New research suggests that cigarette smoke can make a life-threatening, antibiotic-resistant superbug even more aggressive.

Researchers at the University of California, San Diego found that Methicillin-resistant Staphylococcus aureus (MRSA) bacteria exposed to cigarette smoke become even more resistant to killing by the immune system.

"We already know that smoking cigarettes harms human respiratory and immune cells, and now we've shown that, on the flipside, smoke can also stress out invasive bacteria and make them more aggressive," Laura E. Crotty Alexander, senior author of the study, said in a statement.

For the study, researchers tested the bacteria's susceptibility to individual mechanisms macrophages typically employ to kill bacteria. Once inside macrophages, smoke-exposed MRSA were more resistant to killing by reactive oxygen species, the chemical burst that macrophages use to destroy their microbial meals. They also discovered that smoke-exposed MRSA were more resistant to killing by antimicrobial peptides, small protein pieces the immune system uses to poke holes in bacterial cells and trigger inflammation. The effect was dose-dependent, meaning that the more smoke extract they used, the more resistant the MRSA became.

MRSA treated with cigarette smoke extract were also better at sticking to and invading human cells grown in the lab. In a mouse model, MRSA exposed to cigarette smoke survived better and caused pneumonia with a higher mortality rate.

The data suggest that cigarette smoke strengthens MRSA bacteria by altering their cell walls in such a way that they are better able to repel antimicrobial peptides and other charged particles.

"Cigarette smokers are known to be more susceptible to infectious diseases. Now we have evidence that cigarette smoke-induced resistance in MRSA may be an additional contributing factor," Crotty Alexander said.

The findings are detailed in the journal Infection and Immunity.