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Johani K, Malone M, Jensen SO, Dickson HG, Gosbell IB, Hu H, Yang Q, Schultz G, Vickery K. Evaluation of short exposure times of antimicrobial wound solutions against microbial biofilms: from in vitro to in vivo. J Antimicrob Chemother 2019; 73:494-502. [PMID: 29165561 PMCID: PMC5890786 DOI: 10.1093/jac/dkx391] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives Test the performance of topical antimicrobial wound solutions against microbial biofilms using in vitro, ex vivo and in vivo model systems at clinically relevant exposure times. Methods Topical antimicrobial wound solutions were tested under three different conditions: (in vitro) 4% w/v Melaleuca oil, polyhexamethylene biguanide, chlorhexidine, povidone iodine and hypochlorous acid were tested at short duration exposure times for 15 min against 3 day mature biofilms of Staphylococcus aureus and Pseudomonas aeruginosa; (ex vivo) hypochlorous acid was tested in a porcine skin explant model with 12 cycles of 10 min exposure, over 24 h, against 3 day mature P. aeruginosa biofilms; and (in vivo) 4% w/v Melaleuca oil was applied for 15 min exposure, daily, for 7 days, in 10 patients with chronic non-healing diabetic foot ulcers complicated by biofilm. Results In vitro assessment demonstrated variable efficacy in reducing biofilms ranging from 0.5 log10 reductions to full eradication. Repeated instillation of hypochlorous acid in a porcine model achieved <1 log10 reduction (0.77 log10, P = 0.1). Application of 4% w/v Melaleuca oil in vivo resulted in no change to the total microbial load of diabetic foot ulcers complicated by biofilm (median log10 microbial load pre-treatment = 4.9 log10 versus 4.8 log10, P = 0.43). Conclusions Short durations of exposure to topical antimicrobial wound solutions commonly utilized by clinicians are ineffective against microbial biofilms, particularly when used in vivo. Wound solutions should not be used as a sole therapy and clinicians should consider multifaceted strategies that include sharp debridement as the gold standard.
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Affiliation(s)
- K Johani
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Central Military Laboratories and Blood Bank, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M Malone
- High Risk Foot Service, Liverpool Hospital, South West Sydney LHD, Sydney, Australia.,Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Medical Research, Sydney, Australia.,Medical Sciences Research Group, Microbiology & Infectious Diseases, School of Medicine, Western Sydney University, Sydney, Australia
| | - S O Jensen
- Medical Sciences Research Group, Microbiology & Infectious Diseases, School of Medicine, Western Sydney University, Sydney, Australia.,Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia
| | - H G Dickson
- Ambulatory Care Department (PIXI), Liverpool Hospital, South West Sydney LHD, Sydney, Australia
| | - I B Gosbell
- Medical Sciences Research Group, Microbiology & Infectious Diseases, School of Medicine, Western Sydney University, Sydney, Australia.,Antimicrobial Resistance and Mobile Elements Group, Ingham Institute of Applied Medical Research, Sydney, Australia.,Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, New South Wales Health Pathology, Liverpool, Sydney, Australia
| | - H Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Q Yang
- Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, USA
| | - G Schultz
- Department of Obstetrics and Gynecology, Institute for Wound Research, University of Florida, Gainesville, FL, USA
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Janek T, Krasowska A, Czyżnikowska Ż, Łukaszewicz M. Trehalose Lipid Biosurfactant Reduces Adhesion of Microbial Pathogens to Polystyrene and Silicone Surfaces: An Experimental and Computational Approach. Front Microbiol 2018; 9:2441. [PMID: 30386313 PMCID: PMC6198247 DOI: 10.3389/fmicb.2018.02441] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/24/2018] [Indexed: 12/26/2022] Open
Abstract
