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Mishra SK, Baidya S, Bhattarai A, Shrestha S, Homagain S, Rayamajhee B, Hui A, Willcox M. Bacteriology of endotracheal tube biofilms and antibiotic resistance: a systematic review. J Hosp Infect 2024; 147:146-157. [PMID: 38522561 DOI: 10.1016/j.jhin.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
Bacteria commonly adhere to surfaces and produce polymeric material to encase the attached cells to form communities called biofilms. Within these biofilms, bacteria can appear to be many times more resistant to antibiotics or disinfectants. This systematic review explores the prevalence and microbial profile associated with biofilm production of bacteria isolated from endotracheal tubes and its associations with antimicrobial resistance. A comprehensive search was performed on databases PubMed, Embase, and Google Scholar for relevant articles published between 1st January 2000 and 31st December 2022. The relevant articles were exported to Mendeley Desktop 1.19.8 and screened by title and abstract, followed by full text screening based on the eligibility criteria of the study. Quality assessment of the studies was performed using the Newcastle-Ottawa Scale (NOS) customized for cross-sectional studies. Furthermore, the prevalence of antimicrobial resistance in biofilm-producers isolated from endotracheal tube specimens was investigated. Twenty studies encompassing 981 endotracheal tubes met the eligibility criteria. Pseudomonas spp. and Acinetobacter spp. were predominant isolates among the biofilm producers. These biofilms provided strong resistance against commonly used antibiotics. The highest resistance rate observed in Pseudomonas spp. was against fluoroquinolones whereas the least resistance was seen against piperacillin-tazobactam. A similar trend of susceptibility was observed in Acinetobacter spp. with a very high resistance rate against fluoroquinolones, third-generation cephalosporins and carbapenems. In conclusion, endotracheal tubes were associated with colonization by biofilm forming bacteria with varying levels of antimicrobial resistance. Biofilms may promote the occurrence of recalcitrant infections in endotracheal tubes which need to be managed with appropriate protocols and antimicrobial stewardship. Research focus should shift towards meticulous exploration of biofilm-associated infections to improve detection and management.
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Affiliation(s)
- S K Mishra
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
| | - S Baidya
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - A Bhattarai
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Shrestha
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - S Homagain
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - B Rayamajhee
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia
| | - A Hui
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia; Center for Ocular Research and Education, School of Optometry &Vision Science, University of Waterloo, Ontario, Canada
| | - M Willcox
- School of Optometry and Vision Science, Faculty of Health and Medicine, University of New South Wales, Sydney, Australia
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2
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Alves D, Pereira MO, Lopes SP. Co-immobilization of Ciprofloxacin and Chlorhexidine as a Broad-Spectrum Antimicrobial Dual-Drug Coating for Poly(vinyl chloride) (PVC)-Based Endotracheal Tubes. ACS APPLIED MATERIALS & INTERFACES 2024; 16:16861-16879. [PMID: 38507790 PMCID: PMC10995906 DOI: 10.1021/acsami.4c01334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
The endotracheal tube (ETT) affords support for intubated patients, but the increasing incidence of ventilator-associated pneumonia (VAP) is jeopardizing its application. ETT surfaces promote (poly)microbial colonization and biofilm formation, with a heavy burden for VAP. Devising safe, broad-spectrum antimicrobial materials to tackle the ETT bioburden is needful. Herein, we immobilized ciprofloxacin (CIP) and/or chlorhexidine (CHX), through polydopamine (pDA)-based functionalization, onto poly(vinyl chloride) (PVC) surfaces. These surfaces were characterized regarding physicochemical properties and challenged with single and polymicrobial cultures of VAP-relevant bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis) and fungi (Candida albicans). The coatings imparted PVC surfaces with a homogeneous morphology, varied wettability, and low roughness. The antimicrobial immobilization via pDA chemistry was still evidenced by infrared spectroscopy. Coated surfaces exhibited sustained CIP/CHX release, retaining prolonged (10 days) activity. CIP/CHX-coated surfaces evidencing no A549 lung cell toxicity displayed better antibiofilm outcomes than CIP or CHX coatings, preventing bacterial attachment by 4.1-7.2 Log10 CFU/mL and modestly distressingC. albicans. Their antibiofilm effectiveness was endured toward polymicrobial consortia, substantially inhibiting the adhesion of the bacterial populations (up to 8 Log10 CFU/mL) within the consortia in dual- and even inP. aeruginosa/S. aureus/C. albicans triple-species biofilms while affecting fungal adhesion by 2.7 Log10 CFU/mL (dual consortia) and 1 Log10 CFU/mL (triple consortia). The potential of the dual-drug coating strategy in preventing triple-species adhesion and impairing bacterial viability was still strengthened by live/dead microscopy. The pDA-assisted CIP/CHX co-immobilization holds a safe and robust broad-spectrum antimicrobial coating strategy for PVC-ETTs, with the promise laying in reducing VAP incidence.
