Enterococci in Space: Adaptation, Antibiotic Resistance, and Clinical Implications

Enterococci are gram-positive bacteria that originated when our ancient animal ancestors emerged from the oceans to live on land, and brought their gut flora with them. Enterococcus faecalis (EF) and Enterococcus faecium, are common human commensals and can harbor multidrug resistance. Both have been previously isolated from the International Space Station (ISS). Likely as a consequence of their evolutionary origins, enterococci show remarkable stress resistance within, but also outside, their human hosts. Their antibiotic resistance, coupled with tolerance to desiccation, starvation, and disinfection, make some EF strains potent pathogens in the built environment (e.g., hospitals), and a potential risk to crew health during space missions. Here we describe our planned flight studies, currently in development. Genomic Enumeration of Antibiotic Resistance in Space (GEARS) will characterize the frequency and genomic identity of antibiotic resistant organisms, including enterococci, on the ISS, and expand our future in-space sequencing-based diagnostic capabilities. Enterococcus Growth Advantage on ISS via Tn-seq (EnteroGAIT) will assess the evolutionary selective pressure of the space environment (microgravity, space radiation) using EF as a model system during a long-duration culture and persistence experiment. Adaptation & Evolution of Resilient Enterococcus in Space (AERES) will study existing and newly identified isolates to characterize the “natural” evolutionary history of EF on Earth and in space to reveal mechanisms of microbial adaption including, possibly, natural selection. Our work to date has identified that EF ISS isolates share virulence factors found in clinical strains and commensals, and revealed limitations of current pathogenicity assessment tools. While ISS isolates were, in some cases, multi-drug resistant, current data suggests these are largely commensal strains. Our work will further refine potential crew health risks and improve understanding of EF adaptation to the built environment, of great relevance on Earth where EF is the second leading cause of hospital acquired infection.