Rhodococcus fascians BD8, isolated from Arctic soil, was found to produce biosurfactant when grown on n-hexadecane as the sole carbon source. The glycolipid product was identified as the trehalose lipid with a molecular mass of 848 g mol-1. The purified biosurfactant reduced the surface tension of water from 72 to 34 mN m-1. The critical micelle concentration of trehalose lipid was 0.140 mg mL-1. To examine its potential for biomedical applications, the antimicrobial and antiadhesive activity of the biosurfactant was evaluated against several pathogenic microorganisms. Trehalose lipid showed antimicrobial activity against resistant pathogens. The largest antimicrobial activities of trehalose lipid were observed against Vibrio harveyi and Proteus vulgaris. The highest concentration tested (0.5 mg mL-1) caused a partial (11-34%) inhibition of other Gram-positive and Gram-negative bacteria and 30% inhibition of Candida albicans growth. The trehalose lipid also showed significant antiadhesive properties against all of the tested microorganisms to polystyrene surface and silicone urethral catheters. The biosurfactant showed 95 and 70% antiadhesive activity against C. albicans and Escherichia coli, respectively. Finally, the role and application of trehalose lipid as an antiadhesive compound was investigated by the modification of the polystyrene and silicone surfaces. The intermolecular interaction energy calculations were performed for investigated complexes at the density functional level of theory. The results indicate that the presence of aromatic moieties can be substantial in the stabilization of trehalose lipid-surface complexes. The antimicrobial and antiadhesive activities of trehalose lipid make them promising alternatives to synthetic surfactants in a wide range of medical applications. Based on our findings, we propose that, because of its ability to inhibit microbial colonization of polystyrene and silicone surfaces, trehalose lipid can be used as a surface coating agent.
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Affiliation(s)
- Tomasz Janek
- Department of Biotechnology and Food Microbiology, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - Anna Krasowska
- Department of Biotransformation, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
| | - Żaneta Czyżnikowska
- Department of Inorganic Chemistry, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Łukaszewicz
- Department of Biotransformation, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
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53
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Santos ALSD, Galdino ACM, Mello TPD, Ramos LDS, Branquinha MH, Bolognese AM, Columbano Neto J, Roudbary M. What are the advantages of living in a community? A microbial biofilm perspective! Mem Inst Oswaldo Cruz 2018; 113:e180212. [PMID: 30066753 PMCID: PMC6057313 DOI: 10.1590/0074-02760180212] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/02/2018] [Indexed: 01/05/2023] Open
Abstract
Biofilm formation is the preferred mode of growth lifestyle for many microorganisms, including bacterial and fungal human pathogens. Biofilm is a strong and dynamic structure that confers a broad range of advantages to its members, such as adhesion/cohesion capabilities, mechanical properties, nutritional sources, metabolite exchange platform, cellular communication, protection and resistance to drugs (e.g., antimicrobials, antiseptics, and disinfectants), environmental stresses (e.g., dehydration and ultraviolet light), host immune attacks (e.g., antibodies, complement system, antimicrobial peptides, and phagocytes), and shear forces. Microbial biofilms cause problems in the hospital environment, generating high healthcare costs and prolonged patient stay, which can result in further secondary microbial infections and various health complications. Consequently, both public and private investments must be made to ensure better patient management, as well as to find novel therapeutic strategies to circumvent the resistance and resilience profiles arising from biofilm-associated microbial infections. In this work, we present a general overview of microbial biofilm formation and its relevance within the biomedical context.