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Affiliation(s)
- Diana
Filipa Alves
- CEB
- Centre of Biological Engineering, University
of Minho, 4710-057 Braga, Portugal
- LABBELS—Associate
Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Maria Olívia Pereira
- CEB
- Centre of Biological Engineering, University
of Minho, 4710-057 Braga, Portugal
- LABBELS—Associate
Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Susana Patrícia Lopes
- CEB
- Centre of Biological Engineering, University
of Minho, 4710-057 Braga, Portugal
- LABBELS—Associate
Laboratory, 4710-057 Braga/Guimarães, Portugal
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3
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Symonds NE, Meng EXM, Boyd JG, Boyd T, Day A, Hobbs H, Maslove DM, Norman PA, Semrau JS, Sibley S, Muscedere J. Ceragenin-coated endotracheal tubes for the reduction of ventilator-associated pneumonia: a prospective, longitudinal, cross-over, interrupted time, implementation study protocol (CEASE VAP study). BMJ Open 2024; 14:e076720. [PMID: 38309761 PMCID: PMC10840065 DOI: 10.1136/bmjopen-2023-076720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/11/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Critically ill patients are at high risk of acquiring ventilator-associated pneumonia (VAP), which occurs in approximately 20% of mechanically ventilated patients. VAP results either from aspiration of pathogen-contaminated oropharyngeal secretions or contaminated biofilms that form on endotracheal tubes (ETTs) after intubation. VAP results in increased duration of mechanical ventilation, increased intensive care unit and hospital length of stay, increased risk of death and increased healthcare costs. Because of its impact on patient outcomes and the healthcare system, VAP is regarded as an important patient safety issue and there is an urgent need for better evidence on the efficacy of prevention strategies. Modified ETTs that reduce aspiration of oropharyngeal secretions with subglottic secretion drainage or reduce the occurrence of biofilm with a coating of ceragenins (CSAs) are available for clinical use in Canada. In this implementation study, we will evaluate the efficacy of these two types of Health Canada-licensed ETTs on the occurrence of VAP, and impact on patient-centred outcomes. METHODS In this ongoing, pragmatic, prospective, longitudinal, interrupted time, cross-over implementation study, we will compare the efficacy of a CSA-coated ETT (CeraShield N8 Pharma) with an ETT with subglottic secretion drainage (Taper Guard, Covidien). The study periods consist of four alternating time periods of 11 or 12 weeks or a total of 23 weeks for each ETT. All patients intubated with the study ETT in each time period will be included in an intention-to-treat analysis. Outcomes will include VAP incidence, mortality and health services utilisation including antibiotic use and length of stay. ETHICS AND DISSEMINATION This study has been approved by the Health Sciences Research Ethics Board at Queen's University. The results of this study will be actively disseminated through manuscript publication and conference presentations. TRIAL REGISTRATION NUMBER NCT05761613.
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Affiliation(s)
| | | | - John Gordon Boyd
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Tracy Boyd
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Andrew Day
- Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Hailey Hobbs
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - David M Maslove
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Joanna S Semrau
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Sibley
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
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4
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Bustos IG, Martín-Loeches I, Acosta-González A, Chotirmall SH, Dickson RP, Reyes LF. Exploring the complex relationship between the lung microbiome and ventilator-associated pneumonia. Expert Rev Respir Med 2023; 17:889-901. [PMID: 37872770 DOI: 10.1080/17476348.2023.2273424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Understanding the presence and function of a diverse lung microbiome in acute lung infections, particularly ventilator-associated pneumonia (VAP), is still limited, evidencing significant gaps in our knowledge. AREAS COVERED In this comprehensive narrative review, we aim to elucidate the contribution of the respiratory microbiome in the development of VAP by examining the current knowledge on the interactions among microorganisms. By exploring these intricate connections, we endeavor to enhance our understanding of the disease's pathophysiology and pave the way for novel ideas and interventions in studying the respiratory tract microbiome. EXPERT OPINION The conventional perception of lungs as sterile is deprecated since it is currently recognized the existence of a diverse microbial community within them. However, despite extensive research on the role of the respiratory microbiome in healthy lungs, respiratory chronic diseases and acute lung infections such as pneumonia are not fully understood. It is crucial to investigate further the relationship between the pathophysiology of VAP and the pulmonary microbiome, elucidating the mechanisms underlying the interactions between the microbiome, host immune response and mechanical ventilation for the development of VAP.
