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Black GG, Vaeth AM, Kochheiser M, Chen Y, Truong AY, Reif T, Rozbruch SR, Henry MW, Otterburn DM. Infection After Lower-Limb Osseointegration: A Single-Center Retrospective Evaluation of Pathogens, Management, and Outcomes. Ann Plast Surg 2024; 92:S96-S100. [PMID: 38556655 DOI: 10.1097/sap.0000000000003856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
PURPOSE Osseointegration (OI) is a novel alternative to traditional socket-suspended prostheses for lower-limb amputees, eliminating the socket-skin interface and allowing for weight bearing directly on the skeletal system. However, the stoma through which the implant attaches to the external prosthesis creates an ingress route for bacteria, and infection rates as high as 66% have been reported. The aims of this study are to classify infection management and long-term outcomes in this patient population to maximize implant salvage. METHODS An institutional review board-approved retrospective analysis was performed on all patients who underwent lower-limb OI at our institution between 2017 and 2022. Demographic, operative, and outcome data were collected for all patients. Patients were stratified by the presence and severity of infection. Chi-square and t tests were performed on categorical and continuous data, respectively, using an alpha of 0.05. RESULTS One hundred two patients met our study criteria; 62 had transfemoral OI and 40 had transtibial OI. Patients were followed for 23.8 months on average (range, 3.5-63.7). Osteomyelitis was more likely than soft tissue infection to be polymicrobial in nature (71% vs 23%, P < 0.05). Infections at the stoma were mostly (96%) managed with oral antibiotics alone, whereas deeper soft tissue infections also required intravenous antibiotics (75%) or operative washout (19%). Osteomyelitis was managed with intravenous antibiotics and required operative attention; 5 (71%) underwent washout and 2 (29%) underwent explantation. Both implants were replaced an average of 3.5 months after explantation. There was no correlation between history of soft tissue infection and development of osteomyelitis (P > 0.05). The overall implant salvage rate after infection was 96%. CONCLUSIONS This study describes our institution's experience managing infection after OI and soft tissue reconstruction. Although infections do occur, they are easily treatable and rarely require operative intervention. Explantation due to infection is rare and can be followed up with reimplantation, reaffirming that OI is a safe and effective treatment modality.
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Affiliation(s)
- Grant G Black
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Anna M Vaeth
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Makayla Kochheiser
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Yunchan Chen
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Albert Y Truong
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
| | - Taylor Reif
- Limb Lengthening and Complex Reconstruction Service
| | | | - Michael W Henry
- Division of Infectious Diseases, Hospital for Special Surgery, New York, NY
| | - David M Otterburn
- From the Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine
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Gerner E, Giraldo-Osorno PM, Johansson Loo A, Firdaus R, Ben Amara H, Werthén M, Palmquist A, Thomsen P, Omar O, Almqvist S, Trobos M. Targeting Pseudomonas aeruginosa quorum sensing with sodium salicylate modulates immune responses in vitro and in vivo. Front Cell Infect Microbiol 2023; 13:1183959. [PMID: 37614559 PMCID: PMC10442818 DOI: 10.3389/fcimb.2023.1183959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Chronic infections are a major clinical challenge in hard-to-heal wounds and implanted devices. Pseudomonas aeruginosa is a common causative pathogen that produces numerous virulence factors. Due to the increasing problem of antibiotic resistance, new alternative treatment strategies are needed. Quorum sensing (QS) is a bacterial communication system that regulates virulence and dampens inflammation, promoting bacterial survival. QS inhibition is a potent strategy to reduce bacterial virulence and alleviate the negative impact on host immune response. Aim This study investigates how secreted factors from P. aeruginosa PAO1, cultured in the presence or absence of the QS inhibitor sodium salicylate (NaSa), influence host immune response. Material and methods In vitro, THP-1 macrophages and neutrophil-like HL-60 cells were used. In vivo, discs of titanium were implanted in a subcutaneous rat model with local administration of P. aeruginosa culture supernatants. The host immune response to virulence factors contained in culture supernatants (+/-NaSa) was characterized through cell viability, migration, phagocytosis, gene expression, cytokine secretion, and histology. Results In vitro, P. aeruginosa supernatants from NaSa-containing cultures significantly increased THP-1 phagocytosis and HL-60 cell migration compared with untreated supernatants (-NaSa). Stimulation with NaSa-treated supernatants in vivo resulted in: (i) significantly increased immune cell infiltration and cell attachment to titanium discs; (ii) increased gene expression of IL-8, IL-10, ARG1, and iNOS, and (iii) increased GRO-α protein secretion and decreased IL-1β, IL-6, and IL-1α secretion, as compared with untreated supernatants. Conclusion In conclusion, treating P. aeruginosa with NaSa reduces the production of virulence factors and modulates major immune events, such as promoting phagocytosis and cell migration, and decreasing the secretion of several pro-inflammatory cytokines.
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Affiliation(s)
- Erik Gerner
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
- Mölnlycke Health Care AB, Gothenburg, Sweden
| | - Paula Milena Giraldo-Osorno
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
| | - Anna Johansson Loo
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rininta Firdaus
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
| | - Heithem Ben Amara
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Werthén
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), Gothenburg, Sweden
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Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial Biofilm: A Review on Formation, Infection, Antibiotic Resistance, Control Measures, and Innovative Treatment. Microorganisms 2023; 11:1614. [PMID: 37375116 DOI: 10.3390/microorganisms11061614] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Biofilm is complex and consists of bacterial colonies that reside in an exopolysaccharide matrix that attaches to foreign surfaces in a living organism. Biofilm frequently leads to nosocomial, chronic infections in clinical settings. Since the bacteria in the biofilm have developed antibiotic resistance, using antibiotics alone to treat infections brought on by biofilm is ineffective. This review provides a succinct summary of the theories behind the composition of, formation of, and drug-resistant infections attributed to biofilm and cutting-edge curative approaches to counteract and treat biofilm. The high frequency of medical device-induced infections due to biofilm warrants the application of innovative technologies to manage the complexities presented by biofilm.
