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Costerton WJ, Montanaro L, Balaban N, Arciola CR. Prospecting Gene Therapy of Implant Infections. Int J Artif Organs 2018; 32:689-95. [DOI: 10.1177/039139880903200919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infection still represents one of the most serious and ravaging complications associated with prosthetic devices. Staphylococci and enterococci, the bacteria most frequently responsible for orthopedic postsurgical and implant-related infections, express clinically relevant antibiotic resistance. The emergence of antibiotic-resistant bacteria and the slow progress in identifying new classes of antimicrobial agents have encouraged research into novel therapeutic strategies. The adoption of antisense or “antigene” molecules able to silence or knock-out bacterial genes responsible for their virulence is one possible innovative approach. Peptide nucleic acids (PNAs) are potential drug candidates for gene therapy in infections, by silencing a basic gene of bacterial growth or by tackling the antibiotic resistance or virulence factors of a pathogen. An efficacious contrast to bacterial genes should be set up in the first stages of infection in order to prevent colonization of periprosthesis tissues. Genes encoding bacterial factors for adhesion and colonization (biofilm and/or adhesins) would be the best candidates for gene therapy. But after initial enthusiasm for direct antisense knock-out or silencing of essential or virulence bacterial genes, difficulties have emerged; consequently, new approaches are now being attempted. One of these, interference with the regulating system of virulence factors, such as agr, appears particularly promising.
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Affiliation(s)
- William J. Costerton
- Center for Genomic Sciences Allegheny-Singer Research Institute, Pittsburgh, Pennsylvania - USA
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Naomi Balaban
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts - USA
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
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Montanaro L, Baldassarri L, Corazzari T, Creti R, Ravaioli S, Cangini I, Pirini V, Maso A, Donati MELENA, Pegreffi F, Visai L, Campoccia D, Speziale P, Arciola CR. Panton-Valentine Leukocidin Gene Detected in a Staphylococcus Aureus Strain Isolated from a Knee Arthroprosthesis Infection. Int J Artif Organs 2018; 32:630-4. [DOI: 10.1177/039139880903200912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report focuses on the molecular characterization of a Staphylococcus aureus strain isolated from a knee arthroprosthesis infection and recognized retrospectively as a carrier of the Panton-Valentine leukocidin gene. The stored microbiological isolate, which belonged to the strain collection of the Research Unit on Implant Infections of the Rizzoli Orthopaedic Institute, was retrieved for molecular analysis. Genotyping was carried out, revealing an interesting profile. In addition to the positivity for the Panton-Valentine toxin gene, the results indicated that the isolate belonged to the agr III group and was endowed with bbp and cna genes, both encoding for staphylococcal adhesins that bind bone proteins. The strain had the mecA gene for methicillin resistance, even though it was unable to resist any of the β-lactam or other antibiotics. Its gene configuration matched that of other community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus (CA-MRSA and CA-MSSA) strains which have recently been reported worldwide. As far as we know, this is the first report on a PVL-positive S. aureus strain associated with an orthopedic implant (knee arthroprosthesis) infection.
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Affiliation(s)
- Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Lucilla Baldassarri
- Respiratory and Systemic Disease Unit, Department of Infectious, Parasitic and Immuno-mediated Diseases, National Health Institute, Rome - Italy
| | - Tolmino Corazzari
- Laboratory of Medical Physics, University of Modena and Reggio Emilia, Modena - Italy
| | - Roberta Creti
- Respiratory and Systemic Disease Unit, Department of Infectious, Parasitic and Immuno-mediated Diseases, National Health Institute, Rome - Italy
| | - Stefano Ravaioli
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Ilaria Cangini
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Valter Pirini
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
| | - Alessandra Maso
- Microbiological Analysis Section of the Musculoskeletal Tissue Bank, Rizzoli Orthopedic Institute, Bologna - Italy
| | - M. ELENA Donati
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Currently at the Microbiological Analysis Section of the Musculoskeletal Tissue Bank, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Francesco Pegreffi
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
| | - Livia Visai
- Department of Biochemistry, University of Pavia, Pavia - Italy
| | - Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
| | - Pietro Speziale
- Department of Biochemistry, University of Pavia, Pavia - Italy
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
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103
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Campoccia D, Montanaro L, Ravaioli S, Cangini I, Speziale P, Arciola CR. Description of a New Group of Variants of the Staphylococcus Aureus Elastin-Binding Protein that Lacks an Entire DNA Segment of 180 bp. Int J Artif Organs 2018; 32:621-9. [DOI: 10.1177/039139880903200911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The elastin-binding protein (EbpS) is a microbial surface component recognizing adhesive matrix molecule (MSCRAMM) found in Staphylococcus aureus that mediates bacterial cell binding to soluble elastin and tropoelastin. In scientific literature it is well established that the gene encoding for the elastin-binding protein (ebpS) is present in the vast majority of Staphylococcus aureus clinical isolates. The present study aimed at investigating a group of new variant forms of ebpS gene identified in S. aureus clinical strains isolated from implant-related orthopedic infections. A PCR screening for the ebpS gene, conducted on over two hundred S. aureus clinical isolates from implant-related infections revealed the detection of six strains exhibiting an altered amplicon size, shorter than expected. In order to elucidate the sequence changes present in these gene variants, the trait comprised between the primers was analyzed in all six isolates bearing the modification and in four isolates exhibiting the regular amplicon size. A similar form of the ebpS gene, lacking a DNA trait of 180 bp, was confirmed in all six isolates independently of their clonal origin. Interestingly, only three of these isolates, all with type IV polymorphism of the accessory genes regulator (agr) locus, showed exactly the same sequence and, thus, the same pattern of point mutations with respect to reference strains. From nucleotide translation, the corresponding encoded protein was found to lack an entire peptide segment of 60 amino acids. From nucleotide sequence translation, this modification was found to implicate the disappearance of an entire hydrophobic domain, whose functional significance needs to be further investigated.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
| | - Stefano Ravaioli
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
| | - Ilaria Cangini
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
| | - Pietro Speziale
- Department of Biochemistry, University of Pavia, Pavia - Italy
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
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104
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Baldassarri L, Montanaro L, Creti R, Arciola CR. Underestimated Collateral Effects of Antibiotic Therapy in Prosthesis-Associated Bacterial Infections. Int J Artif Organs 2018; 30:786-91. [DOI: 10.1177/039139880703000907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antibiotic treatment of infections associated with the use of indwelling medical devices in ageing and/or severely ill patients represents a significant healthcare problem due to the difficulty of treating such infections and to the various collateral effects that may be observed following the often aggressive therapy We summarize some effects of antibiotics on the expression of virulence factors of the microorganisms which cause such infections. These effects, particularly those resulting in a stimulation of bacterial virulence, might be usefully included among the other well-known collateral effects of antibiotic therapy
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Affiliation(s)
- L. Baldassarri
- Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome - Italy
| | - L. Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Department of Experimental Pathology of the University of Bologna, Bologna - Italy
| | - R. Creti
- Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome - Italy
| | - C. R. Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Department of Experimental Pathology of the University of Bologna, Bologna - Italy
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105
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Campoccia D, Montanaro L, Arciola CR. Current Methods for Molecular Epidemiology Studies of Implant Infections. Int J Artif Organs 2018; 32:642-54. [DOI: 10.1177/039139880903200914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Over the last few decades, the number of surgical procedures involving prosthetic materials has greatly multiplied, along with the rising medical and economic impact of implant-associated infections. The need to appropriately counteract and deal with this phenomenon has led to growing efforts to elucidate the etiology, pathogenesis and epidemiology of these types of infections, characterized by opportunistic pathogens. Molecular epidemiology studies have progressively emerged as a leading multitask tool to identify and fingerprint bacterial strains, unveil the complex clonal nature of important pathogens, detect outbreak events, track the origin of the infections, assess the clinical significance of individual strain types, survey their distribution, recognize associations of strain types with specific virulence determinants and/or pathological conditions, assess the role played by the specific components of the virulon, and reveal the phylogeny and the mechanisms through which new strain types have emerged. Despite the many advances that have been made thanks to these flourishing new approaches to molecular epidemiology, a number of critical aspects remain challenging. In this paper, we briefly discuss the current limitations and possible developments of molecular epidemiology methods in the investigation and surveillance of implant infections.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
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106
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Arciola CR, Speziale P, Montanaro L. Perspectives on DNA Vaccines. Targeting Staphylococcal Adhesins to Prevent Implant Infections. Int J Artif Organs 2018; 32:635-41. [DOI: 10.1177/039139880903200913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
DNA vaccines consist of a plasmid DNA genetically engineered to produce one or more proteins able to elicit protective immune responses against virulence factors of infectious pathogens. Once introduced into the cells of the host, a DNA vaccine induces a high production of antigens by the endogenous presence of the peptide codifying gene; improves antigen processing and presentation; may be able to simultaneously co-express multiple antigenic molecules; and, lastly, switches on both humoral and cellular immune responses. In this mini-review, we underscore the advantageous characteristics of DNA vaccines compared with traditional ones and provide summaries of some of the more recent studies on them, mainly focusing the possibility of their use in targeting the staphylococcal adhesins that play a key role in the first adhesive phase of implant infections.
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Affiliation(s)
- Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Pietro Speziale
- Department of Biochemistry, University of Pavia, Pavia - Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
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107
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Statin use correlates with reduced risk of chronic osteomyelitis: a nationwide case-control study in Taiwan. Curr Med Res Opin 2017; 33:2235-2240. [PMID: 28699801 DOI: 10.1080/03007995.2017.1354831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVE Potential association between prior statin use and chronic osteomyelitis is examined. METHODS A nationwide case-control study was conducted based on data taken from the Taiwan National Health Insurance program. The case group includes 2338 subjects aged 20-84 years newly diagnosed for chronic osteomyelitis from 2000 to 2013; the control group included 2338 randomly selected subjects without chronic osteomyelitis matched for sex, age, and index year. Statin use was respectively defined as "current", "recent" or "past" if the most recent statin prescription was filled <3 months, 3-6 months or ≥6 months prior to the chronic osteomyelitis diagnosis. Relative risk of chronic osteomyelitis associated with statin use was measured by the odds ratio (OR) with 95% confidence interval (CI) using the conditional logistic regression model. RESULTS After controlling for potential confounders, the adjusted ORs of chronic osteomyelitis were 0.57 for subjects with current statin use (95% CI 0.45, 0.72), 0.80 for subjects with recent statin use (95% CI 0.48, 1.33), and 1.00 for subjects with past statin use (95% CI 0.83, 1.20), compared patients with no prior statin use. In further analysis, the adjusted ORs of chronic osteomyelitis were 0.70 for subjects with cumulative statin use <12 months (95% CI 0.47, 1.07), and 0.56 for subjects with cumulative statins use ≥12 months (95% CI 0.41, 0.77), compared with those with no prior statin use. CONCLUSIONS Current statin use is associated with reduced concurrent diagnosis of chronic osteomyelitis, particularly for a cumulative statin use ≥12 months.