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Affiliation(s)
- Ingrid G Bustos
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Doctorado de Biociencias, Department of Engineering, Universidad de la Sabana, Chia, Colombia
| | - Ignacio Martín-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St James's Hospital, Dublin, Ireland
| | - Alejandro Acosta-González
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Bioprospection Research Group (GIBP), Department of Engineering, Universidad de La Sabana, Chia, Colombia
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Robert P Dickson
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA
- Weil Institute for Critical Care Research & Innovation, Ann Arbor, MI, USA
| | - Luis Felipe Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Critical Care Department, Clinica Universidad de La Sabana, Chia, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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5
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Alves D, Grainha T, Pereira MO, Lopes SP. Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress. Acta Biomater 2023; 158:32-55. [PMID: 36632877 DOI: 10.1016/j.actbio.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. STATEMENT OF SIGNIFICANCE: The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed.
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Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Susana Patrícia Lopes
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
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6
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Fady M, Rizwana H, Alarjani KM, Alghamdi MA, Ibrahim SS, Geyer J, Abbas A. Evaluation of antibiofilm and cytotoxicity effect of Rumex vesicarius methanol extract. OPEN CHEM 2023. [DOI: 10.1515/chem-2022-0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Abstract
Background
Bacterial resistant to antibiotics represents an obstacle in medication management in hospitals. Biofilm can be easily formed by bacteria in indwelling medical devices. By increasing numbers of patients using indwelling medical devices, we have to find an effective antibiofilm for the eradication of biofilm-associated infections.
Methods
The present study was designed to evaluate the antibiofilm and cytotoxicity effect of methanol extract of Rumex vesicarius L. leaves (Polygonaceae). Antibacterial and antibiofilm assays were investigated in this study against different standard and pathogenic bacteria isolates from endotracheal tubes in intensive care units (Staphylococcus aureus, Staphylococcus epidermidis, Proteus vulgaris, Klebsiella pneumoniae, and Pseudomonas aeruginosa). Scanning electron microscopy was used to demonstrate the reduction of biofilm formation using methanol extract of R. vesicarius. Also, cytotoxicity of R. vesicarius L. was evaluated by using the lactate dehydrogenase assay.
Results
R. vesicarius displayed a broad spectrum and antibacterial activity against the tested organisms. The minimal inhibitory concentration of the methanol extract was 62.5–125 mg/mL for gram positive while in case of gram negative, it was 125–250 mg/mL. While the result in case of minimal bactericidal concentration was 250–500 mg/mL in case of gram positive and was 500–1,000 mg/mL in case of gram negative.
Conclusion
Our results recommend usage of R. vesicarius as a promising antibiofilm to combat infection in indwelling medical devices.
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Affiliation(s)
- Marwa Fady
- Zagazig University Hospitals, Infection Control Unit , Zagazig , 44519 , Egypt
- Department of Microbiology and Immunology, Modern University for Technology & Information, Pharmacy College , Cairo , Egypt
| | - Humaira Rizwana
- Department of Botany and Microbiology, College of Science, King Saud University , Riyadh 11451 , Saudi Arabia
| | - Khaloud Mohammed Alarjani
- Department of Botany and Microbiology, College of Science, King Saud University , Riyadh 11451 , Saudi Arabia
| | - Mai Ahmed Alghamdi
- Department of Botany and Microbiology, College of Science, King Saud University , Riyadh 11451 , Saudi Arabia
| | - Shebl Salah Ibrahim
- Department of Biochemistry, King Saud University, College of Science , Riyadh 11451 Saudi Arabia
| | - Jessica Geyer
- Department of Biology, University of Dayton , Dayton , OH 45469 , USA
| | - Ahmad Abbas
- Chest Department, Zagazig University , 44519 , Zagazig , Egypt
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7
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Endotracheal tube biofilm in critically ill patients during the COVID-19 pandemic : description of an underestimated microbiological compartment. