production enabled an Enterobacter sp. strain SPS_532 to protect its otherwise susceptible biofilm cohabitants. To understand the {beta}-lactamase driven cross-protection in the human microbiome we aggregated genomic (n = 200,000) and patient microbial data (n = 27,000), developed a cross-protection assay, studied a representative strain collection (n = 118) and established a complex biofilm in vitro model (with an average of 133 species from 164 found in dental plaque). Multiple oral allochthonous species, e.g., Enterobacter, Klebsiella, Escherichia, Staphylococcus, and only a single typical oral microorganism, Haemophilus, were able to cross-protect. Diverse bla genes conferred activity, via a high expression of chromosomal gene, e.g., blaAmpC gene or by the presence of plasmidic gene, e.g., blaTEM-1 gene. Invaders not only cross-protected the biofilm from the antibiotic, but also supported expansion of opportunistic pathogens like Fusobacterium species. Cross-protection in complex biofilms depended on the diffusion rate and population size of the invader, which could be bio-controlled with a phage. Deciphering polymicrobial resistance might support the development of diagnostic and therapeutic approaches to combat implant-associated biofilm infections in the human mouth.