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Affiliation(s)
| | - Anna Clara Milesi Galdino
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Geral, Laboratório de Estudos Avançados em Microrganismos Emergentes e Resistentes, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Instituto de Química, Programa de Pós-Graduação em Bioquímica, Rio de Janeiro, RJ, Brasil
| | - Thaís Pereira de Mello
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Geral, Laboratório de Estudos Avançados em Microrganismos Emergentes e Resistentes, Rio de Janeiro, RJ, Brasil
| | - Lívia de Souza Ramos
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Geral, Laboratório de Estudos Avançados em Microrganismos Emergentes e Resistentes, Rio de Janeiro, RJ, Brasil
| | - Marta Helena Branquinha
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Geral, Laboratório de Estudos Avançados em Microrganismos Emergentes e Resistentes, Rio de Janeiro, RJ, Brasil
| | - Ana Maria Bolognese
- Universidade Federal do Rio de Janeiro, Faculdade de Odontologia, Departamento de Odontopediatria e Ortodontia, Rio de Janeiro, RJ, Brasil
| | - José Columbano Neto
- Faculdades São José, Faculdade de Odontologia, Disciplina de Ortodontia e Clínica Integrada Infantil, Rio de Janeiro, RJ, Brasil
| | - Maryam Roudbary
- Iran University of Medical Sciences, School of Medicine, Department of Medical Mycology and Parasitology, Tehran, Iran
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Wixtrom RN. Commentary on: Hypochlorous Acid Versus Povidone-Iodine Containing Irrigants: Which Antiseptic is More Effective for Breast Implant Pocket Irrigation? Aesthet Surg J 2018; 38:728-730. [PMID: 29767713 DOI: 10.1093/asj/sjy040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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55
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Percival SL, Malone M, Mayer D, Salisbury AM, Schultz G. Role of anaerobes in polymicrobial communities and biofilms complicating diabetic foot ulcers. Int Wound J 2018; 15:776-782. [PMID: 29863794 DOI: 10.1111/iwj.12926] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/28/2018] [Indexed: 11/29/2022] Open
Abstract
Infected tissues in the feet of people with diabetes in the form of a diabetic foot ulcer (DFU) present a complex pathology for clinicians to manage. This is partly attributed to the multi-factorial nature of the disease, which may include; altered foot architecture leading to excessive plantar pressures and frictional forces peripheral arterial disease and loss of protective sensation. In addition, to the above co-morbid variables, it is understood that a delayed wound healing state may be perpetuated by the presence of microorganisms residing in the wound tissue. The microbiology of chronic DFUs has often been reported as being polymicrobial. Of growing interest is the presence and potential role of anaerobic microorganisms in the pathology of DFUs and how they may contribute to the infective process or delayed healing. The presence of anaerobes in DFUs has been greatly underestimated, largely due to the limitations of conventional culture methods in identifying them from samples. Advancements in molecular and microscopy techniques have extended our view of the wound microbiome in addition to observing the growth and behaviour (planktonic or biofilm) of microorganisms in situ. This review paper will reflect on the evidence for the role and significance of anaerobes in DFUs and infection. A focus of this review will be to explore recent advancements in molecular genomics and microscopy techniques in order to better assess the roles of anaerobic bacteria in chronic DFUs and in biofilm-based wound care.