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Affiliation(s)
- Satish Sharma
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
| | - James Mohler
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Supriya D Mahajan
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Stanley A Schwartz
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Medicine, VA Western New York Healthcare System, Buffalo, NY 14215, USA
| | - Liana Bruggemann
- Department of Biomedical Informatics, University at Buffalo, Buffalo, NY 14260, USA
| | - Ravikumar Aalinkeel
- Department of Urology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
- Department of Medicine, Division of Allergy, Immunology, and Rheumatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Medicine, VA Western New York Healthcare System, Buffalo, NY 14215, USA
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Hagberg K, Ghasemi Jahani SA, Omar O, Thomsen P. Osseointegrated prostheses for the rehabilitation of patients with transfemoral amputations: A prospective ten-year cohort study of patient-reported outcomes and complications. J Orthop Translat 2022; 38:56-64. [PMCID: PMC9588992 DOI: 10.1016/j.jot.2022.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 02/16/2023] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Kerstin Hagberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden,Corresponding author. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Shadi Afarin Ghasemi Jahani
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tillander JAN, Rilby K, Svensson Malchau K, Skovbjerg S, Lindberg E, Rolfson O, Trobos M. Treatment of periprosthetic joint infections guided by minimum biofilm eradication concentration (MBEC) in addition to minimum inhibitory concentration (MIC): protocol for a prospective randomised clinical trial. BMJ Open 2022; 12:e058168. [PMID: 36109038 PMCID: PMC9478849 DOI: 10.1136/bmjopen-2021-058168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Prosthetic joint infections (PJIs) are disastrous complications for patients and costly for healthcare organisations. They may promote bacterial resistance due to the extensive antibiotic use necessary in the PJI treatment. The PJI incidence is estimated to be 1%-3%, but the absolute numbers worldwide are high and increasing as large joint arthroplasties are performed by the millions each year. Current treatment algorithms, based on implant preserving surgery or full revision followed by a semitailored antibiotic regimen for no less than 2-3 months, lead to infection resolution in approximately 60% and 90%, respectively. Antibiotic choice is currently guided by minimum inhibitory concentrations (MICs) of free-living bacteria and not of bacteria in biofilm growth mode. Biofilm assays with relatively rapid output for the determination of minimum biofilm eradication concentrations (MBECs) have previously been developed but their clinical usefulness have not been established. METHODS AND ANALYSIS This single-blinded, two-arm randomised study of hip or knee staphylococcal PJI will evaluate 6-week standard of care (MIC guided), or an alternative antibiotic regimen according to an MBEC-guided-based decision algorithm. Sixty-four patients with a first-time PJI treated according to the debridement, antibiotics, and implant retention principle will be enrolled at a single tertiary orthopaedic centre (Sahlgrenska University Hospital). Patients will receive 14 days of standard parenteral antibiotics before entering the comparative study arms. The primary outcome measurement is the proportion of changes in antimicrobial regimen from first-line treatment dependent on randomisation arm. Secondary endpoints are unresolved infection, how microbial properties including biofilm abilities and emerging antimicrobial resistance correlate to infection outcomes, patient reported outcomes and costs with a 12-month follow-up. ETHICS AND DISSEMINATION Approval is received from the Swedish Ethical Review Authority, no 2020-01471 and the Swedish Medical Products Agency, EudraCT, no 2020-003444-80. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT04488458.
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Affiliation(s)
- Jonatan A N Tillander
- Department of Infectious Diseases, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Goteborg, Sweden
| | - Karin Rilby
- Department of Orthopaedics, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Karin Svensson Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Susann Skovbjerg
- Department of Clinical Microbiology, Institute of Biomedicine, University of Gothenburg, Goteborg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Erika Lindberg
- Department of Clinical Microbiology, Institute of Biomedicine, University of Gothenburg, Goteborg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
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Masters EA, Ricciardi BF, Bentley KLDM, Moriarty TF, Schwarz EM, Muthukrishnan G. Skeletal infections: microbial pathogenesis, immunity and clinical management. Nat Rev Microbiol 2022; 20:385-400. [PMID: 35169289 PMCID: PMC8852989 DOI: 10.1038/s41579-022-00686-0] [Citation(s) in RCA: 156] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/13/2022]
Abstract
Osteomyelitis remains one of the greatest risks in orthopaedic surgery. Although many organisms are linked to skeletal infections, Staphylococcus aureus remains the most prevalent and devastating causative pathogen. Important discoveries have uncovered novel mechanisms of S. aureus pathogenesis and persistence within bone tissue, including implant-associated biofilms, abscesses and invasion of the osteocyte lacuno-canalicular network. However, little clinical progress has been made in the prevention and eradication of skeletal infection as treatment algorithms and outcomes have only incrementally changed over the past half century. In this Review, we discuss the mechanisms of persistence and immune evasion in S. aureus infection of the skeletal system as well as features of other osteomyelitis-causing pathogens in implant-associated and native bone infections. We also describe how the host fails to eradicate bacterial bone infections, and how this new information may lead to the development of novel interventions. Finally, we discuss the clinical management of skeletal infection, including osteomyelitis classification and strategies to treat skeletal infections with emerging technologies that could translate to the clinic in the future.
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Affiliation(s)
- Elysia A Masters
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, USA
| | - Benjamin F Ricciardi
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
| | - Karen L de Mesy Bentley
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
| | - Gowrishankar Muthukrishnan
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA
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Stogov MV, Emanov AA, Goodovykh NV, Ovchinnikov EN, Tushina NV, Kuznetsov VP. Microbiological Profile of the Implantation Zone under Different Mechanical Compression of Percutaneous Implants: Experimental Study. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022; 28:38-47. [DOI: 10.17816/2311-2905-1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Background. Infection of percutaneous implants in patients with limb amputation is the most common complication.
Aim of the study evaluation of the microflora in the implantation zone depending on the mechanical compression of the implant in conditions of its additional external fixation.
Methods. The study was performed on 36 male rabbits. The tibia of all the rabbits was sawn at the border of the upper and middle parts. The medullary canal was reamed and a percutaneous implant was placed in the tibial stump. The segment and the implant were fixed with an Ilizarov apparatus. An additional compression device was installed in 30 animals. We used 5 compression modes, accordingly, 6 experimental groups were formed, 6 animals in each: group 1 without compression, group 2 compression on the implant with force of 0.053 N/mm2, group 3 compression on the implant with force of 0.105 N/mm2, group 4 compression on the implant with force of 0.158 N/mm2, group 5 compression on the implant with force of 0.211 N/mm2, group 6 compression on the implant with force of 0.263 N/mm2. The restraint was removed 6 weeks after implantation for a total follow-up of 26 weeks. The microflora of the place where the implant enters the skin (the implant / skin interface) was investigated, the level of blood leukocytes and the level of C-reactive protein in blood serum were determined.
Results. On days 9-10 after implantation, significant differences in the microbial landscape were found at the site of the exit of the metal implant in animals of different groups. The largest number of strains was found in animals of groups 1, 5 and 6, the smallest in groups 2 and 3. The most frequently detected strains: S. saprophyticus and Enterococcus spp. It was found that the greatest statistically significant increase in the level of CRP in the blood serum was observed in animals of group 6. The level of leukocytes in animals of all groups did not change statistically significantly relative to preoperative values. Animals with better osseointegration (groups 2 and 3 no cases of implant loss) showed a minimal number of growing strains.
Conclusions. The microbiological profile of the implantation zone of percutaneous implants changes depending on the amount of mechanical compression. The optimal mode is 0.053-0.105 N/mm2.
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Genomics of Staphylococcus aureus and Staphylococcus epidermidis from Periprosthetic Joint Infections and Correlation to Clinical Outcome. Microbiol Spectr 2022; 10:e0218121. [PMID: 35762769 PMCID: PMC9430453 DOI: 10.1128/spectrum.02181-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The approach of sequencing or genotyping to characterize the pathogenic potential of staphylococci from orthopedic device-related infection (ODRI) has been applied in recent studies. These studies described the genomic carriage of virulence in clinical strains and compared it with those in commensal strains. Only a few studies have directly correlated genomic profiles to patient outcome and phenotypic virulence properties in periprosthetic joint infections (PJIs). We investigated the association between genomic variations and virulence-associated phenotypes (biofilm-forming ability and antimicrobial resistance) in 111 staphylococcal strains isolated from patients with PJI and the infection outcome (resolved/unresolved). The presence of a strong biofilm phenotype in Staphylococcus aureus and an antibiotic-resistant phenotype in Staphylococcus epidermidis were both associated with treatment failure of PJI. In S. epidermidis, multidrug resistance (MDR) and resistance to rifampicin were associated with unresolved infection. Sequence type 45 (ST45) and ST2 were particularly enriched in S. aureus and S. epidermidis, respectively. S. epidermidis ST2 caused the majority of relapses and was associated with MDR and strong biofilm production, whereas ST215 correlated with MDR and non/weak biofilm production. S. aureusagr II correlated with resolved infection, while S. epidermidisagr I was associated with strong biofilm production and agr III with non/weak production. Collectively, our results highlight the importance of careful genomic and phenotypic characterization to anticipate the probability of the strain causing treatment failure in PJI. Due to the high rate of resistant S. epidermidis strains identified, this study provides evidence that the current recommended treatment of rifampicin and a fluoroquinolone should not be administered without knowledge of the resistance pattern. IMPORTANCE This study addresses the presence and frequency of particular genetic variants and virulence factors found in staphylococcal bacteria causing periprosthetic joint infection (PJI) of the hip and knee to ascertain their clinical relevance as predictors of treatment failure. We characterized the genetic virulence traits of a large collection of clinical staphylococci isolated from patients with PJI and evaluated their association with the patient’s infection outcome. The results showed that S. aureus strains that produced strong biofilms and S. epidermidis strains with resistance to several antibiotics associated significantly with unresolved infection. Some particular genetic variants associated with biofilm formation and multidrug resistance. These traits should be considered important risk factors for the diagnosis and treatment guidance in PJI.
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Johansson ML, Hultén L, Jonsson O, Ben Amara H, Thomsen P, Edwin B. Achieving stomal continence with an ileal pouch and a percutaneous implant. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:7. [PMID: 34982258 PMCID: PMC8727424 DOI: 10.1007/s10856-021-06633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
In this study, a soft-tissue-anchored, percutaneous port used as a mechanical continence-preserving valve in reservoir ileo- and urostomies was functionally and morphologically evaluated in eight dogs. During follow-up, the skin failed to attach to the implant, but the intestine inside the stoma port appeared to be attached to the mesh. After reaching adequate reservoir volume, the urostomies were rendered continent by attaching a lid to the implant. The experiments were ended at different time intervals due to implant-related adverse events. In only one case did the histological evaluation reveal integration at both the implant-intestine and implant-skin interfaces, with a low degree of inflammation and the absence of bacterial colonisation. In the remaining cases, integration was not obtained and instead mucosal downgrowth and biofilm formation were observed. The skin-implant junction was characterised by the absence of direct contact between the epidermis and the implant. Varying degrees of epidermal downgrowth, granulation tissue formation, inflammatory cell infiltration and bacterial growth and biofilm formation were prominent findings. In contrast, the subcutaneously located anchor part of the titanium port was well integrated and encapsulated by fibrous tissue. These results demonstrate the opportunity to achieve integration between a soft-tissue-anchored titanium port, skin and intestine. However, predictable long-term function could not be achieved in these animal models due to implant- and non-implant-related adverse events. Unless barriers at both the implant-skin and implant-intestine junctions are created, epidermal and mucosal downward migration and biofilm formation will jeopardise implant performance.
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Affiliation(s)
- Martin L Johansson
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Leif Hultén
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Olof Jonsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Heithem Ben Amara
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bjørn Edwin
- The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Shaban TF, Alkawareek MY. Prediction of qualitative antibiofilm activity of antibiotics using supervised machine learning techniques. Comput Biol Med 2022; 140:105065. [PMID: 34839184 DOI: 10.1016/j.compbiomed.2021.105065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022]
Abstract
Although biofilm-specific antibiotic susceptibility assays are available, they are time-consuming and resource-intensive, and hence they are not usually performed in clinical settings. Herein, we introduce a machine learning-based predictive modeling approach that uses routinely available and easily accessible data to qualitatively predict in vitro antibiofilm activity of antibiotics with relatively high accuracy. Three optimized models based on logistic regression, decision tree, and random forest algorithms were successfully developed in this study using data manually collected from published literature. In these models, independent variables that serve as significant predictors of antibiofilm activity are minimum inhibitory concentration, bacterial Gram type, biofilm formation method, in addition to antibiotic's mechanism of action, molecular weight, and pKa. The cross-validation method showed that the optimized models exhibit prediction accuracy of 67% ± 6.1% for the logistic regression model, 73% ± 5.8% for the decision tree model, and 74% ± 5% for the random forest model. However, the one-way ANOVA test revealed that the difference in prediction accuracy between the 3 models is not statistically significant, and hence they can be considered to have comparable performance. The presented modeling approach can serve as an alternative to the resource-intensive biofilm assays to rapidly and properly manage biofilm-associated infections, especially in resource-limited clinical settings.
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Affiliation(s)
- Taqwa F Shaban
- School of Pharmacy, The University of Jordan, Amman, Jordan
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Hussain T, Khan AA, Mohamed HI. Potential Efficacy of Biofilm-Forming Biosurfactant Bacillus firmus HussainT-Lab.66 Against Rhizoctonia solani and Mass Spectrometry Analysis of its Metabolites. Int J Pept Res Ther 2021. [DOI: 10.1007/s10989-021-10318-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Zaborowska M, Vazirisani F, Shah FA, Firdaus R, Omar O, Ekström K, Trobos M, Thomsen P. Immunomodulatory effects exerted by extracellular vesicles from Staphylococcus epidermidis and Staphylococcus aureus isolated from bone-anchored prostheses. Biomaterials 2021; 278:121158. [PMID: 34619562 DOI: 10.1016/j.biomaterials.2021.121158] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
Staphylococcus aureus and Staphylococcus epidermidis are the bacteria that most frequently cause osteomyelitis. This study aimed to determine whether staphylococci isolated from osteomyelitis associated with septic loosening of orthopedic prostheses release extracellular vesicles (EVs) and, if so, to determine tentative immunomodulatory effects on the human monocytic cell line THP-1. EVs were isolated from bacterial cultures using filtration and ultracentrifugation and characterized by scanning electron microscopy, nanoparticle tracking analysis and Western Blot. The cytotoxic effect of EVs was analyzed by NucleoCounter and lactate dehydrogenase (LDH) analyses. Confocal laser scanning microscopy was employed to visualize the uptake of EVs by THP-1 cells. Activation of the transcription factor nuclear factor-κB (NF-κB) was determined in THP1-Blue™ NF-κB cells, and the gene expression and secretion of cytokines were determined by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. All investigated strains, irrespective of their biofilm formation ability, were able to secrete EVs in vitro. The S. aureus strains produced significantly more EVs than the S. epidermidis strains. Both S. aureus-derived EVs and S. epidermidis-derived EVs were internalized by THP-1 cells, upregulated Toll-like receptor 3 (TLR3) gene expression, activated NF-κB, and promoted the gene expression and secretion of interleukin (IL)-8, monocyte chemoattractant protein (MCP)-1, matrix metallopeptidase (MMP)-9 and IL-10. Whereas EVs from both staphylococcal species upregulated the proapoptotic DNA damage-inducible transcript 4 (DDIT4) gene and downregulated the antiapoptotic B-cell lymphoma 2 (Bcl-2) gene, cytolysis was preferentially induced in S. aureus EV-stimulated cells, possibly related to the expression of cytolytic proteins predominantly in S. aureus EVs. In conclusion, staphylococcal EVs possess potent cytolytic and immunomodulatory properties.
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Affiliation(s)
- Magdalena Zaborowska
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Forugh Vazirisani
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rininta Firdaus
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Ekström
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Svensson Malchau K, Tillander J, Zaborowska M, Hoffman M, Lasa I, Thomsen P, Malchau H, Rolfson O, Trobos M. Biofilm properties in relation to treatment outcome in patients with first-time periprosthetic hip or knee joint infection. J Orthop Translat 2021; 30:31-40. [PMID: 34485075 PMCID: PMC8385121 DOI: 10.1016/j.jot.2021.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/27/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022] Open
Abstract
Background Periprosthetic joint infections (PJI) are challenging complications following arthroplasty. Staphylococci are a frequent cause of PJI and known biofilm producers. Biofilm formation decreases antimicrobial susceptibility, thereby challenging favourable treatment outcomes. The aims of this study were to characterize the biofilm abilities and antimicrobial susceptibilities of staphylococci causing first-time PJI and correlate them to clinical outcome (infection resolution and recurrence). Methods Reoperations for PJI of the hip or knee between 1st January 2012 to 30th June 2015 performed at the Sahlgrenska University Hospital were identified in a local database. Medical records were reviewed and clinical parameters recorded for patients whose intraoperative bacterial isolates had been stored at the clinical laboratory. Staphylococcal strains isolated from reoperations due to first-time PJI were characterised by their ability to form biofilms using the microtiter plate test. Antimicrobial susceptibility of the strains was determined by minimum inhibitory concentration (MIC) when grown planktonically, and by minimum biofilm eradication concentration (MBEC) when grown as biofilms. MBEC determination was conducted using the Calgary biofilm device (CBD) and a custom-made antimicrobial susceptibility plate containing eight clinically relevant antimicrobial agents. Results The study group included 49 patients (70 bacterial strains) from first-time PJI, whereof 24 (49%) patients had recurrent infection. Strong biofilm production was significantly associated with recurrent infection. Patients infected with strong biofilm producers had a five-fold increased risk for recurrent infection. Strains grown as biofilms were over 8000 times more resistant to antimicrobial agents compared to planktonic cultures. Biofilms were more susceptible to rifampicin compared to other antimicrobials in the assay. Increased biofilm susceptibility (MBEC > MIC) was observed for the majority of the bacterial strains and antimicrobial agents. Conclusions Strong biofilm production was significantly associated with increased antimicrobial resistance and PJI recurrence. This underscores the importance of determining biofilm production and susceptibility as part of routine diagnostics in PJI. Strong staphylococcal biofilm production may have implications on therapeutic choices and suggest more extensive surgery. Furthermore, despite the increased biofilm resistance to rifampicin, results from this study support its use in staphylococcal PJI. The Translational Potential of this Article Like for many biomaterial-associated infections, staphylococci are a common cause of PJI. Their ability to adhere to surfaces and produce biofilms on medical devices is proposed to play a role. However, clinical studies where biofilm properties are directly linked to patient outcome are scarce. This study demonstrates that the majority of staphylococci isolated from first-time PJI were biofilm producers with increased antimicrobial resistance. Patients suffering an infection caused by a staphylococcal strain with strong biofilm production ability had a five-fold greater risk of recurrent infection. This novel finding suggests the importance of evaluating biofilm production as a diagnostic procedure for the guidance of treatment decisions in PJI.
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Affiliation(s)
- Karin Svensson Malchau
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Tillander
- Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magdalena Zaborowska
- Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Hoffman
- Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Iñigo Lasa
- Microbial Pathogenesis Research Unit, Public University of Navarre, Pamplona, Spain
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Center for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sesquiterpene Lactones from Cotula cinerea with Antibiotic Activity against Clinical Isolates of Enterococcus faecalis. Antibiotics (Basel) 2021; 10:antibiotics10070819. [PMID: 34356740 PMCID: PMC8300741 DOI: 10.3390/antibiotics10070819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 02/01/2023] Open
Abstract
Cotula cinerea, belonging to the tribe Anthemideae, is a plant widespread in the Southern hemisphere. It is frequently used in folk medicine in North African countries for several of its medical properties, shown by its extracts and essential oils. The dichloromethane extract obtained from its aerial parts demonstrated antibiotic activity against Enterococcus faecalis and was fractionated by bioguided purification procedures affording five main sesquiterpene lactones. They were identified by spectroscopic methods (NMR and ESIMS data) as guaiantrienolides, i.e., 6-acetoxy-1β-,6-acetoxy-1α-, and 6-acetoxy-10-β-hydroxyguaiantrienolide (1-3), and germacrenolides, i.e., haagenolide and 1,10-epoxyhaagenolide (4 and 5). The absolute configuration was assigned by applying the advanced Mosher's method to haagenolide and by X-ray diffraction analysis to 1,10-epoxyhaagenolide. The specific antibiotic and antibiofilm activities were tested toward the clinical isolates of Enterococcus faecalis. The results showed that compounds 3-5 have antibacterial activity against all the strains of E. faecalis, while compound 2 exhibited activity only toward some strains. Compound 1 did not show this activity but had only antibiofilm properties. Thus, these metabolites have potential as new antibiotics and antibiofilm against drug resistant opportunistic pathogens.
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15
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A Novel Biofilm Model System to Visualise Conjugal Transfer of Vancomycin Resistance by Environmental Enterococci. Microorganisms 2021; 9:microorganisms9040789. [PMID: 33918930 PMCID: PMC8070047 DOI: 10.3390/microorganisms9040789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Enterococci and biofilm-associated infections are a growing problem worldwide, given the rise in antibiotic resistance in environmental and clinical settings. The increasing incidence of antibiotic resistance and its propagation potential within enterococcal biofilm is a concern. This requires a deeper understanding of how enterococcal biofilm develops, and how antibiotic resistance transfer takes place in these biofilms. Enterococcal biofilm assays, incorporating the study of antibiotic resistance transfer, require a system which can accommodate non-destructive, real-time experimentation. We adapted a Gene Frame® combined with fluorescence microscopy as a novel non-destructive platform to study the conjugal transfer of vancomycin resistance in an established enterococcal biofilm.A multi-purpose fluorescent in situ hybridisation (FISH) probe, in a novel application, allowed the identification of low copy number mobile elements in the biofilm. Furthermore, a Hoechst stain and ENU 1470 FISH probe identified Enterococcus faecium transconjugants by excluding Enterococcus faecalis MF06036 donors. Biofilm created with a rifampicin resistant E. faecalis (MW01105Rif) recipient had a transfer efficiency of 2.01 × 10-3; double that of the biofilm primarily created by the donor (E. faecalis MF06036). Conjugation in the mixed enterococcal biofilm was triple the efficiency of donor biofilm. Double antibiotic treatment plus lysozyme combined with live/dead imaging provided fluorescent micrographs identifying de novo enterococcal vancomycin resistant transconjugants inside the biofilm. This is a model system for the further study of antibiotic resistance transfer events in enterococci. Biofilms promote the survival of enterococci and reduce the effectiveness of drug treatment in clinical settings, hence giving enterococci an advantage. Enterococci growing in biofilms exchange traits by means of horizontal gene transfer, but currently available models make study difficult. This work goes some way to providing a non-destructive, molecular imaging-based model system for the detection of antibiotic resistance gene transfer in enterococci.
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Li P, Gao Z, Tan Z, Xiao J, Wei L, Chen Y. New developments in anti-biofilm intervention towards effective management of orthopedic device related infections (ODRI's). BIOFOULING 2021; 37:1-35. [PMID: 33618584 DOI: 10.1080/08927014.2020.1869725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
Orthopedic device related infections (ODRI's) represent a difficult to treat situation owing to their biofilm based nature. Biofilm infections once established are difficult to eradicate even with an aggressive treatment regimen due to their recalcitrance towards antibiotics and immune attack. The involvement of antibiotic resistant pathogens as the etiological agent further worsens the overall clinical picture, pressing on the need to look into alternative treatment strategies. The present review highlightes the microbiological challenges associated with treatment of ODRI's due to biofilm formation on the implant surface. Further, it details the newer anti-infective modalities that work either by preventing biofilm formation and/or through effective disruption of the mature biofilms formed on the medical implant. The study, therefore aims to provide a comprehensive insight into the newer anti-biofilm interventions (non-antibiotic approaches) and a better understanding of their mechanism of action essential for improved management of orthopedic implant infections.
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Affiliation(s)
- Ping Li
- Department of Orthopedics, Ya'an People's Hospital, Yaan City, China
| | - Zhenwu Gao
- Department of Orthopedics, Shanxi Bethune Hospital, Taiyuan City, China
| | - Zhenwei Tan
- Department of Orthopedics, Western Theater Air Force Hospital of PLA, Chengdu, China
| | - Jun Xiao
- Department of Orthopedics, Ya'an People's Hospital, Yaan City, China
| | - Li Wei
- Nursing Department, Three Gorges Hospital Affiliated to Chongqing University, Chongqing, China
| | - Yirui Chen
- Department of Orthopedics, Three Gorges Hospital Affiliated to Chongqing University, Chongqing, China
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17
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A. KS, P. D, G. D, J. N, G.S. H, S. AS, K. J, R. M. Super-hydrophobicity: Mechanism, fabrication and its application in medical implants to prevent biomaterial associated infections. J IND ENG CHEM 2020. [DOI: 10.1016/j.jiec.2020.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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18
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Turri A, Čirgić E, Shah FA, Hoffman M, Omar O, Dahlin C, Trobos M. Early plaque formation on PTFE membranes with expanded or dense surface structures applied in the oral cavity of human volunteers. Clin Exp Dent Res 2020; 7:137-146. [PMID: 33169543 PMCID: PMC8019762 DOI: 10.1002/cre2.344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives This clinical randomized study aimed to evaluate the early plaque formation on nonresorbable polytetrafluoroethylene (PTFE) membranes having either a dense (d‐PTFE) or an expanded (e‐PTFE) microstructure and exposed to the oral cavity. Material and Methods Twelve individuals were enrolled in this study. In a split‐mouth design, five test membranes (e‐PTFE) with a dual‐layer configuration and five control membranes (d‐PTFE) were bonded on the buccal surfaces of posterior teeth of each subject. All study subjects refrained from toothbrushing during the study period. Specimens were detached from the teeth at 4 and 24 hr and subjected to viability counting, confocal microscopy, and scanning electron microscopy. Plaque samples were harvested from neighboring teeth at baseline, 4, and 24 hr, as control. Wilcoxon signed rank test was applied. Results No bond failure of the membranes was reported. Between the early and late time points, viable bacterial counts increased on all membranes, with no difference between the test and control. The number of Staphylococcus spp. decreased on the tooth surfaces and increased on both membranes overtime, with a significant difference compared to teeth. The total biomass and average biofilm thickness of live and dead cells were significantly greater at the d‐PTFE barriers after 4 hr. Conclusion This study demonstrated that the e‐PTFE membrane was associated with a lesser degree of biofilm accumulation during the initial exposure compared to the d‐PTFE membrane. The present experimental setup provides a valuable toolbox to study the in vivo behavior of different membranes used in guided bone regeneration (GBR).
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Affiliation(s)
- Alberto Turri
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,The Brånemark Clinic, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Emina Čirgić
- Department of Orthodontics, University Clinics of Odontology, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden.,Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Hoffman
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Omar Omar
- Vice Deanship for Postgraduate Studies and Scientific Research, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Christer Dahlin
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Oral, Maxillofacial Surgery and Research and Development, NU-Hospital Organisation, Trollhättan, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hobusch GM, Döring K, Brånemark R, Windhager R. Advanced techniques in amputation surgery and prosthetic technology in the lower extremity. EFORT Open Rev 2020; 5:724-741. [PMID: 33204516 PMCID: PMC7608512 DOI: 10.1302/2058-5241.5.190070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone-anchored implants give patients with unmanageable stump problems hope for drastic improvements in function and quality of life and are therefore increasingly considered a viable solution for lower-limb amputees and their orthopaedic surgeons, despite high infection rates.Regarding diversity and increasing numbers of implants worldwide, efforts are to be supported to arrange an international bone-anchored implant register to transparently overview pros and cons.Due to few, but high-quality, articles about the beneficial effects of targeted muscle innervation (TMR) and regenerative peripheral nerve interface (RPNI), these surgical techniques ought to be directly transferred into clinical protocols, observations and routines.Bionics of the lower extremity is an emerging cutting-edge technology. The main goal lies in the reduction of recognition and classification errors in changes of ambulant modes. Agonist-antagonist myoneuronal interfaces may be a most promising start in controlling of actively powered ankle joints.As advanced amputation surgical techniques are becoming part of clinical routine, the development of financing strategies besides medical strategies ought to be boosted, leading to cutting-edge technology at an affordable price.Microprocessor-controlled components are broadly available, and amputees do see benefits. Devices from different manufacturers differ in gait kinematics with huge inter-individual varieties between amputees that cannot be explained by age. Active microprocessor-controlled knees/ankles (A-MPK/As) might succeed in uneven ground-walking. Patients ought to be supported to receive appropriate prosthetic components to reach their everyday goals in a desirable way.Increased funding of research in the field of prosthetic technology could enhance more high-quality research in order to generate a high level of evidence and to identify individuals who can profit most from microprocessor-controlled prosthetic components. Cite this article: EFORT Open Rev 2020;5:724-741. DOI: 10.1302/2058-5241.5.190070.