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Affiliation(s)
- Hsien-Feng Lin
- a School of Chinese Medicine , China Medical University , Taichung , Taiwan
- b Department of Family Medicine , China Medical University Hospital , Taichung , Taiwan
| | - Kuan-Fu Liao
- c Department of Internal Medicine , Taichung Tzu Chi General Hospital , Taichung , Taiwan
- d College of Medicine , Tzu Chi University , Hualien , Taiwan
- e Graduate Institute of Integrated Medicine, China Medical University , Taichung , Taiwan
| | - Ching-Mei Chang
- f Department of Nursing , Tungs' Taichung Metro Habor Hospital , Taichung , Taiwan
| | - Cheng-Li Lin
- g College of Medicine , China Medical University , Taichung , Taiwan
- h Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
| | - Shih-Wei Lai
- b Department of Family Medicine , China Medical University Hospital , Taichung , Taiwan
- g College of Medicine , China Medical University , Taichung , Taiwan
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108
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Pseudomonas aeruginosa Septic Arthritis and Osteomyelitis after Closed Reduction and Percutaneous Pinning of a Supracondylar Humerus Fracture: A Case Report and Review of the Literature. Case Rep Orthop 2017; 2017:8721835. [PMID: 29348955 PMCID: PMC5733764 DOI: 10.1155/2017/8721835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 10/26/2017] [Indexed: 12/23/2022] Open
Abstract
Infectious complications of closed reduction and percutaneous pinning of supracondylar humerus fractures are exceedingly rare. Although postoperative Pseudomonas infection is a feared complication associated with noncompliance and a wet cast, there are no reports in the literature of this occurring. We present the devastating complication of a pediatric patient who developed Pseudomonas aeruginosa subperiosteal abscess, osteomyelitis, and elbow septic arthritis after presenting to the clinic multiple times with a wet cast after closed reduction and percutaneous pinning of a supracondylar humerus fracture. We describe the treatment course for this patient, followed by the sequelae of posterolateral rotary instability. This case not only confirms that patients can get Pseudomonas infections if they get their cast wet but also stresses the importance of patient communication and compliance in preventing unfortunate complications.
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109
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Dapunt U, Bürkle C, Günther F, Pepke W, Hemmer S, Akbar M. Surgical site infections following instrumented stabilization of the spine. Ther Clin Risk Manag 2017; 13:1239-1245. [PMID: 29033574 PMCID: PMC5614754 DOI: 10.2147/tcrm.s141082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Implant-associated infections are still a feared complication in the field of orthopedics. Bacteria attach to the implant surface and form so-called biofilm colonies that are often difficult to diagnose and treat. Since the majority of studies focus on prosthetic joint infections (PJIs) of the hip and knee, current treatment options (eg, antibiotic prophylaxis) of implant-associated infections have mostly been adapted according to these results. Objective The aim of this study was to evaluate patients with surgical site infections following instrumented stabilization of the spine with regard to detected bacteria species and the course of the disease. Patients and methods We performed a retrospective single-center analysis of implant-associated infections of the spine from 2010 to 2014. A total of 138 patients were included in the study. The following parameters were evaluated: C-reactive protein serum concentration, microbiological evaluation of tissue samples, the time course of the disease, indication for instrumented stabilization of the spine, localization of the infection, and the number of revision surgeries required until cessation of symptoms. Results Coagulase-negative Staphylococcus spp. were most commonly detected (n=69, 50%), followed by fecal bacteria (n=46, 33.3%). In 23.2% of cases, no bacteria were detected despite clinical suspicion of an infection. Most patients suffered from degenerative spine disorders (44.9%), followed by spinal fractures (23.9%), non-degenerative scoliosis (20.3%), and spinal tumors (10.1%). Surgical site infections occurred predominantly within 3 months (64.5%), late infections after 2 years were rare (4.3%), in particular when compared with PJIs. Most cases were successfully treated after 1 revision surgery (60.9%), but there were significant differences between bacteria species. Fecal bacteria were more difficult to treat and often required more than 1 revision surgery. Conclusion In summary, we were able to demonstrate significant differences between spinal implant-associated infections and PJIs. These aspects should be considered early on in the treatment of surgical site infections following instrumented stabilization of the spine.
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Affiliation(s)
- Ulrike Dapunt
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital
| | - Caroline Bürkle
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital
| | - Frank Günther
- Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University, Heidelberg, Germany
| | - Wojciech Pepke
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital
| | - Stefan Hemmer
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital
| | - Michael Akbar
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital
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110
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Martinez-Perez M, Perez-Jorge C, Lozano D, Portal-Nuñez S, Perez-Tanoira R, Conde A, Arenas MA, Hernandez-Lopez JM, de Damborenea JJ, Gomez-Barrena E, Esbrit P, Esteban J. Evaluation of bacterial adherence of clinical isolates of Staphylococcus sp. using a competitive model: An in vitro approach to the "race for the surface" theory. Bone Joint Res 2017; 6:315-322. [PMID: 28522445 PMCID: PMC5457649 DOI: 10.1302/2046-3758.65.bjr-2016-0226.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/06/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives Implant-related infection is one of the most devastating complications in orthopaedic surgery. Many surface and/or material modifications have been developed in order to minimise this problem; however, most of the in vitro studies did not evaluate bacterial adhesion in the presence of eukaryotic cells, as stated by the ‘race for the surface’ theory. Moreover, the adherence of numerous clinical strains with different initial concentrations has not been studied. Methods We describe a method for the study of bacterial adherence in the presence of preosteoblastic cells. For this purpose we mixed different concentrations of bacterial cells from collection and clinical strains of staphylococci isolated from implant-related infections with preosteoblastic cells, and analysed the minimal concentration of bacteria able to colonise the surface of the material with image analysis. Results Our results show that clinical strains adhere to the material surface at lower concentrations than collection strains. A destructive effect of bacteria on preosteoblastic cells was also detected, especially with higher concentrations of bacteria. Conclusions The method described herein can be used to evaluate the effect of surface modifications on bacterial adherence more accurately than conventional monoculture studies. Clinical strains behave differently than collection strains with respect to bacterial adherence. Cite this article: M. Martinez-Perez, C. Perez-Jorge, D. Lozano, S. Portal-Nuñez, R. Perez-Tanoira, A. Conde, M. A. Arenas, J. M. Hernandez-Lopez, J. J. de Damborenea, E. Gomez-Barrena, P. Esbrit, J. Esteban. Evaluation of bacterial adherence of clinical isolates of Staphylococcus sp. using a competitive model: An in vitro approach to the “race for the surface” theory. Bone Joint Res 2017;6:315–322. DOI: 10.1302/2046-3758.65.BJR-2016-0226.R2.
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Affiliation(s)
- M Martinez-Perez
- Department of Clinical Microbiology, IIS-Fundación Jimènez Díaz, UAM, Madrid, Spain
| | - C Perez-Jorge
- Department of Clinical Microbiology, IIS-Fundación Jimènez Díaz, UAM, Madrid, Spain
| | - D Lozano
- IIS-Fundación Jimènez Díaz UAM, Cooperative Research Thematic Network on Aging and Frailty (RETICEF), Madrid, Spain
| | - S Portal-Nuñez
- IIS-Fundación Jimènez Díaz UAM, Cooperative Research Thematic Network on Aging and Frailty (RETICEF), Madrid, Spain
| | - R Perez-Tanoira
- Department of Clinical Microbiology, IIS-Fundación Jimènez Díaz, UAM, Madrid, Spain
| | - A Conde
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research. (CENIM-CSIC) Avda. Gregorio del Amo, Madrid, Spain
| | - M A Arenas
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research. (CENIM-CSIC) Avda. Gregorio del Amo, Madrid, Spain
| | - J M Hernandez-Lopez
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research. (CENIM-CSIC) Avda. Gregorio del Amo, Madrid, Spain
| | - J J de Damborenea
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research. (CENIM-CSIC) Avda. Gregorio del Amo, Madrid, Spain
| | - E Gomez-Barrena
- Department of Orthopaedic Surgery, IdIPaz-Hospital Universitario La Paz. Universidad Autónoma de Madrid, Madrid, Spain
| | - P Esbrit
- IIS-Fundación Jimènez Díaz UAM, Cooperative Research Thematic Network on Aging and Frailty (RETICEF), Madrid, Spain
| | - J Esteban
- Department of Surface Engineering Corrosion and Durability. National Centre for Metallurgical Research, IIS-Fundación Jimènez Díaz, UAM, Madrid, Spain
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111
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Baicalin inhibits biofilm formation, attenuates the quorum sensing-controlled virulence and enhances Pseudomonas aeruginosa clearance in a mouse peritoneal implant infection model. PLoS One 2017; 12:e0176883. [PMID: 28453568 PMCID: PMC5409170 DOI: 10.1371/journal.pone.0176883] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
The quorum sensing (QS) circuit plays a role in the precise regulation of genes controlling virulence factors and biofilm formation in Pseudomonas aeruginosa. QS-controlled biofilm formation by Pseudomonas aeruginosa in clinical settings has remained controversial due to emerging drug resistance; therefore, screening diverse compounds for anti-biofilm or anti-QS activities is important. This study demonstrates the ability of sub-minimum inhibitory concentrations (sub-MICs) of baicalin, an active natural compound extracted from the traditional Chinese medicinal Scutellaria baicalensis, to inhibit the formation of Pseudomonas aeruginosa biofilms and enhance the bactericidal effects of various conventional antibiotics in vitro. In addition, baicalin exerted dose-dependent inhibitory effects on virulence phenotypes (LasA protease, LasB elastase, pyocyanin, rhamnolipid, motilities and exotoxin A) regulated by QS in Pseudomonas aeruginosa. Moreover, the expression levels of QS-regulatory genes, including lasI, lasR, rhlI, rhlR, pqsR and pqsA, were repressed after sub-MIC baicalin treatment, resulting in significant decreases in the QS signaling molecules 3-oxo-C12-HSL and C4-HSL, confirming the ability of baicalin-mediated QS inhibition to alter gene and protein expression. In vivo experiments indicated that baicalin treatment reduces Pseudomonas aeruginosa pathogenicity in Caenorhabditis elegans. Greater worm survival in the baicalin-treated group manifested as an increase in the LT50 from 24 to 96 h. In a mouse peritoneal implant infection model, baicalin treatment enhanced the clearance of Pseudomonas aeruginosa from the implants of mice infected with Pseudomonas aeruginosa compared with the control group. Moreover, the combination of baicalin and antibiotics significantly reduced the numbers of colony-forming units in the implants to a significantly greater degree than antibiotic treatment alone. Pathological and histological analyses revealed mitigation of the inflammatory response and reduced cell infiltration in the peritoneal tissue surrounding the implants after baicalin treatment. Measurement of the cytokine levels in the peritoneal lavage fluid of mice in the baicalin treatment group revealed a decrease in IL-4, an increase in interferon γ (IFN-γ), and a reversed IFN-γ/IL-4 ratio compared with the control group, indicating that baicalin treatment activated the Th1-induced immune response to expedite bacterial load clearance. Based on these results, baicalin might be a potent QS inhibitor and anti-biofilm agent for combating Pseudomonas aeruginosa biofilm-related infections.