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Affiliation(s)
- Steven L Percival
- 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science and Technologies (CEBST), Liverpool Bio-Innovation Hub, Liverpool, UK
| | - Matthew Malone
- Infectious Disease and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia.,High Risk Foot Service, Liverpool Hospital South Western Sydney LHD, Sydney, New South Wales, Australia
| | - Dieter Mayer
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Fribourg, Switzerland
| | - Anne-Marie Salisbury
- 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science and Technologies (CEBST), Liverpool Bio-Innovation Hub, Liverpool, UK
| | - Gregory Schultz
- Institute for Wound Research, Department Obstetrics & Gynaecology, University of Florida, Gainesville, Florida
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56
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Macià MD, del Pozo JL, Díez-Aguilar M, Guinea J. Diagnóstico microbiológico de las infecciones relacionadas con la formación de biopelículas. Enferm Infecc Microbiol Clin 2018; 36:375-381. [DOI: 10.1016/j.eimc.2017.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 01/12/2023]
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57
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The Effect of Negative Pressure Wound Therapy with and without Instillation on Mature Biofilms In Vitro. MATERIALS 2018; 11:ma11050811. [PMID: 29772696 PMCID: PMC5978188 DOI: 10.3390/ma11050811] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 01/02/2023]
Abstract
Background: To investigate the effect of negative pressure wound therapy (NPWT) with and without instillation (NPWTi) on in vitro mature biofilm. Methods: Mature biofilms of Pseudomonas aeruginosa and Staphylococcus aureus were grown under shear (130 rpm) on polycarbonate coupons in a CDC biofilm reactor for 3 days. Coupons containing biofilms were placed in a sterile petri dish and sealed using NPWT or NPWTi. Coupons were exposed to treatment for 24 h with NPWT alone or with instillation of: Povidone iodine solution (PVP-I) (10% w/v equivalent to 1% w/v available iodine, BETADINE®, Mundipharma, Singapore), surfactant based antimicrobial solution with polyhexamethylene biguanide (SBPHMB) (Prontosan®, B Braun Medical, Melsungen, Germany), Gentamicin 1 µg/mL (GM) (G1264 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) Rifampicin 24 µg/mL (RF) (R3501 Sigma-Aldrich Pty Ltd., Castle Hill, Australia) and NaCl 0.9% (Baxter, Deerfield, IL, USA). Bacterial cell viability and biofilm architecture pre-and post-treatment were assessed using colony forming units (cfu), Live/Dead viability staining, confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Results: Significant reductions were obtained in S. aureus biofilm thickness (65%) and mass (47%) when treated with NPWTi as compared to NPWT only. NPWTi with instillation of SBPHMB, PVP-I and RF achieved between 2 and 8 log10 reductions against S. aureus biofilm (p < 0.05–0.001). Conversely, PVP-I and SBMO achieved a 3.5 log10 reduction against P. aeruginosa (p < 0.05). Conclusions: NPWT alters biofilm architecture by reducing biofilm thickness and mass, but this does not affect bacterial cell viability. NPWT with instillation of certain antimicrobials solutions may provide a further synergistic effect in reducing the number of viable biofilm microorganisms. Our in vitro model may be used for screening the effectiveness of antimicrobials used under instillation prior to animal or human studies.
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58
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Nguyen CQ, Thrift WJ, Bhattacharjee A, Ranjbar S, Gallagher T, Darvishzadeh-Varcheie M, Sanderson RN, Capolino F, Whiteson K, Baldi P, Hochbaum AI, Ragan R. Longitudinal Monitoring of Biofilm Formation via Robust Surface-Enhanced Raman Scattering Quantification of Pseudomonas aeruginosa-Produced Metabolites. ACS APPLIED MATERIALS & INTERFACES 2018; 10:12364-12373. [PMID: 29589446 DOI: 10.1021/acsami.7b18592] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Detection of bacterial metabolites at low concentrations in fluids with complex background allows for applications ranging from detecting biomarkers of respiratory infections to identifying contaminated medical instruments. Surface-enhanced Raman scattering (SERS) spectroscopy, when utilizing plasmonic nanogaps, has the relatively unique capacity to reach trace molecular detection limits in a label-free format, yet large-area device fabrication incorporating nanogaps with this level of performance has proven difficult. Here, we demonstrate the advantages of using chemical assembly to fabricate SERS surfaces with controlled nanometer gap spacings between plasmonic nanospheres. Control of nanogap spacings via the length of the chemical crosslinker provides uniform SERS signals, exhibiting detection of pyocyanin, a secondary metabolite of Pseudomonas aeruginosa, in aqueous media at concentration of 100 pg·mL-1. When using machine learning algorithms to analyze the SERS data of the conditioned medium from a bacterial culture, having a more complex background, we achieve 1 ng·mL-1 limit of detection of pyocyanin and robust quantification of concentration spanning 5 orders of magnitude. Nanogaps are also incorporated in an in-line microfluidic device, enabling longitudinal monitoring of P. aeruginosa biofilm formation via rapid pyocyanin detection in a medium effluent as early as 3 h after inoculation and quantification in under 9 h. Surface-attached bacteria exposed to a bactericidal antibiotic were differentially less susceptible after 10 h of growth, indicating that these devices may be useful for early intervention of bacterial infections.