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Affiliation(s)
- Gerhard M Hobusch
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Kevin Döring
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - Rickard Brånemark
- Gothenburg University, Gothenburg, Sweden.,Biomechatronics Group, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Reinhard Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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Zaborowska M, Taulé Flores C, Vazirisani F, Shah FA, Thomsen P, Trobos M. Extracellular Vesicles Influence the Growth and Adhesion of Staphylococcus epidermidis Under Antimicrobial Selective Pressure. Front Microbiol 2020; 11:1132. [PMID: 32714283 PMCID: PMC7346684 DOI: 10.3389/fmicb.2020.01132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/05/2020] [Indexed: 12/30/2022] Open
Abstract
Staphylococcus epidermidis causes infections associated with orthopedic implants due to its ability to establish persistent biofilms, making infections chronic and hard to treat. Extracellular vesicles (EVs) are part of the bacterial communication system, but the role of S. epidermidis-derived EVs in biofilm formation processes and survival is completely unknown. The aims of this study were (i) to investigate the effect of subinhibitory concentrations of antibiotics on vesiculation in S. epidermidis and evaluate the role of EVs in bacterial survival and adhesion under antimicrobial selective pressure and (ii) to evaluate whether EVs derived from a gentamicin-resistant S. epidermidis strain influence the susceptibility and adhesion of a gentamicin-susceptible strain. A gentamicin-susceptible (GENS) strain isolated from implant-associated osteomyelitis was cultured with EVs previously isolated from the same strain growing with subinhibitory concentrations of GEN (0, 0.03, and 0.06 μg × mL–1) or with EVs from a gentamicin-resistant (GENR) strain. EVs were characterized regarding their size, number and protein content. The growth of S. epidermidis cultured with increasing concentrations of GEN (<=> MIC of 0.12 μg × mL–1) was recorded, viability was determined by quantitative culturing and fluorescence staining, and biofilm biomass on polystyrene was quantified by crystal violet staining. Cells grown in subinhibitory concentrations of GEN produced a larger number of EVs of similar size but with greater protein content than cells grown in control (Ctrl) conditions (0 GEN). Under antimicrobial pressure, EVs promoted different mechanisms of antimicrobial tolerance depending on the EV and GEN concentrations. Cell adhesion to polystyrene decreased in the presence of 0 and 0.03 μg × mL–1 GEN upon EV stimulation. Compared with Ctrl cells, cells treated with EVs from a GENR strain showed increased cell division during the exponential growth phase, faster maximal growth rate, shorter doubling time (8–33 min), and dramatically inhibited cell adhesion. These findings suggest that vesiculation in S. epidermidis is a survival response to subinhibitory concentrations of gentamicin. EVs may contribute to bacterial survival through their involvement (1) in the modulation of the growth rate, affecting cell division, and (2) in cell adhesion, decreasing cell attachment to polystyrene and glass.
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Affiliation(s)
- Magdalena Zaborowska
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Carles Taulé Flores
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Forugh Vazirisani
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Furqan A Shah
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden
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Hwang SC, Hwang DS, Kim HY, Kim MJ, Kang YH, Byun SH, Rho GJ, Lee HJ, Lee HC, Kim SH, Baik SC, Park JS, Oh SH, Byun JH. Development of bone regeneration strategies using human periosteum-derived osteoblasts and oxygen-releasing microparticles in mandibular osteomyelitis model of miniature pig. J Biomed Mater Res A 2019; 107:2183-2194. [PMID: 31116505 DOI: 10.1002/jbm.a.36728] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
Abstract
Hypoxia and limited vascularization inhibit bone growth and recovery after surgical debridement to treat osteomyelitis. Similarly, despite significant efforts to create functional tissue-engineered organs, clinical success is often hindered by insufficient oxygen diffusion and poor vascularization. To overcome these shortcomings, we previously used the oxygen carrier perfluorooctane (PFO) to develop PFO emulsion-loaded hollow microparticles (PFO-HPs). PFO-HPs act as a local oxygen source that increase cell viability and maintains the osteogenic differentiation potency of human periosteum-derived cells (hPDCs) under hypoxic conditions. In the present study, we used a miniature pig model of mandibular osteomyelitis to investigate bone regeneration using hPDCs seeded on PFO-HPs (hPDCs/PFO-HP) or hPDCs seeded on phosphate-buffered saline (PBS)-HPs (hPDCs/PBS-HP). Osteomyelitis is characterized by a series of microbial invasion, vascular disruption, bony necrosis, and sequestrum formation due to impaired host defense response. Sequential plain radiography, computed tomography (CT), and 3D reconstructed CT images revealed new bone formation was more advanced in defects that had been implanted with the hPDCs/PFO-HPs than in defects implanted with the hPDCs/PBS-HP. Thus, PFO-HPs are a promising tissue engineering approach to repair challenging bone defects and regenerate structurally organized bone tissue with 3D architecture.