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Jørgensen NP, Hansen K, Andreasen CM, Pedersen M, Fuursted K, Meyer RL, Petersen E. Hyperbaric Oxygen Therapy is Ineffective as an Adjuvant to Daptomycin with Rifampicin Treatment in a Murine Model of Staphylococcus aureus in Implant-Associated Osteomyelitis. Microorganisms 2017; 5:microorganisms5020021. [PMID: 28441320 PMCID: PMC5488092 DOI: 10.3390/microorganisms5020021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/16/2022] Open
Abstract
Implant-associated infections caused by bacterial biofilms are difficult to treat. Surgical intervention is often necessary to cure the patient, as the antibiotic recalcitrance of biofilms renders them untreatable with conventional antibiotics. Intermittent hyperbaric oxygen treatment (HBOT) has been proposed as an adjuvant to conventional antibiotic treatment and it has been speculated that combining HBOT with antibiotics could improve treatment outcomes for biofilm infections. In this study we addressed whether HBOT could improve treatment outcomes of daptomycin and rifampicin combination therapy. The effect of HBOT on the treatment outcomes of daptomycin and rifampicin against implant-associated osteomyelitis was quantified in a murine model. In total, 80 mice were randomized into two groups receiving antibiotics, either alone or in combination with daily intermittent HBOT (304 kPa for 60 min) following injection of antibiotics. Treatment was initiated 11 days after animals were infected with Staphylococcus aureus and treatment duration was 14 days. We found that HBOT did not improve the cure rate and did not reduce the bacterial load on the implant surface or in the surrounding tissue. Cure rates of daptomycin + rifampicin were 40% in infected tibias and 75% for implants while cure rates for HBOT-daptomycin + rifampicin were 50% and 85%, respectively, which were not significantly higher (Fisher’s exact test). While it is encouraging that the combination of daptomycin and rifampicin is very effective, our study demonstrates that this efficacy cannot be improved by adjuvant HBOT.
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Affiliation(s)
- Nis Pedersen Jørgensen
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark.
- Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark.
| | - Kasper Hansen
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark.
| | | | - Michael Pedersen
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark.
| | - Kurt Fuursted
- Microbiology and Infection Control, Statens Serum Institut, 2300 Copenhagen, Denmark.
| | - Rikke L Meyer
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, 8000 Aarhus, Denmark.
- Department of Bioscience, Aarhus University, 8000 Aarhus, Denmark.
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus, Denmark.
- Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark.
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113
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Zimmerli W, Sendi P. Orthopaedic biofilm infections. APMIS 2017; 125:353-364. [PMID: 28407423 DOI: 10.1111/apm.12687] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/10/2017] [Indexed: 02/01/2023]
Abstract
Many infections of the musculoskeletal system are biofilm infections that develop on non-living surfaces. Microorganisms adhere either on dead bone (sequesters) or implants. As a rule for a curative concept, chronic osteomyelitis or implant-associated bone infection must be treated with a combination of surgery and antimicrobial therapy. If an implant is kept in place, or a new device is implanted before complete healing of infection, a biofilm-active antibiotic should be used. Rifamycins are active against biofilms of staphylococci, and fluoroquinolones against those of Gram-negative bacilli. In this review, the management of chronic osteomyelitis, periprosthetic joint infection and implant-associated osteomyelitis of long bones is presented.
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Affiliation(s)
- Werner Zimmerli
- Kantonsspital Baselland, Basel University Medical Clinic and Interdisciplinary Unit for Orthopaedic Infections, Liestal, Switzerland
| | - Parham Sendi
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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114
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Guo G, Wang J, You Y, Tan J, Shen H. Distribution characteristics of Staphylococcus spp. in different phases of periprosthetic joint infection: A review. Exp Ther Med 2017; 13:2599-2608. [PMID: 28587320 PMCID: PMC5450602 DOI: 10.3892/etm.2017.4300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/26/2017] [Indexed: 01/31/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating condition and Staphylococcus spp. are the predominant pathogens responsible, particularly coagulase-negative staphylococci (CoNS) and Staphylococcus aureus. The aim of the present systematic review was to evaluate the distribution characteristics of specific Staphylococcus spp. in different PJI phases, reveal the effect of pathogens' feature on their distribution and suggest recommendations for antibiotic treatment of Staphylococcal PJI. The present systematic review was performed using PubMed and EMBASE databases with the aim to identify existing literature that presented the spectrum of Staphylococcus spp. that occur in PJI. Once inclusion and exclusion criteria were applied, 20 cohort studies involving 3,344 cases in 3,199 patients were included. The predominant pathogen involved in PJI was indicated to be CoNS (31.2%), followed by S. aureus (28.8%). This trend was more apparent in hip replacement procedures. In addition, almost equal proportions of CoNS and S. aureus (28.6 and 30.0%, respectively) were indicated in the delayed phase. CoNS (36.6%) were the predominant identified organism in the early phase, whereas S. aureus (38.3%) occurred primarily in the late phase. In PJI caused by S. aureus, the number of cases of methicillin-sensitive Staphylococcus aureus (MSSA) was ~2.5-fold greater than that of methicillin-resistant Staphylococcus aureus (MRSA). MRSA occurred predominantly in the early phase, whereas MSSA was largely observed in the delayed and late phases. With regards to antibiotic treatment, the feature of various pathogens and the phases of PJI were the primary considerations. The present review provides useful information for clinical practice and scientific research of PJI.
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Affiliation(s)
- Geyong Guo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Jiaxing Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yanan You
- Department of Obstetrics, Fudan University Affiliated Obstetrics and Gynecology Hospital, Shanghai 200233, P.R. China
| | - Jiaqi Tan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Hao Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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115
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Guo G, Zhou H, Wang Q, Wang J, Tan J, Li J, Jin P, Shen H. Nano-layered magnesium fluoride reservoirs on biomaterial surfaces strengthen polymorphonuclear leukocyte resistance to bacterial pathogens. NANOSCALE 2017; 9:875-892. [PMID: 27995243 DOI: 10.1039/c6nr07729c] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Biomaterial-related bacterial infections cause patient suffering, mortality and extended periods of hospitalization, imposing a substantial burden on medical systems. In this context, understanding of nanomaterials-bacteria-cells interactions is of both fundamental and clinical significance. Herein, nano-MgF2 films were deposited on titanium substrate via magnetron sputtering. Using this platform, the antibacterial behavior and mechanism of the nano-MgF2 films were investigated in vitro and in vivo. It was found that, for S. aureus (CA-MRSA, USA300) and S. epidermidis (RP62A), the nano-MgF2 films possessed excellent anti-biofilm activity, but poor anti-planktonic bacteria activity in vitro. Nevertheless, both the traditional SD rat osteomyelitis model and the novel stably luminescent mouse infection model demonstrated that nano-MgF2 films exerted superior anti-infection effect in vivo, which cannot be completely explained by the antibacterial activity of the nanomaterial itself. Further, using polymorphonuclear leukocytes (PMNs), the critical immune cells of innate immunity, a complementary investigation of MgF2-bacteria-PMNs co-culturing revealed that the nano-MgF2 films improved the antibacterial effect of PMNs through enhancing their phagocytosis and stability. To our knowledge, this is the first time of exploring the antimicrobial mechanism of nano-MgF2 from the perspective of innate immunity both in vitro and in vivo. Based on the research results, a plausible mechanism is put forward for the predominant antibacterial effect of nano-MgF2in vivo, which may originate from the indirect immune enhancement effect of nano-MgF2 films. In summary, this study of surface antibacterial design using MgF2 nanolayer is a meaningful attempt, which can promote the host innate immune response to bacterial pathogens. This may give us a new understanding towards the antibacterial behavior and mechanism of nano-MgF2 films and pave the way towards their clinical applications.
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Affiliation(s)
- Geyong Guo
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Huaijuan Zhou
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China.
| | - Qiaojie Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Jiaxing Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Jiaqi Tan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Jinhua Li
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China. and University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ping Jin
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China.
| | - Hao Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
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116
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Barros J, Grenho L, Fontenente S, Manuel CM, Nunes OC, Melo LF, Monteiro FJ, Ferraz MP. Staphylococcus aureusandEscherichia colidual-species biofilms on nanohydroxyapatite loaded with CHX or ZnO nanoparticles. J Biomed Mater Res A 2016; 105:491-497. [DOI: 10.1002/jbm.a.35925] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/14/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Joana Barros
- FEUP - Faculdade de Engenharia, Departamento de Engenharia Metalúrgica e Materiais; Universidade do Porto; Portugal
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Portugal
- INEB - Instituto de Engenharia Biomédica; Universidade do Porto; Portugal
| | - Liliana Grenho
- FEUP - Faculdade de Engenharia, Departamento de Engenharia Metalúrgica e Materiais; Universidade do Porto; Portugal
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Portugal
- INEB - Instituto de Engenharia Biomédica; Universidade do Porto; Portugal
| | - Sílvia Fontenente
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Portugal
- IPATIMUP - Institute of Molecular Pathology and Immunology of the University of Porto; Portugal
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Departamento de Engenharia Química; Universidade do Porto; Portugal
| | - Cândida M. Manuel
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Departamento de Engenharia Química; Universidade do Porto; Portugal
- ULP-Universidade Lusófona do Porto; Portugal
| | - Olga C. Nunes
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Departamento de Engenharia Química; Universidade do Porto; Portugal
| | - Luís F. Melo
- LEPABE - Laboratory for Process Engineering, Environment, Biotechnology and Energy, Departamento de Engenharia Química; Universidade do Porto; Portugal
| | - Fernando J. Monteiro
- FEUP - Faculdade de Engenharia, Departamento de Engenharia Metalúrgica e Materiais; Universidade do Porto; Portugal
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Portugal
- INEB - Instituto de Engenharia Biomédica; Universidade do Porto; Portugal
| | - Maria P. Ferraz
- FP-ENAS/CEBIMED; University Fernando Pessoa Energy, Environment and Health Research Unit/Biomedical Research Center; Porto Portugal
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117
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Schneiders W, Lamping S, Rammelt S, Olbrich A, Zwipp H. [Elective and acute procedures in trauma surgery. Complications requiring revision]. Unfallchirurg 2016; 118:439-46. [PMID: 24132669 DOI: 10.1007/s00113-013-2519-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Using data between 2010 and 31 March 2012, a cohort study concerning complications of all discharged patients who had undergone surgery was performed. PATIENTS AND METHODS In our detailed analysis, we defined two groups out of the 5,248 cases: an acute trauma patient group (n = 3,942) and an elective patient group (n = 1,306). Complications were divided into the following groups: (1) technical complications (failure of the implant, poor indication, instability or non-union), (2) local complication (hematoma or delayed wound healing), and (3) infection. RESULTS In 4.4% of patients (n = 233), treatment was delayed because of a complication. In 2.3% (n = 123), a technical complication was observed, followed by local complications in 1.3% [e.g., hematoma 0.6%, other wound healing disturbance (0.6%)]. In the elective surgery group, the percentage of complications needing revision (3.1%) was significantly lower compared to the trauma surgery group (4.9%). The patient's age for the non-complicated surgery group was significantly lower (54 vs. 63 years) and length of hospital stay (6.7 days longer) was significantly higher in patients with complications. Risk factors such as smoking were significantly more frequent in patients with complications (9% vs. 18.5%). CONCLUSION Recording and evaluating of complications in surgery plays a major role for quality control. Certain factors (e.g., comorbidity and the age of the patient) cannot be influenced, but complications caused by technical problems could theoretically be avoided. Especially these cases must be analyzed in detail to reduce the percentage of complications requiring revision.
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Affiliation(s)
- W Schneiders
- Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland,
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118
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Zaborowska M, Tillander J, Brånemark R, Hagberg L, Thomsen P, Trobos M. Biofilm formation and antimicrobial susceptibility of staphylococci and enterococci from osteomyelitis associated with percutaneous orthopaedic implants. J Biomed Mater Res B Appl Biomater 2016; 105:2630-2640. [PMID: 27779811 DOI: 10.1002/jbm.b.33803] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/24/2016] [Accepted: 10/02/2016] [Indexed: 11/06/2022]
Abstract
Staphylococci and enterococci account for most deep infections associated with bone-anchored percutaneous implants for amputation treatment. Implant-associated infections are difficult to treat; therefore, it is important to investigate if these infections have a biofilm origin and to determine the biofilm antimicrobial susceptibility to improve treatment strategies. The aims were: (i) to test a novel combination of the Calgary biofilm device and a custom-made susceptibility MIC plate (Sensititre® ), (ii) to determine the biofilm formation and antimicrobial resistance in clinical isolates causing implant-associated osteomyelitis, and (iii) to describe the associated clinical outcome. Enterococci and staphylococci were characterized by microtitre plate assay, Congo Red Agar plate test, and PCR. Biofilm susceptibility to 10 antimicrobials and its relationship to treatment outcomes were determined. The majority of the strains produced biofilm in vitro showing inter- and intraspecies differences. Biofilms showed a significantly increased antimicrobial resistance compared with their planktonic counterparts. Slime-producing strains tolerated significantly higher antimicrobial concentrations compared with non-producers. All seven staphylococcal strains carried ica genes, but two did not produce slime. The degree of biofilm formation and up-regulated antibiotic resistance may translate into a variable risk of treatment failure. This new method set-up allows for the reproducible determination of minimum biofilm eradication concentration of antimicrobial agents, which may guide future antimicrobial treatment decisions in orthopaedic implant-associated infection. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2630-2640, 2017.
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Affiliation(s)
- Magdalena Zaborowska
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Tillander
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rickard Brånemark
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopaedics, International Center for Osseointegration Research Education and Surgery (iCORES), University of California, San Francisco
| | - Lars Hagberg
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Biomatcell Vinn Excellence Center of Biomaterials and Cell Therapy, PO Box 412, 405 30, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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119
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Cooper JJ, Florance H, McKinnon JL, Laycock PA, Aiken SS. Elution profiles of tobramycin and vancomycin from high-purity calcium sulphate beads incubated in a range of simulated body fluids. J Biomater Appl 2016; 31:357-65. [PMID: 27511982 DOI: 10.1177/0885328216663392] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to characterise the elution profiles of antibiotics in combination with pharmaceutical grade calcium sulphate beads in phosphate buffered saline and other physiological solutions which more closely mimic the in vivo environment. Synthetic recrystallised calcium sulphate was combined with vancomycin hydrochloride powder and tobramycin sulphate solution and the paste was formed into 3 mm diameter hemispherical beads. Then 2 g of beads were immersed in 2 ml of either phosphate buffered saline, Dulbecco's Modified Eagle Medium or Hartmann's solution and incubated at 37℃ for up to 21 days. At a range of time points, eluent was removed for analysis by liquid chromatography-mass spectrometry (LC-MS). Tobramycin sulphate and vancomycin hydrochloride release was successfully quantified against standard curves from solutions eluted in all three physiological media (phosphate buffered saline, Dulbecco's Modified Eagle Medium and Hartmann's solution) during incubation with calcium sulphate beads. One hour eluate concentrations were high, up to 2602 µg/ml for tobramycin in phosphate buffered saline and 7417 µg/ml for vancomycin, whereas in DMEM, the levels of tobramycin were 2458 µg/ml and 4401 µg/ml for vancomycin. The levels in HRT were 2354 µg/ml for tobramycin and 5948 µg/ml for vancomycin. The results show highest levels of antibiotic elution over the first 24 h, which gradually diminish over the following 21 days.
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Affiliation(s)
- J J Cooper
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
| | - H Florance
- Centre for Synthetic and Systems Biology, University of Edinburgh, Edinburgh, UK Exeter Mass Spectrometry Facility, Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - J L McKinnon
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
| | - P A Laycock
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
| | - S S Aiken
- Biocomposites Ltd., Keele Science Park, Staffordshire, UK
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120
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Clonality, virulence and the occurrence of genes encoding antibiotic resistance among Staphylococcus warneri isolates from bloodstream infections. J Med Microbiol 2016; 65:828-836. [DOI: 10.1099/jmm.0.000287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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121
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Wang X, Cai Y, Xing H, Wu W, Wang G, Li L, Chen J. Increased therapeutic efficacy of combination of azithromycin and ceftazidime on Pseudomonas aeruginosa biofilm in an animal model of ureteral stent infection. BMC Microbiol 2016; 16:124. [PMID: 27341798 PMCID: PMC4921005 DOI: 10.1186/s12866-016-0744-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/15/2016] [Indexed: 12/04/2022] Open
Abstract
Background Infection caused by ureteral stent indwelling is one of the most difficult medical problems, since once bacteria reside in biofilms they are extremely resistant to antibiotics as well as to the host immune defences. In this study we assessed the in vitro and in vivo efficacy of azithromycin and ceftazidime in preventing ureteral stent infection by Pseudomonas aeruginosa. Results The susceptibility testing with adherent bacteria showed that the biofilm was strongly inhibited by azithromycin treatment, ceftazidime against adherent bacteria in the presence of azithromycin showed the minimum inhibitory concentrations (MICs) and minimum bacteriocidal concentrations (MBCs) dramatically lower than those obtained in the absence of azithromycin. Moreover, ceftazidime plus azithromycin reduced twitching motility and production of rhamnolipid. For the single-treatment groups, in vivo intravenous injection of ceftazidime showed the highest inhibitory effect on bacterial load. Azithromycin prophylactic injection combined with ceftazidime showed increased inhibitory effect on bacterial load than that of each single antibiotic. Conclusions Combination of azithromycin and ceftazidime effectively prevent the formation of biofilm and reduced bacteria load of Pseudomonas aeruginosa compared to separate treatment of either of these two antibiotics. This combined treatment option have the potential to contribute to the success of Pseudomonas biofilm elimination in the clinical environment.
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Affiliation(s)
- Xianfeng Wang
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Yongqing Cai
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Haiyan Xing
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Wei Wu
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Guanying Wang
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Ling Li
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Jianhong Chen
- Department of Pharmacy, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, 400042, China.