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59
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Sjollema J, Zaat SAJ, Fontaine V, Ramstedt M, Luginbuehl R, Thevissen K, Li J, van der Mei HC, Busscher HJ. In vitro methods for the evaluation of antimicrobial surface designs. Acta Biomater 2018; 70:12-24. [PMID: 29432983 DOI: 10.1016/j.actbio.2018.02.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/12/2018] [Accepted: 02/01/2018] [Indexed: 11/16/2022]
Abstract
Bacterial adhesion and subsequent biofilm formation on biomedical implants and devices are a major cause of their failure. As systemic antibiotic treatment is often ineffective, there is an urgent need for antimicrobial biomaterials and coatings. The term "antimicrobial" can encompass different mechanisms of action (here termed "antimicrobial surface designs"), such as antimicrobial-releasing, contact-killing or non-adhesivity. Biomaterials equipped with antimicrobial surface designs based on different mechanisms of action require different in vitro evaluation methods. Available industrial standard evaluation tests do not address the specific mechanisms of different antimicrobial surface designs and have therefore been modified over the past years, adding to the myriad of methods available in the literature to evaluate antimicrobial surface designs. The aim of this review is to categorize fourteen presently available methods including industrial standard tests for the in vitro evaluation of antimicrobial surface designs according to their suitability with respect to their antimicrobial mechanism of action. There is no single method or industrial test that allows to distinguish antimicrobial designs according to all three mechanisms identified here. However, critical consideration of each method clearly relates the different methods to a specific mechanism of antimicrobial action. It is anticipated that use of the provided table with the fourteen methods will avoid the use of wrong methods for evaluating new antimicrobial designs and therewith facilitate translation of novel antimicrobial biomaterials and coatings to clinical use. The need for more and better updated industrial standard tests is emphasized. STATEMENT OF SIGNIFICANCE European COST-action TD1305, IPROMEDAI aims to provide better understanding of mechanisms of antimicrobial surface designs of biomaterial implants and devices. Current industrial evaluation standard tests do not sufficiently account for different, advanced antimicrobial surface designs, yet are urgently needed to obtain convincing in vitro data for approval of animal experiments and clinical trials. This review aims to provide an innovative and clear guide to choose appropriate evaluation methods for three distinctly different mechanisms of antimicrobial design: (1) antimicrobial-releasing, (2) contact-killing and (3) non-adhesivity. Use of antimicrobial evaluation methods and definition of industrial standard tests, tailored toward the antimicrobial mechanism of the design, as identified here, fulfill a missing link in the translation of novel antimicrobial surface designs to clinical use.