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Affiliation(s)
- Sun-Chul Hwang
- Department of Orthopaedic Surgery, Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Dae Seok Hwang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University and Pusan National University Dental Hospital, Yangsan, Republic of Korea
| | - Ho Yong Kim
- Department of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - Min Ji Kim
- Department of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - Young-Hoon Kang
- Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,The Korean Society of Maxillofacial Aesthetic Surgery, Seoul, Republic of Korea
| | - Sung-Hoon Byun
- Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Gyu-Jin Rho
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Hyeon-Jeong Lee
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Hee-Chun Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Sang-Hyun Kim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Seung Chul Baik
- Department of Microbiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, Republic of Korea
| | - Jin-Sik Park
- Department of Microbiology, Gyeongsang National University School of Medicine, Institute of Health Sciences, Jinju, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science, Dankook University, Cheonan, Republic of Korea
| | - June-Ho Byun
- Department of Oral and Maxillofacial Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.,The Korean Society of Maxillofacial Aesthetic Surgery, Seoul, Republic of Korea
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22
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Albrektsson T, Becker W, Coli P, Jemt T, Mölne J, Sennerby L. Bone loss around oral and orthopedic implants: An immunologically based condition. Clin Implant Dent Relat Res 2019; 21:786-795. [DOI: 10.1111/cid.12793] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Tomas Albrektsson
- Department of BiomaterialsUniversity of Gothenburg Gothenburg Sweden
- Department of ProsthodonticsUniversity of Malmö Malmö Sweden
| | - William Becker
- Department of PeriodonticsUniversity of Southern California School of Dentistry Los Angeles California
- Department of PeriodonticsUniversity of Washington School of Dentistry Seattle Washington
| | | | - Torsten Jemt
- Department of ProsthodonticsUniversity of Gothenburg Gothenburg Sweden
| | - Johan Mölne
- Department of Pathology and GeneticsInstitute of Biomedicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Lars Sennerby
- Department of Oral & Maxillofacial SurgeryUniversity of Gothenburg Gothenburg Sweden
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23
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Khatoon Z, McTiernan CD, Suuronen EJ, Mah TF, Alarcon EI. Bacterial biofilm formation on implantable devices and approaches to its treatment and prevention. Heliyon 2018; 4:e01067. [PMID: 30619958 PMCID: PMC6312881 DOI: 10.1016/j.heliyon.2018.e01067] [Citation(s) in RCA: 555] [Impact Index Per Article: 92.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 02/06/2023] Open
Abstract
In living organisms, biofilms are defined as complex communities of bacteria residing within an exopolysaccharide matrix that adheres to a surface. In the clinic, they are typically the cause of chronic, nosocomial, and medical device-related infections. Due to the antibiotic-resistant nature of biofilms, the use of antibiotics alone is ineffective for treating biofilm-related infections. In this review, we present a brief overview of concepts of bacterial biofilm formation, and current state-of-the-art therapeutic approaches for preventing and treating biofilms. Also, we have reviewed the prevalence of such infections on medical devices and discussed the future challenges that need to be overcome in order to successfully treat biofilms using the novel technologies being developed.
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Affiliation(s)
- Zohra Khatoon
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4W7, Canada
| | - Christopher D. McTiernan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4W7, Canada
| | - Erik J. Suuronen
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4W7, Canada
| | - Thien-Fah Mah
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Emilio I. Alarcon
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4W7, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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24
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Furst AL, Smith MJ, Francis MB. New Techniques for the Generation and Analysis of Tailored Microbial Systems on Surfaces. Biochemistry 2018; 57:3017-3026. [DOI: 10.1021/acs.biochem.8b00324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ariel L. Furst
- Department of Chemistry, University of California, Berkeley, Berkeley, California 94720-1460, United States
| | - Matthew J. Smith
- Department of Chemistry, University of California, Berkeley, Berkeley, California 94720-1460, United States
| | - Matthew B. Francis
- Department of Chemistry, University of California, Berkeley, Berkeley, California 94720-1460, United States
- Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720-1460, United States
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25
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Shevtsov MA, Yudintceva NM, Blinova MI, Voronkina IV, Suslov DN, Galibin OV, Gavrilov DV, Akkaoui M, Raykhtsaum G, Albul AV, Pitkin E, Pitkin M. Evaluation of the temporary effect of physical vapor deposition silver coating on resistance to infection in transdermal skin and bone integrated pylon with deep porosity. J Biomed Mater Res B Appl Biomater 2018; 107:169-177. [PMID: 29573163 DOI: 10.1002/jbm.b.34108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
Abstract
Periprosthetic infection via skin-implant interface is a leading cause of failures and revisions in direct skeletal attachment of limb prostheses. Implants with deep porosity fabricated with skin and bone integrated pylons (SBIP) technology allow for skin ingrowth through the implant's structure creating natural barrier against infection. However, until the skin cells remodel in all pores of the implant, additional care is required to prevent from entering bacteria to the still nonoccupied pores. Temporary silver coating was evaluated in this work as a means to provide protection from infection immediately after implantation followed by dissolution of silver layer in few weeks. A sputtering coating with 1 µm thickness was selected to be sufficient for fighting infection until the deep ingrowth of skin in the porous structure of the pylon is completed. In vitro study showed less bacterial (Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa) growth on silver coated tablets compared to the control group. Analysis of cellular density of MG-63 cells, fibroblasts, and mesenchymal stem cells (MSCs) showed that silver coating did not inhibit the cell growth on the implants and did not affect cellular functional activity. The in vivo study did not show any postoperative complications during the 6-month observation period in the model of above-knee amputation in rabbits when SBIP implants, either silver-coated or untreated were inserted into the bone residuum. Three-phase scintigraphy demonstrated angiogenesis in the pores of the pylons. The findings suggest that a silver coating with well-chosen specifications can increase the safety of porous implants for direct skeletal attachment. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 169-177, 2019.
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Affiliation(s)
- Maxim A Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Technical University of Munich, Munich, Germany.,Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia.,Polenov Russian Scientific Research Institute of Neurosurgery, St. Petersburg, Russia
| | - Natalia M Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Miralda I Blinova
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Irina V Voronkina
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Dmitriy N Suslov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Oleg V Galibin
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Dmitriy V Gavrilov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | | | | | - Andrey V Albul
- Veterinary Clinic "Neurology, Traumatology and Intensive Therapy of Doctor Sotnikov V.V.,", St. Petersburg, Russia
| | - Emil Pitkin
- Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Pitkin
- Poly-Orth International, Sharon, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
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26
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Willy C, Krettek C. [Transcutaneous osseointegrated prosthesis (TOP) after limb amputation : Status quo and perspectives]. Unfallchirurg 2018; 120:395-402. [PMID: 28396957 DOI: 10.1007/s00113-017-0347-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The majority of transfemoral and transtibial amputees can be functionally fitted with conventional suspension sockets; however, due to socket problems using conventional stump care, 60% of the patients have limited function and even in younger patients approximately one sixth are unable to wear the prosthesis daily. After the introduction of transcutaneous osseointegrated prostheses (TOP) the inherent problems of socket-stump care can be avoided for these patients. Against this background this article reviews the recent clinical development of TOP in Sweden, Germany, the Netherlands, Australia and USA currently in nine centers. Unanimously, all groups show that TOP enables physiological weight bearing, improved range of motion in the proximal joint, as well as osseoperceptive sensory feedback and better control of the artificial limb. Likewise, there is agreement that as a rule that there is a clinically less relevant superficial contamination of the stoma. Furthermore, TOP is nowadays also used for transhumeral amputees and after thumb amputation and the development of the indications for this technique are increasing. Future aspects include novel treatment options using implanted intramedullary electrodes allowing permanent and unlimited bidirectional communication with the human body (osseointegrated human-machine gateway). This could possibly realize an innovative form of prosthesis control as well as the combination of TOP and targeted muscle reinnervation (TMR) surgery to create more advanced prosthesis systems for upper and lower extremity amputees.