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122
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Dapunt U, Hänsch GM, Arciola CR. Innate Immune Response in Implant-Associated Infections: Neutrophils against Biofilms. MATERIALS 2016; 9:ma9050387. [PMID: 28773509 PMCID: PMC5503022 DOI: 10.3390/ma9050387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/28/2016] [Accepted: 05/06/2016] [Indexed: 12/15/2022]
Abstract
Biofilm has been recognized as a well-protected form of living for bacteria, contributing to bacterial pathogenicity, particularly for opportunistic species. Biofilm-associated infections are marked by their persistence. Extensive research has been devoted to the formation and composition of biofilms. The immune response against biofilms remains rather unexplored, but there is the notion that bacteria within a biofilm are protected from host defences. Here we glance at the mechanisms by which neutrophils recognize and face biofilms in implant infections and discuss the implications of this interplay, as well as speculate on its significance.
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Affiliation(s)
- Ulrike Dapunt
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, Heidelberg 69118, Germany.
| | - Gertrud Maria Hänsch
- Institute for Immunology, Heidelberg University, Im Neuenheimer Feld 305, Heidelberg 69120, Germany.
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna 40136, Italy.
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40126, Italy.
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Clinical features and outcome of bone and joint infections with streptococcal involvement: 5-year experience of interregional reference centres in the south of France. New Microbes New Infect 2016; 12:8-17. [PMID: 27222712 PMCID: PMC4872313 DOI: 10.1016/j.nmni.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 01/10/2023] Open
Abstract
Streptococcal bone and joint infections are less common than staphylococcal cases. Few studies have reported the cases with well-identified Streptococcus species. Their clinical features and prognosis are not clearly known to date. Moreover, no treatment regimen has yet been clarified. We reviewed the streptococcal bone and joint infection cases managed in our centres from January 2009 to December 2013. We described the epidemiology, clinical and microbiologic characteristics, treatment approach and outcome. Among the 93 cases, 83% of patients were men with a median age of 60 years, and 90% of patients had comorbidities or risk factors. Bacteraemia occurred in 14% of cases. Serious complications occurred in six patients, including severe sepsis (two cases) and infective endocarditis (two cases). Orthopaedic device infections were observed in 35% of cases, including 17 patients with internal osteosynthesis device infection, 14 with prosthetic joint infection and three with vertebral osteosynthesis device infection. The median time between orthopaedic device implantation and onset of infection was 447 days. Fourteen species of Streptococcus were identified, including 97 isolates using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and three isolates using molecular identification. The five most represented species included S. agalactiae (37%), S. dysgalactiae (12%), S. anginosus (11%), S. constellatus (10%) and S. pneumoniae (9%). Streptococci isolates were susceptible to amoxicillin, with the exception of one S. mitis isolate. Remission 1 year after the end of treatment was recorded in 83%. One patient died of infection; eight patients had infections that failed to respond to treatment; and seven patients experienced relapse. Twenty patients (22%) had an unfavourable functional outcome, including 19 amputations and one arthrodesis. Five significant prognostic factors associated with an unfavourable clinical outcome were identified, including peripheral neuropathy (p 0.009), peripheral arterial disease (p 0.019), diabetes mellitus (p 0.031), location in the femur (p 0.0036), location in the foot (p 0.0475), osteitis without an orthopaedic device (p 0.041) and infection caused by S. dysgalactiae (p 0.020). The rate of poor outcomes remains high despite the low number of Streptococcus isolates resistant to antibiotics. Some prognostic factors, such as the presence of S. dysgalactiae, are associated with an unfavourable clinical outcome. Antibiotic regimens of streptococcal bone and joint infections are not standardized and need to be further investigated.
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Jørgensen NP, Skovdal SM, Meyer RL, Dagnæs-Hansen F, Fuursted K, Petersen E. Rifampicin-containing combinations are superior to combinations of vancomycin, linezolid and daptomycin against Staphylococcus aureus biofilm infection in vivo and in vitro. Pathog Dis 2016; 74:ftw019. [PMID: 27036412 DOI: 10.1093/femspd/ftw019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 11/14/2022] Open
Abstract
Susceptibility to antibiotics is dramatically reduced when bacteria form biofilms. In clinical settings this has a profound impact on treatment of implant-associated infections, as these are characterized by biofilm formation. Current routine susceptibility testing of microorganisms from infected implants does not reflect the actual susceptibility, and the optimal antibiotic strategy for treating implant-associated infections is not established. In this study of biofilm formation in implant-associated osteomyelitis, we compared thein vitroandin vivoefficacy of selected antibiotics alone and in combination againstStaphylococcus aureus.We tested vancomycin, linezolid, daptomycin and tigecycline alone and in combination with rifampicin, vancomycin, linezolid and daptomycin againstS. aureusIn vitro, biofilm formation dramatically reduced susceptibility by a factor of 500-2000.In vivo, antibiotic combinations were tested in a murine model of implant-associated osteomyelitis. Mice were infected by inserting implants colonized withS. aureustrough their tibia. After 11 days, the animals were divided into different groups (five animals/group) and given 14 days of antibiotic therapy. All antibiotics resulted in a reduced bacterial load in the infected bone surrounding the implant. Overall, the most effective antibiotic combinations contained rifampicin. Combinations containing two non-rifampicin antibiotics were not more active than single drugs.
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Affiliation(s)
- Nis Pedersen Jørgensen
- Department of Infectious Diseases, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens bvld 99, 8200 Aarhus, Denmark Department of Clinical Microbiology, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens bvld 99, 8200 Aarhus, Denmark
| | - Sandra M Skovdal
- Department of Infectious Diseases, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens bvld 99, 8200 Aarhus, Denmark Department of Clinical Microbiology, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens bvld 99, 8200 Aarhus, Denmark
| | - Rikke L Meyer
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Gustav Wieds vej 14, 8000 Aarhus, Denmark Department of Bioscience, Aarhus University, Vennelyst Boulevard 4, 8000 Aarhus, Denmark
| | - Frederik Dagnæs-Hansen
- Department of Biomedicine, Faculty of Health Sciences, Aarhus University, Vennelyst Boulevard 4, 8000 Aarhus, Denmark
| | - Kurt Fuursted
- Microbiology and Infection Control, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | - Eskild Petersen
- Department of Infectious Diseases, Institute of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens bvld 99, 8200 Aarhus, Denmark
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Rahim MI, Rohde M, Rais B, Seitz JM, Mueller PP. Susceptibility of metallic magnesium implants to bacterial biofilm infections. J Biomed Mater Res A 2016; 104:1489-99. [DOI: 10.1002/jbm.a.35680] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Muhammad Imran Rahim
- Helmholtz Centre for Infection Research; Inhoffenstrasse 7 Braunschweig 38124 Germany
| | - Manfred Rohde
- Helmholtz Centre for Infection Research; Inhoffenstrasse 7 Braunschweig 38124 Germany
| | - Bushra Rais
- Helmholtz Centre for Infection Research; Inhoffenstrasse 7 Braunschweig 38124 Germany
| | - Jan-Marten Seitz
- Institute of Materials Science, Leibniz University of Hannover; An Der Universität 2 Garbsen 30823 Germany
- Department of Materials Science and Engineering; Michigan Technological University; 1400 Townsend Dr Houghton Michigan 49931
| | - Peter P. Mueller
- Helmholtz Centre for Infection Research; Inhoffenstrasse 7 Braunschweig 38124 Germany
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Montanaro L, Ravaioli S, Ruppitsch W, Campoccia D, Pietrocola G, Visai L, Speziale P, Allerberger F, Arciola CR. Molecular Characterization of a Prevalent Ribocluster of Methicillin-Sensitive Staphylococcus aureus from Orthopedic Implant Infections. Correspondence with MLST CC30. Front Cell Infect Microbiol 2016; 6:8. [PMID: 26909340 PMCID: PMC4754407 DOI: 10.3389/fcimb.2016.00008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/15/2016] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus is the leading etiologic agent of orthopedic implant infections. Here a ribocluster of 27 S. aureus strains underwent further molecular characterization and subtyping by multilocus sequence typing (MLST) and spa-typing. This cluster had been detected by automated ribotyping (with the EcoRI restriction enzyme) of 200 S. aureus isolates from periprosthetic infections of patients who underwent revision at the Rizzoli Orthopaedic Institute. The ribocluster, consisting of agr type III strains, with a 74% co-occurrence of bone sialoprotein-binding (bbp) and collagen-binding (cna) genes, lacked mecA and IS256, and exhibited a high prevalence of the toxic shock syndrome toxin gene (tst, 85%). Strains' relatedness was analyzed by BURP and eBURST. Two predominant spa types, t012 (32%) and t021 (36%), and one predominant sequence type, ST30 (18/27, 67%) were identified: a S. aureus lineage spread worldwide belonging to MLST CC30. Two new sequence types (ST2954, ST2960) and one new spa type (t13129) were detected for the first time. Interestingly, the 27-strain cluster detected by ribotyping corresponded exactly to MLST CC30, the sole CC identified by eBURST.
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Affiliation(s)
- Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopaedic InstituteBologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of BolognaBologna, Italy
| | - Stefano Ravaioli
- Research Unit on Implant Infections, Rizzoli Orthopaedic InstituteBologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of BolognaBologna, Italy
| | - Werner Ruppitsch
- Division of Human Medicine, Austrian Agency for Health and Food Safety Vienna, Austria
| | - Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute Bologna, Italy
| | - Giampiero Pietrocola
- Unit of Biochemistry, Department of Molecular Medicine, University of Pavia Pavia, Italy
| | - Livia Visai
- Molecular Medicine Department, Center for Health Technologies (CHT), UdR INSTM, University of PaviaPavia, Italy; Department of Occupational Medicine, Toxicology and Environmental Risks, S. Maugeri FoundationIRCCS, Pavia, Italy
| | - Pietro Speziale
- Unit of Biochemistry, Department of Molecular Medicine, University of Pavia Pavia, Italy
| | - Franz Allerberger
- Division of Human Medicine, Austrian Agency for Health and Food Safety Vienna, Austria
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic InstituteBologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine, University of BolognaBologna, Italy
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Getzlaf MA, Lewallen EA, Kremers HM, Jones DL, Bonin CA, Dudakovic A, Thaler R, Cohen RC, Lewallen DG, van Wijnen AJ. Multi-disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee. J Orthop Res 2016; 34:177-86. [PMID: 26449208 PMCID: PMC4824296 DOI: 10.1002/jor.23068] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/06/2015] [Indexed: 02/04/2023]
Abstract
Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria.
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Affiliation(s)
- Matthew A. Getzlaf
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Eric A. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Hilal M. Kremers
- Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Dakota L. Jones
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905,Department of Biomedical Engineering and Physiology, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Carolina A. Bonin
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Roman Thaler
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Robert C. Cohen
- Reconstructive Research and Development, Stryker Orthopedics, 325 Corporate Drive, Mahwah, New Jersey 07430
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, Minnesota 55905
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Abstract
PURPOSE OF REVIEW The term osteomyelitis covers a wide range of inflammatory bone disorders caused by microbial invasion or due to autoinflammatory processes, but furthermore osteomyelitis also occurs at different ages and at preferred localizations in the human skeleton. This article aims to give an overview of the current literature focussing on pathognomonic aspects of osteomyelitis because of microbial invasion. RECENT FINDINGS Outlining the chronological sequence of osteomyelitis originating from the invasion of microbes finally leading to destruction of bone tissue, the formation and proliferation of biofilm structures play a key role in the development of inflammatory bone disorders. The components of the biofilm on the one hand mediate an immune response leading to an increase of local cytokines and induction of osteoclastogenesis but on the other hand also directly interact with the osteoblasts. As a result, the bone-remodelling process is immensely diminished by induction of proapoptotic pathways, decreased proliferation and differentiation of osteoblasts and an additional promotion of osteoclastogenesis. SUMMARY Although microbial invasion is responsible to be the cause for inflammatory bone disorders, except for an autoinflammatory origin, the underlying and detailed mechanisms in the pathogenesis of osteomyelitis are not yet fully understood, but represent an absolute precondition for the development of effective causal treatment strategies in the future.
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Effects of Fibronectin Coating on Bacterial and Osteoblast Progenitor Cells Adherence in a Co-culture Assay. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 973:17-30. [DOI: 10.1007/5584_2016_41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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130
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Grenho L, Salgado CL, Fernandes MH, Monteiro FJ, Ferraz MP. Antibacterial activity and biocompatibility of three-dimensional nanostructured porous granules of hydroxyapatite and zinc oxide nanoparticles--an in vitro and in vivo study. NANOTECHNOLOGY 2015; 26:315101. [PMID: 26180062 DOI: 10.1088/0957-4484/26/31/315101] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Ceramic scaffolds are widely studied in the bone tissue engineering field due to their potential in regenerative medicine. However, adhesion of microorganisms on biomaterials with subsequent formation of antibiotic-resistant biofilms is a critical factor in implant-related infections. Therefore, new strategies are needed to address this problem. In the present study, three-dimensional and interconnected porous granules of nanostructured hydroxyapatite (nanoHA) incorporated with different amounts of zinc oxide (ZnO) nanoparticles were produced using a simple polymer sponge replication method. As in vitro experiments, granules were exposed to Staphylococcus aureus and Staphylococcus epidermidis and, after 24 h, the planktonic and sessile populations were assessed. Cytocompatibility towards osteoblast-like cells (MG63 cell line) was also evaluated for a period of 1 and 3 days, through resazurin assay and imaging flow cytometry analysis. As in vivo experiments, nanoHA porous granules with and without ZnO nanoparticles were implanted into the subcutaneous tissue in rats and their inflammatory response after 3, 7 and 30 days was examined, as well as their antibacterial activity after 1 and 3 days of S. aureus inoculation. The developed composites proved to be especially effective at reducing bacterial activity in vitro and in vivo for a weight percentage of 2% ZnO, with a low cell growth inhibition in vitro and no differences in the connective tissue growth and inflammatory response in vivo. Altogether, these results suggest that nanoHA-ZnO porous granules have a great potential to be used in orthopaedic and dental applications as a template for bone regeneration and, simultaneously, to restrain biomaterial-associated infections.
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Affiliation(s)
- L Grenho
- Faculdade de Engenharia, Departamento de Engenharia Metalúrgica e Materiais, Universidade do Porto, Rua Dr Roberto Frias, s/n 4200-465 Porto, Portugal. i3s-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal. INEB-Instituto de Engenharia Biomédica, Universidade do Porto, Rua do Campo Alegre 823, 4150-180 Porto, Portugal
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Antibacterial Modification of Kirschner Wires with Polyluteolin toward Methicillin-Resistant Staphylococcus aureus (MRSA). MATERIALS 2015; 8:4876-4883. [PMID: 28793478 PMCID: PMC5455526 DOI: 10.3390/ma8084876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/23/2015] [Accepted: 07/10/2015] [Indexed: 11/16/2022]
Abstract
In this study we report antibacterial modification of Kirschner wires (K-wires) with polyluteolin (PL) toward methicillin-resistant Staphylococcus aureus (MRSA). K-wires were modified by immersing them in the luteolin-containing aqueous solution for 24 h. Characterizations using scanning electron microscopy and electrochemical methods confirmed the presence of the PL coatings on the K-wires. The PL-coated K-wires were further found to show antibacterial activity toward MRSA and remained unimpaired antibacterial activity even after the steam sterilization treatment.
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132
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Grenho L, Barros J, Ferreira C, Santos VR, Monteiro FJ, Ferraz MP, Cortes ME. In vitroantimicrobial activity and biocompatibility of propolis containing nanohydroxyapatite. Biomed Mater 2015; 10:025004. [DOI: 10.1088/1748-6041/10/2/025004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Arciola CR, Campoccia D, Ravaioli S, Montanaro L. Polysaccharide intercellular adhesin in biofilm: structural and regulatory aspects. Front Cell Infect Microbiol 2015; 5:7. [PMID: 25713785 PMCID: PMC4322838 DOI: 10.3389/fcimb.2015.00007] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/14/2015] [Indexed: 01/05/2023] Open
Abstract
Staphylococcus aureus and Staphylococcus epidermidis are the leading etiologic agents of implant-related infections. Biofilm formation is the main pathogenetic mechanism leading to the chronicity and irreducibility of infections. The extracellular polymeric substances of staphylococcal biofilms are the polysaccharide intercellular adhesin (PIA), extracellular-DNA, proteins, and amyloid fibrils. PIA is a poly-β(1-6)-N-acetylglucosamine (PNAG), partially deacetylated, positively charged, whose synthesis is mediated by the icaADBC locus. DNA sequences homologous to ica locus are present in many coagulase-negative staphylococcal species, among which S. lugdunensis, however, produces a biofilm prevalently consisting of proteins. The product of icaA is an N-acetylglucosaminyltransferase that synthetizes PIA oligomers from UDP-N-acetylglucosamine. The product of icaD gives optimal efficiency to IcaA. The product of icaC is involved in the externalization of the nascent polysaccharide. The product of icaB is an N-deacetylase responsible for the partial deacetylation of PIA. The expression of ica locus is affected by environmental conditions. In S. aureus and S. epidermidis ica-independent alternative mechanisms of biofilm production have been described. S. epidermidis and S. aureus undergo to a phase variation for the biofilm production that has been ascribed, in turn, to the transposition of an insertion sequence in the icaC gene or to the expansion/contraction of a tandem repeat naturally harbored within icaC. A role is played by the quorum sensing system, which negatively regulates biofilm formation, favoring the dispersal phase that disseminates bacteria to new infection sites. Interfering with the QS system is a much debated strategy to combat biofilm-related infections. In the search of vaccines against staphylococcal infections deacetylated PNAG retained on the surface of S. aureus favors opsonophagocytosis and is a potential candidate for immune-protection.
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Affiliation(s)
- Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute Bologna, Italy ; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna Bologna, Italy
| | - Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute Bologna, Italy
| | - Stefano Ravaioli
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute Bologna, Italy ; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna Bologna, Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute Bologna, Italy ; Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna Bologna, Italy
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Aiken SS, Cooper JJ, Florance H, Robinson MT, Michell S. Local release of antibiotics for surgical site infection management using high-purity calcium sulfate: an in vitro elution study. Surg Infect (Larchmt) 2015; 16:54-61. [PMID: 25148101 PMCID: PMC4363816 DOI: 10.1089/sur.2013.162] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to characterize the elution of four antibiotics from pharmaceutical-grade calcium sulfate beads and show that the eluted antibiotics retained efficacy. METHODS Calcium sulfate was combined with gentamicin, tobramycin, vancomycin, or rifampicin (ratio: 20 g of calcium sulfate, to 240 mg, 500 mg, 900 mg, and 600 mg of antibiotic, respectively). Three grams of beads were immersed in 4 mL of sterile phosphate-buffered saline (PBS) at 37°C. At each time point (4, 8, 24 h; 2, 7, 14, 28, 42 d), eluates were removed for analysis by liquid chromatography-mass spectrometry. The antimicrobial efficacy of antibiotics combined with calcium sulfate beads after 42 d was tested by a modified Kirby-Bauer disc diffusion assay. RESULTS All samples showed a generally exponential decay in the eluted antibiotic concentration. At the first time point, both gentamicin and tobramycin had eluted to a peak concentration of approximately 10,000 mcg/mL. For rifampicin, the peak concentration occurred at 24 h, whereas for vancomycin, it occurred at 48 h. The eluted concentrations exceeded the minimum inhibitory concentration for common periprosthetic joint infection pathogens for the entire span of the 42 study days. Mass spectrometry confirmed all antibiotics were unchanged when eluted from the calcium sulfate carrier. Antimicrobial efficacy was unaltered after 42 d in combination with calcium sulfate at 37°C. CONCLUSIONS Pharmaceutical-grade calcium sulfate has the potential for targeted local release of tobramycin, gentamicin, vancomycin, and rifampicin over a clinically meaningful time period.