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Affiliation(s)
- Jelmer Sjollema
- University of Groningen, University Medical Center Groningen, Department of BioMedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Sebastian A J Zaat
- Department of Medical Microbiology, CINIMA (Center for Infection and Immunity Amsterdam), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Veronique Fontaine
- Unit of Pharmaceutical Microbiology and Hygiene, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), Campus Plaine, Boulevard du Triomphe, 1050 Brussels, Belgium
| | | | - Reto Luginbuehl
- RMS Foundation, Bischmattstrasse 12, 2544 Bettlach, Switzerland
| | - Karin Thevissen
- Centre for Microbial and Plant Genetics, CMPG, University of Leuven, Kasteelpark Arenberg 20, 3001 Heverlee, Belgium
| | - Jiuyi Li
- School of Civil Engineering, Beijing Jiaotong University, 3 Shangyuancun, Xizhimenwai, Beijing 100044, China
| | - Henny C van der Mei
- University of Groningen, University Medical Center Groningen, Department of BioMedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Henk J Busscher
- University of Groningen, University Medical Center Groningen, Department of BioMedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Vatan A, Saltoglu N, Yemisen M, Balkan II, Surme S, Demiray T, Mete B, Tabak F. Association between biofilm and multi/extensive drug resistance in diabetic foot infection. Int J Clin Pract 2018; 72:e13060. [PMID: 29381248 DOI: 10.1111/ijcp.13060] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI). METHODS Demographic, clinical, laboratory and outcome data of 165 patients, prospectively recorded and followed between January 2008 and December 2015 by a multidisciplinary committee, were analysed. Standard microbiological methods were adopted. Risk factors associated with biofilm were determined by univariate and multivariate analyses. RESULTS The overall rate of biofilm production among 339 wound isolates was 34%. The biofilm production rate was significantly higher in Gram-negative micro-organisms (39%) in comparison with Gram positives (21%) (P = .01). A. baumannii presented the highest biofilm production (62%), followed by P. aeruginosa (52%) and Klebsiella spp. (40%). On univariate analysis, significant factors associated with biofilm were antibiotic use within last 3 months (OR:2.94, CI: 1.5-5.75, P = .002), recurrent DFI within last 6 months (OR:2.35, CI: 1.23-4.53, P = .01), hospitalisation within last 3 months due to ipsilateral recurrent DFI (OR:2.44, CI: 1.06-5.58, P = .03), presence of amputation history (OR: 2.20, CI: 1.14-4.24, P = .01), multidrug-resistant (MDR) micro-organism (OR: 7.76, CI: 4.53-13.35, P<.001) and extensively drug-resistant (XDR) micro-organism (OR:11.33, CI:4.97-26.55, P<.001). Multivariate regression analysis revealed two variables to be significant factors associated with biofilm: MDR micro-organism (OR: 3.63, CI: 1.58-8.33, P = .002) and XDR micro-organism (OR:4.06, CI: 1.25-13.1, P = .01). CONCLUSIONS Multi/extensive drug resistance and previous recurrent DFIs were significantly associated with biofilm formation in patients with diabetic foot.
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Affiliation(s)
- Aslı Vatan
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Nese Saltoglu
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Mucahit Yemisen
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Ilker Inanc Balkan
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Serkan Surme
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Tayfur Demiray
- Sakarya University Medical Faculty, Microbiology, Sakarya, Turkey
| | - Birgul Mete
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
| | - Fehmi Tabak
- Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul University, Istanbul, Turkey
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61
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Coenye T, Goeres D, Van Bambeke F, Bjarnsholt T. Should standardized susceptibility testing for microbial biofilms be introduced in clinical practice? Clin Microbiol Infect 2018; 24:570-572. [PMID: 29337253 DOI: 10.1016/j.cmi.2018.01.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 01/29/2023]
Affiliation(s)
- T Coenye
- Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium; ESCMID Study Group for Biofilms, Switzerland.
| | - D Goeres
- Center for Biofilm Engineering, Montana State University, Bozeman, MT, USA
| | - F Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium; ESCMID PK/PD of Anti-Infectives Study Group, Switzerland
| | - T Bjarnsholt
- ESCMID Study Group for Biofilms, Switzerland; Department of Immunology and Microbiology, Costerton Biofilm Center, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, Stoodley P, Swanson T, Tachi M, Wolcott RD. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. Wound Repair Regen 2017; 25:744-757. [PMID: 28960634 DOI: 10.1111/wrr.12590] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 09/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine. METHODS A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic nonhealing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic nonhealing wounds. Final consensus statements were agreed on in a face-to-face meeting. RESULTS Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening antibiofilm agents; and levels of evidence when choosing antibiofilm treatments. CONCLUSION This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic nonhealing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements.