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Affiliation(s)
- Christian Willy
- Abteilung Unfallchirurgie und Orthopädie, Septisch-rekonstruktive Chirurgie, Bundeswehrkrankenhaus Berlin, Scharnhorststraße 13, 10115, Berlin, Deutschland.
| | - Christian Krettek
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, Hannover, Deutschland
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27
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Juhlin A, Svensson S, Thomsen P, Trobos M. Staphylococcal biofilm gene expression on biomaterials - A methodological study. J Biomed Mater Res A 2017; 105:3400-3412. [PMID: 28782178 DOI: 10.1002/jbm.a.36171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/01/2017] [Indexed: 01/02/2023]
Abstract
The combination of increased healthcare access, universal aging, and infallible therapy demands, synergistically drive the need for the development of biomaterial technologies that mitigate the challenge of biomaterial-associated infections (BAI). Staphylococcus epidermidis and Staphylococcus aureus account for the majority of BAI due to their ability to accumulate in adherent multilayered biofilm. This investigation details the development of gene expression assays to evaluate the genetic processes of attachment, accumulation, maturation, and dispersal phases of biofilms on biomaterials in vitro, while abiding by the Minimum Information for Publication of Quantitative Real-Time PCR Experiments (MIQE) guidelines. The biofilm formation of S. epidermidis on polyurethane (PU) central venous catheters and S. aureus on machined titanium (Ti) was examined in terms of gene expression at early and late time points. The results provided insight into how each stage of biofilm formation is orchestrated over time on these biomaterials in vitro. Furthermore, the results suggested that mechanical RNA extraction, organic solvents, elimination of genomic DNA, and preamplification are advisable strategies to implement for biofilm gene expression analysis. It is concluded that this method can be employed for the assessment of biofilm-biomaterial interactions at the molecular level. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3400-3412, 2017.
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Affiliation(s)
- Annika Juhlin
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden
| | - Sara Svensson
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden
| | - Peter Thomsen
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, University of Gothenburg, P.O. Box 412, 40530, Gothenburg, Sweden
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28
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Johnson V, Webb T, Norman A, Coy J, Kurihara J, Regan D, Dow S. Activated Mesenchymal Stem Cells Interact with Antibiotics and Host Innate Immune Responses to Control Chronic Bacterial Infections. Sci Rep 2017; 7:9575. [PMID: 28851894 PMCID: PMC5575141 DOI: 10.1038/s41598-017-08311-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/19/2017] [Indexed: 12/26/2022] Open
Abstract
Chronic bacterial infections associated with biofilm formation are often difficult to resolve without extended courses of antibiotic therapy. Mesenchymal stem cells (MSC) exert antibacterial activity in vitro and in acute bacterial infection models, but their activity in chronic infection with biofilm models has not been previously investigated. Therefore, we studied the effects of MSC administration in mouse and dog models of chronic infections associated with biofilms. Mice with chronic Staphylococcus aureus implant infections were treated by i.v. administration of activated or non-activated MSC, with or without antibiotic therapy. The most effective treatment protocol was identified as activated MSC co-administered with antibiotic therapy. Activated MSC were found to accumulate in the wound margins several days after i.v. administration. Macrophages in infected tissues assumed an M2 phenotype, compared to untreated infections which contained predominately M1 macrophages. Bacterial killing by MSC was found to be mediated in part by secretion of cathelicidin and was significantly increased by antibiotics. Studies in pet dogs with spontaneous chronic multi drug-resistant wound infections demonstrated clearance of bacteria and wound healing following repeated i.v. administration of activated allogeneic canine MSC. Thus, systemic therapy with activated MSC may be an effective new, non-antimicrobial approach to treatment of chronic, drug-resistant infections.
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Affiliation(s)
- Valerie Johnson
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Tracy Webb
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Annalis Norman
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Jonathan Coy
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Jade Kurihara
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Daniel Regan
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA
| | - Steven Dow
- Center for Immune and Regenerative Medicine, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Ft. Collins, CO, USA.
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29
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Scheuermann-Poley C, Wagner C, Hoffmann J, Moter A, Willy C. Bedeutung des Biofilms für die Infektbehandlung in der Unfallchirurgie. Unfallchirurg 2017; 120:461-471. [DOI: 10.1007/s00113-017-0361-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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30
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Lennerås M, Tsikandylakis G, Trobos M, Omar O, Vazirisani F, Palmquist A, Berlin Ö, Brånemark R, Thomsen P. The clinical, radiological, microbiological, and molecular profile of the skin-penetration site of transfemoral amputees treated with bone-anchored prostheses. J Biomed Mater Res A 2016; 105:578-589. [PMID: 27750392 PMCID: PMC5216444 DOI: 10.1002/jbm.a.35935] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
The breach of the skin barrier is a critical issue associated with the treatment of individuals with transfemoral amputation (TFA) using osseointegrated, percutaneous titanium implants. Thirty TFA patients scheduled for abutment exchange or removal were consecutively enrolled. The aims were to determine the macroscopic skin signs, the presence of bacteria and the gene expression in abutment‐adherent cells and to conduct correlative and comparative analyses between the different parameters. Redness and a granulation ring were present in 47% of the patients. Bacteria were detected in 27/30 patients, commonly in the bone canal. Staphylococcus aureus, coagulase‐negative staphylococci, streptococci, and Enterococcus faecalis were the most common. A positive correlation was found between TNF‐α expression and the detection of S. aureus. Staphylococcus aureus together with other bacterial species revealed a positive relationship with MMP‐8 expression. A negative correlation was demonstrated between the length of the residual femur bone and the detection of a granulation ring and E. faecalis. A positive correlation was revealed between fixture loosening and pain and the radiological detection of endosteal bone resorption. Fixture loosening was also correlated with the reduced expression of interleukin‐10 and osteocalcin. It is concluded that several relationships exist between clinical, radiological, microbiological, and molecular assessments of the percutaneous area of TFAs. Further long term studies on larger patient cohorts are required to determine the precise cause‐effect relationships and unravel the role of host‐bacteria interactions in the skin, bone canal and on the abutment for the longevity of percutaneous implants as treatment of TFA. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 578–589, 2017.
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Affiliation(s)
- Maria Lennerås
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Georgios Tsikandylakis
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.,Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden
| | - Margarita Trobos
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Omar Omar
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Forugh Vazirisani
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Anders Palmquist
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
| | - Örjan Berlin
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.,Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities (CARE) Sahlgrenska University Hospital, Mölndal, SE-431 30, Sweden
| | - Rickard Brånemark
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.,Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.,Centre for Advanced Reconstruction of Extremities (CARE) Sahlgrenska University Hospital, Mölndal, SE-431 30, Sweden.,Department of Orthopaedics, International Center for Osseointegration Research, Education and Surgery (iCORES), University of California, San Francisco
| | - Peter Thomsen
- Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.,BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412
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