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Affiliation(s)
- Sean S. Aiken
- Biocomposites Ltd., Keele Science Park, Staffordshire, United Kingdom
| | - John J. Cooper
- Biocomposites Ltd., Keele Science Park, Staffordshire, United Kingdom
| | - Hannah Florance
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Matthew T. Robinson
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Stephen Michell
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Abstract
BACKGROUND Few studies have described the presentation, bacteriology, risk factors, and complications of Kirschner wire infections in pediatrics. The purpose of this study is to describe these factors to better understand, prevent, and treat infectious complications of smooth wires. METHODS A retrospective review was performed to identify all patients (birth to 16 y) who were hospitalized for Kirschner wire infection from 1995 to 2012. Presentation, hospital course, bacteriology, outcomes, and complications were recorded. A management algorithm was developed from the experience. RESULTS Kirschner wire infections were present in 12 patients: 5 supracondylar fractures, 3 lateral humeral condylar fractures, a distal tibia physeal fracture, a great toe open fracture, a distal radius fracture, and an elective osteotomy for hallux valgus. The patients presented with cellulitis in 3 cases, soft-tissue abscess in 4 cases, osteomyelitis in 4 cases, and 1 case of toxic shock syndrome. A history of missed appointments or wet dressing was present in 60% of cases. Reoperation was required in 5 patients with abscess, septic arthritis, or osteomyelitis. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most common pathogen followed by Pseudomonas aeruginosa. Methicillin-resistant S. aureus was not seen. Complications were present in 5 patients and included: loss of range of motion, joint destruction, wound breakdown, catheter migration, and toxic shock syndrome. CONCLUSIONS Infected Kirschner wires are rare and may be maintained in a nonunited bone if the infection is superficial. Infections in this series commonly had a history of missed appointments and wet dressings, which suggests that improved postoperative education may reduce the risk. Osteomyelitis was often preceded by pin-site drainage and failed oral antibiotic therapy. MSSA and Pseudomonas were most commonly cultured and should be considered when empiric antibiotic therapy is necessary. LEVEL OF EVIDENCE Prognostic level IV.
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Current bacterial speciation and antibiotic resistance in deep infections after operative fixation of fractures. J Orthop Trauma 2015; 29:7-17. [PMID: 24854665 DOI: 10.1097/bot.0000000000000158] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Infection after fracture fixation is a major source of morbidity. Information regarding bacterial speciation and antibiotic resistance is lacking. We attempted to determine the speciation and drug resistance profiles associated with fracture fixation infections. DESIGN Retrospective study. SETTING Level I trauma center. PATIENTS Two hundred eleven patients with 214 infections underwent surgery for postoperative infection from December 2006 to December 2010. Deep postoperative infections within 12 months of fixation were included. INTERVENTION None. MAIN OUTCOME MEASUREMENTS Incidence of each bacterial species and rate of clinically relevant resistance in Staphylococcus aureus, gram-negative rod (GNR), and Enterococcus species. The effect of timing of infection presentation and location of fracture on bacterial speciation was also investigated. RESULTS Fifty-six percent of infections had S. aureus present, with 58% of those (32% of all infections) being methicillin-resistant S. aureus. Thirty-two percent of infections had at least one GNR present, with only 4% of those being multidrug resistant. We found a marked increase in the rate of GNR infections of the pelvis, acetabulum, and proximal femur (63%) compared with other locations (27%), which was statistically significant (P = 0.0002). CONCLUSIONS At our center, S. aureus and GNR are most often found in deep postoperative infections after fixation. Methicillin-resistant S. aureus is common in this population. Our GNR rate is high, but resistance in this group was low. The proportion of GNR infections in the pelvis, acetabulum, and proximal femur was high even in closed fractures. These data provide a modern snapshot of orthopaedic infections after fracture fixation and might be useful in designing future studies and protocols for antibiotic prophylactic treatment. We are considering the use of aminoglycosides in the treatment of closed fractures of the pelvis, acetabulum, and proximal femur. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Biofilm-based implant infections in orthopaedics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 830:29-46. [PMID: 25366219 DOI: 10.1007/978-3-319-11038-7_2] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The demand for joint replacement surgery is continuously increasing with rising costs for hospitals and healthcare systems. Staphylococci are the most prevalent etiological agents of orthopedic infections. After an initial adhesin-mediated implant colonization, Staphylococcus aureus and Staphylococcus epidermidis produce biofilm. Biofilm formation proceeds as a four-step process: (1) initial attachment of bacterial cells; (2) cell aggregation and accumulation in multiple cell layers; (3) biofilm maturation and (4) detachment of cells from the biofilm into a planktonic state to initiate a new cycle of biofilm formation elsewhere. The encasing of bacteria in biofilms gives rise to insuperable difficulties not only in the treatment of the infection, but also in assessing the state and the nature of the infection using traditional cultural methods. Therefore, DNA-based molecular methods have been developed to provide rapid identification of all microbial pathogens. To combat biofilm-centered implant infections, new strategies are being developed, among which anti-infective or infective-resistant materials are at the forefront. Infection-resistant materials can be based on different approaches: (i) modifying the biomaterial surface to give anti-adhesive properties, (ii) doping the material with antimicrobial substances, (iii) combining anti-adhesive and antimicrobial effects in the same coating, (iv) designing materials able to oppose biofilm formation and support bone repair.
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Bioburden after Staphylococcus aureus inoculation in type 1 diabetic rats undergoing internal fixation. Plast Reconstr Surg 2014; 134:412e-419e. [PMID: 25158718 DOI: 10.1097/prs.0000000000000434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
SUMMARY Fracture stabilization in the diabetic patient is associated with higher complication rates, particularly infection and impaired wound healing, which can lead to major tissue damage, osteomyelitis, and higher amputation rates. With an increasing prevalence of diabetes and an aging population, the risks of infection of internal fixation devices are expected to grow. Although numerous retrospective clinical studies have identified a relationship between diabetes and infection, currently there are few animal models that have been used to investigate postoperative surgical-site infections associated with internal fixator implantation and diabetes. The authors therefore refined the protocol for inducing hyperglycemia and compared the bacterial burden in controls to pharmacologically induced type 1 diabetic rats after undergoing internal fracture plate fixation and Staphylococcus aureus surgical-site inoculation. Using an initial series of streptozotocin doses, followed by optional additional doses to reach a target blood glucose range of 300 to 600 mg/dl, the authors reliably induced diabetes in 100 percent of the rats (n = 16), in which a narrow hyperglycemic range was maintained 14 days after onset of diabetes (mean ± SEM, 466 ± 16 mg/dl; coefficient of variation, 0.15). With respect to their primary endpoint, the authors quantified a significantly higher infectious burden in inoculated diabetic animals (median, 3.2 × 10 colony-forming units/mg dry tissue) compared with inoculated nondiabetic animals (7.2 × 10 colony-forming units/mg dry tissue). These data support the authors' hypothesis that uncontrolled diabetes adversely affects the immune system's ability to clear Staphylococcus aureus associated with internal hardware.
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Role of protein environment and bioactive polymer grafting in the S. epidermidis response to titanium alloy for biomedical applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 45:176-83. [DOI: 10.1016/j.msec.2014.08.054] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 07/15/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022]
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140
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Jørgensen NP, Meyer R, Dagnæs-Hansen F, Fuursted K, Petersen E. A modified chronic infection model for testing treatment of Staphylococcus aureus biofilms on implants. PLoS One 2014; 9:e103688. [PMID: 25279456 PMCID: PMC4184782 DOI: 10.1371/journal.pone.0103688] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 07/05/2014] [Indexed: 02/02/2023] Open
Abstract
Bacterial biofilms causing implant-associated osteomyelitis is a severe complication with limited antimicrobial therapy options. We designed an animal model, in which implant associated osteomyelitis arise from a Staphylococcus aureus biofilm on a tibia implant. Two bioluminescently engineered (luxA-E transformed), strains of S. aureus were utilized, Xen29 and Xen31. Biofilm formation was assessed with epifluorescence microscopy. Quantitative measurements were performed day 4, 6, 8, 11 and 15 post-surgery. Bacteria were extracted from the biofilm by sonication and the bacterial load quantified by culturing. Biofilm formation was evident from day 6 post-implantation. Mean bacterial load from implants was ∼1×10(4) CFU/implant, while mean bacterial load from infected tibias were 1×10(6) CFU/bone. Bioluminesence imaging revealed decreasing activity throughout the 15-day observation period, with signal intensity for both strains reaching that of the negative control by day 15 while there was no significant reduction in bacterial load. The model is suitable for testing antimicrobial treatment options for implant associated OM, as treatment efficacy on both biofilm and viable counts can be assessed.