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Affiliation(s)
- Gregory Schultz
- Department of Obstetrics & Gynecology, Institute for Wound Research, University of Florida, Gainesville, Florida
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Garth A James
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana
| | - David J Leaper
- Clinical Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Andrew J McBain
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Matthew Malone
- Liverpool Hospital, South West Sydney LHD, Sydney, New South Wales, Australia.,LIVEDIAB, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity, and Orthopaedics, Ohio State University, Columbus, Ohio
| | | | - Masahiro Tachi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
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A Review of the Combination Therapy of Low Frequency Ultrasound with Antibiotics. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2317846. [PMID: 29124063 PMCID: PMC5662814 DOI: 10.1155/2017/2317846] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/01/2017] [Accepted: 08/29/2017] [Indexed: 11/24/2022]
Abstract
Single antimicrobial therapy has been unable to resist the global spread of bacterial resistance. Literatures of available in vitro and in vivo studies were reviewed and the results showed that low frequency ultrasound (LFU) has a promising synergistic bactericidal effect with antibiotics against both planktonic and biofilm bacteria. It also can facilitate the release of antibiotics from medical implants. As a noninvasive and targeted therapy, LFU has great potential in treating bacterial infections. However, more in-depth and detailed studies are still needed before LFU is officially applied as a combination therapy in the field of anti-infective treatment.
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64
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Malone M, Swanson T. Biofilm-based wound care: the importance of debridement in biofilm treatment strategies. Br J Community Nurs 2017; 22:S20-S25. [PMID: 28570133 DOI: 10.12968/bjcn.2017.22.sup6.s20] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Malone
- High Risk Foot Service, Liverpool Hospital, South West Sydney LHD; Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Medical Research; Medical Sciences Research Group, Infectious Diseases and Microbiology, Faculty of Medicine Western Sydney University
| | - Terry Swanson
- South West Healthcare, Warrnambool, Victoria, Australia
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65
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Dusane DH. CORR Insights ®: Does Extracellular DNA Production Vary in Staphylococcal Biofilms Isolated From Infected Implants versus Controls? Clin Orthop Relat Res 2017; 475:2114-2116. [PMID: 28429266 PMCID: PMC5498386 DOI: 10.1007/s11999-017-5360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Devendra H. Dusane
- 0000 0001 2285 7943grid.261331.4Center for Microbial Interface Biology, The Ohio State University, 460 West, 12th Ave., Columbus, OH 43210 USA
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Yavvari PS, Gupta S, Arora D, Nandicoori VK, Srivastava A, Bajaj A. Clathrin-Independent Killing of Intracellular Mycobacteria and Biofilm Disruptions Using Synthetic Antimicrobial Polymers. Biomacromolecules 2017; 18:2024-2033. [DOI: 10.1021/acs.biomac.7b00106] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Prabhu S. Yavvari
- Department
of Chemistry, Indian Institute of Science Education and Research, Bhopal By-pass Road, Bhopal-462066, Madhya Pradesh, India
| | - Siddhi Gupta
- Laboratory
of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, Third Milestone Faridabad-Gurgaon Expressway, NCR Biotech Cluster, Faridabad-121001, Haryana, India
| | - Divya Arora
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, Delhi-110067, India
| | - Vinay K. Nandicoori
- National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, Delhi-110067, India
| | - Aasheesh Srivastava
- Department
of Chemistry, Indian Institute of Science Education and Research, Bhopal By-pass Road, Bhopal-462066, Madhya Pradesh, India
| | - Avinash Bajaj
- Laboratory
of Nanotechnology and Chemical Biology, Regional Centre for Biotechnology, Third Milestone Faridabad-Gurgaon Expressway, NCR Biotech Cluster, Faridabad-121001, Haryana, India
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67
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Davies P, McCarty S, Hamberg K. Silver-containing foam dressings with Safetac: a review of the scientific and clinical data. J Wound Care 2017; 26:S1-S32. [DOI: 10.12968/jowc.2017.26.sup6a.s1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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