In vitro skin model to investigate novel anti-infective treatments against staphylococcal dysbiosis
An air-liquid interface in vitro skin model with minimal nutrition reproduces skin conditions and shows that rhamnolipids combined with antibiotics reduce staphylococcal biofilm viability more than antibiotics alone, but all data are preclinical and do not support direct clinical application.
| Outcome | Grade | Direction | Effect | Studies |
|---|---|---|---|---|
| Bacterial viability in biofilm (rhamnolipid+antibiotic vs. antibiotic alone) | D | ▲ Favorable | não reportado quantitativamente | 1 |
| Antibiotic tolerance in air-liquid interface model vs. standard broth culture | D | ▼ Unfavorable | maior tolerância no modelo AI-L; tamanho de efeito não reportado | 1 |
| Staphylococcal biofilm formation in the in vitro model | D | — Insufficient | confirmada no modelo; dados quantitativos não disponíveis no fragmento | 1 |
| Effect of rhamnolipids alone on biofilm | D | — Insufficient | não reportado quantitativamente no fragmento disponível | 1 |
Context
Hidradenitis suppurativa (acne inversa) is a chronic inflammatory skin disease characterized by bacterial dysbiosis and biofilm formation in sinus tracts, where conventional antibiotics have limited efficacy. Experimental models mimicking the cutaneous microenvironment are needed to screen novel agents. Rhamnolipids are biosurfactants with potential to disrupt the EPS matrix and enhance antibiotic diffusion.
What the study showed
The air-liquid interface model with minimal nutrition induced staphylococcal biofilm formation with higher antibiotic tolerance compared to standard broth cultures. Combination of rhamnolipids with antibiotics reduced biofilm bacterial viability more than antibiotic monotherapy. Absolute CFU counts and effect sizes with 95% CI are not reported in the available text excerpt. The model demonstrated that environmental factors (air interface, low nutrition) modulate bacterial susceptibility to treatments.
How it was done
In vitro (preclinical) study using an artificial air-liquid interface skin model with minimal nutrition to cultivate Staphylococcus spp. Response to rhamnolipids, antibiotics, and their combinations was assessed. Sample size, exact number of biological replicates, and experiment duration are not fully described in the available excerpt.
Effect magnitude
Quantitative effect sizes with 95% CI are not reported in the available text fragment; the superiority of rhamnolipid+antibiotic combination over monotherapy is described qualitatively only.
Limitations
Strictly in vitro (preclinical) study; absence of animal model or clinical trial validation precludes any extrapolation to patients. Risk of bias tools (RoB 2, ROBINS-I) are not applicable to in vitro studies. Partial text availability limits assessment of effect sizes, replicates, and controls.
In clinical practice
No basis for changing clinical practice exists from this study. Clinicians should maintain established protocols for hidradenitis suppurativa until clinical trials evaluate rhamnolipids in humans. This study serves only as a reference for future translational research design.
What is still missing
Animal model studies and subsequently controlled clinical trials are needed to evaluate the safety, pharmacokinetics, and efficacy of rhamnolipids combined with antibiotics in patients with hidradenitis suppurativa.