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Affiliation(s)
- Nis Pedersen Jørgensen
- Department of Infectious Diseases, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rikke Meyer
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus, Denmark
| | - Frederik Dagnæs-Hansen
- Department of Biomedicine, Faculty of Health Sciences Aarhus University, Aarhus, Denmark
| | - Kurt Fuursted
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Eskild Petersen
- Department of Infectious Diseases, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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141
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Abstract
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
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Affiliation(s)
- Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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142
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Campoccia D, Visai L, Renò F, Cangini I, Rizzi M, Poggi A, Montanaro L, Rimondini L, Arciola CR. Bacterial adhesion to poly-(D,L)lactic acid blended with vitamin E: toward gentle anti-infective biomaterials. J Biomed Mater Res A 2014; 103:1447-58. [PMID: 25046271 DOI: 10.1002/jbm.a.35284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 06/28/2014] [Accepted: 07/18/2014] [Indexed: 12/23/2022]
Abstract
Anti-infective properties of biomedical materials are often achieved by loading or coating them with powerful bactericides. Undesirably, these bioactive molecules can damage the host cells at the biomaterial-tissues interface and, sometimes, even determine systemic toxic effects. The search for biomaterials able to actively resist infection while displaying a safe cytocompatibility profile toward eukaryotic cells is being progressively developed. Poly-(D,L)lactic acid (PLA) is a broadly used resorbable material with established biocompatibility properties. The dissolving surfaces of a biodegradable material tend to be per se elusive for bacteria. Here, films of pristine PLA, of PLA blended with vitamin E (VitE) and PLA blended with vitamin E acetate (VitE ac) were challenged in vitro with the biofilm-producers Staphylococcus epidermidis RP62A and Staphylococcus aureus ATCC25923. The bacterial adhesion properties of the different materials were investigated on small film disc specimens by a method based on microtiter plates. Adherent bacteria were quantified by both CFU plating and bioluminescence. Significant decrease in bacterial adhesion and biofilm accumulation was found on the surface of both the enriched polymers. These findings, together with the favorable intrinsic properties of PLA and the desirable bioactivities conferred by VitE, point up the VitE-blended PLA polymers as gentle anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy
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143
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Post V, Wahl P, Uçkay I, Ochsner P, Zimmerli W, Corvec S, Loiez C, Richards RG, Moriarty TF. Phenotypic and genotypic characterisation of Staphylococcus aureus causing musculoskeletal infections. Int J Med Microbiol 2014; 304:565-76. [DOI: 10.1016/j.ijmm.2014.03.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/10/2014] [Accepted: 03/24/2014] [Indexed: 01/09/2023] Open
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144
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Bronk JK, Russell BH, Rivera JJ, Pasqualini R, Arap W, Höök M, Barbu EM. A multifunctional streptococcal collagen-mimetic protein coating prevents bacterial adhesion and promotes osteoid formation on titanium. Acta Biomater 2014; 10:3354-62. [PMID: 24732634 DOI: 10.1016/j.actbio.2014.04.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/28/2014] [Accepted: 04/04/2014] [Indexed: 02/01/2023]
Abstract
The major barriers to the clinical success of orthopedic and dental implants are poor integration of fixtures with bone tissue and biomaterial-associated infections. Although multifunctional device coatings have long been considered a promising strategy, their development is hindered by difficulties in integrating biocompatibility, anti-infective activity and antithrombotic properties within a single grafting agent. In this study, we used cell adhesion assays and confocal microscopy of primary murine osteoblasts and human osteoblast cell lines MG-63 and Saos-2 to demonstrate that a streptococcal collagen-like protein engineered to display the α1 and α2 integrin recognition sequences enhances osteoblast adhesion and spreading on titanium fixtures. By measuring calcium deposition and alkaline phosphatase activity, we also showed that selective activation of α2β1 integrin induces osteoblast differentiation, osteoid formation and mineralization. Moreover, cell adhesion assays and scanning electron microscopy of clinical isolates Staphylococcus aureus Philips and Staphylococcus epidermidis 9491 indicated that streptococcal collagen-mimetic proteins inhibit bacterial colonization and biofilm formation irrespective of their interaction with integrins. Given that streptococcal collagenous substrates neither interact with platelets nor trigger a strong immune response, this novel bioactive coating appears to have desirable multifaceted properties with promising translational applications.
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145
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Cabal B, Alou L, Cafini F, Couceiro R, Sevillano D, Esteban-Tejeda L, Guitián F, Torrecillas R, Moya JS. A new biocompatible and antibacterial phosphate free glass-ceramic for medical applications. Sci Rep 2014; 4:5440. [PMID: 24961911 PMCID: PMC4069691 DOI: 10.1038/srep05440] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/06/2014] [Indexed: 02/01/2023] Open
Abstract
In the attempt to find valid alternatives to classic antibiotics and in view of current limitations in the efficacy of antimicrobial-coated or loaded biomaterials, this work is focused on the development of a new glass-ceramic with antibacterial performance together with safe biocompatibility. This bactericidal glass-ceramic composed of combeite and nepheline crystals in a residual glassy matrix has been obtained using an antimicrobial soda-lime glass as a precursor. Its inhibitory effects on bacterial growth and biofilm formation were proved against five biofilm-producing reference strains. The biocompatibility tests by using mesenchymal stem cells derived from human bone indicate an excellent biocompatibility.
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Affiliation(s)
- Belén Cabal
- Nanomaterials and Nanotechnology Research Center (CINN-CSIC) - Universidad de Oviedo (UO) - Principado de Asturias, Parque Tecnológico de Asturias, 33428, Llanera, Spain
| | - Luís Alou
- Microbiology Unit, Medicine Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
| | - Fabio Cafini
- Microbiology Unit, Medicine Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
| | - Ramiro Couceiro
- Instituto de Cerámica de Galicia, Avda. Maestro Mateo, 15782 Santiago de Compostela, Spain
| | - David Sevillano
- Microbiology Unit, Medicine Department, School of Medicine, Universidad Complutense, Avda. Complutense s/n, 28040 Madrid, Spain
| | | | - Francisco Guitián
- Instituto de Cerámica de Galicia, Avda. Maestro Mateo, 15782 Santiago de Compostela, Spain
| | - Ramón Torrecillas
- 1] Nanomaterials and Nanotechnology Research Center (CINN-CSIC) - Universidad de Oviedo (UO) - Principado de Asturias, Parque Tecnológico de Asturias, 33428, Llanera, Spain [2] Moscow State University of Technology (STANKIN), Vadkovskij per. 1, Moscow, Moscow Oblast, Russian Federation
| | - José S Moya
- Institute of Materials Science of Madrid (ICMM-CSIC), Cantoblanco, 28049, Madrid, Spain
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146
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The interaction of bacteria with engineered nanostructured polymeric materials: a review. ScientificWorldJournal 2014; 2014:410423. [PMID: 25025086 PMCID: PMC4084677 DOI: 10.1155/2014/410423] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/08/2014] [Accepted: 05/10/2014] [Indexed: 12/17/2022] Open
Abstract
Bacterial infections are a leading cause of morbidity and mortality worldwide. In spite of great advances in biomaterials research and development, a significant proportion of medical devices undergo bacterial colonization and become the target of an implant-related infection. We present a review of the two major classes of antibacterial nanostructured materials: polymeric nanocomposites and surface-engineered materials. The paper describes antibacterial effects due to the induced material properties, along with the principles of bacterial adhesion and the biofilm formation process. Methods for antimicrobial modifications of polymers using a nanocomposite approach as well as surface modification procedures are surveyed and discussed, followed by a concise examination of techniques used in estimating bacteria/material interactions. Finally, we present an outline of future sceneries and perspectives on antibacterial applications of nanostructured materials to resist or counteract implant infections.
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147
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Alhede M, Bjarnsholt T, Givskov M, Alhede M. Pseudomonas aeruginosa biofilms: mechanisms of immune evasion. ADVANCES IN APPLIED MICROBIOLOGY 2014; 86:1-40. [PMID: 24377853 DOI: 10.1016/b978-0-12-800262-9.00001-9] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The opportunistic gram-negative bacterium Pseudomonas aeruginosa is implicated in many chronic infections and is readily isolated from chronic wounds, medical devices, and the lungs of cystic fibrosis patients. P. aeruginosa is believed to persist in the host organism due to its capacity to form biofilms, which protect the aggregated, biopolymer-embedded bacteria from the detrimental actions of antibiotic treatments and host immunity. A key component in the protection against innate immunity is rhamnolipid, which is a quorum sensing (QS)-regulated virulence factor. QS is a cell-to-cell signaling mechanism used to coordinate expression of virulence and protection of aggregated biofilm cells. Rhamnolipids are known for their ability to cause hemolysis and have been shown to cause lysis of several cellular components of the human immune system, for example, macrophages and polymorphonuclear leukocytes (PMNs). In this chapter, the interplay between P. aeruginosa and the PMNs in chronic infections is discussed with focus on the role of rhamnolipids and extracellular DNA.
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Affiliation(s)
- Maria Alhede
- Department of International Health, Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Bjarnsholt
- Department of International Health, Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Michael Givskov
- Department of International Health, Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark; Singapore Centre on Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Morten Alhede
- Department of International Health, Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
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148
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The macrophage inflammatory proteins MIP1α (CCL3) and MIP2α (CXCL2) in implant-associated osteomyelitis: linking inflammation to bone degradation. Mediators Inflamm 2014; 2014:728619. [PMID: 24795505 PMCID: PMC3984830 DOI: 10.1155/2014/728619] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/18/2014] [Indexed: 12/22/2022] Open
Abstract
Bacterial infections of bones remain a serious complication of endoprosthetic surgery. These infections are difficult to treat, because many bacterial species form biofilms on implants, which are relatively resistant towards antibiotics. Bacterial biofilms elicit a progressive local inflammatory response, resulting in tissue damage and bone degradation. In the majority of patients, replacement of the prosthesis is required. To address the question of how the local inflammatory response is linked to bone degradation, tissue samples were taken during surgery and gene expression of the macrophage inflammatory proteins MIP1α (CCL3) and MIP2α (CXCL2) was assessed by quantitative RT-PCR. MIPs were expressed predominantly at osteolytic sites, in close correlation with CD14 which was used as marker for monocytes/macrophages. Colocalisation of MIPs with monocytic cells could be confirmed by histology. In vitro experiments revealed that, aside from monocytic cells, also osteoblasts were capable of MIP production when stimulated with bacteria; moreover, CCL3 induced the differentiation of monocytes to osteoclasts. In conclusion, the multifunctional chemokines CCL3 and CXCL2 are produced locally in response to bacterial infection of bones. In addition to their well described chemokine activity, these cytokines can induce generation of bone resorbing osteoclasts, thus providing a link between bacterial infection and osteolysis.
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149
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Boanini E, Torricelli P, Cassani MC, Gentilomi GA, Ballarin B, Rubini K, Bonvicini F, Bigi A. Cationic-anionic polyelectrolyte interaction as a tool to graft silver nanoparticles on hydroxyapatite crystals and prevent cytotoxicity. RSC Adv 2014. [DOI: 10.1039/c3ra45846f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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150
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An overview of the methodological approach to the in vitro study of anti-infective biomaterials. Int J Artif Organs 2013; 35:800-16. [PMID: 23065889 DOI: 10.5301/ijao.5000140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 02/05/2023]
Abstract
Biomaterial-associated infections have an enormous impact in terms of morbidity of the patients and costs to national health systems. Perioperative antibiotics and aseptic procedures have not proved sufficient to eradicate the occurrence of this type of infections which often lead to devastating effects. Adjunctive strategies for preventing the establishment of infections are increasingly being centered on the development of new biomaterials with anti-infective properties. The creation of new anti-infective biomaterials can be obtained by alternative approaches oriented to achieve either bacteria-repellent surfaces or bioactive surfaces expressing self-sterilizing properties when not even able to treat pre-existing infections in the surrounding tissues. Here, we offer a short overview of the currently available in vitro methods that can be used to investigate and assess the performance of anti-infective biomaterials, with special emphasis on those whose mechanism of action is based on bacteria-repellent surfaces.
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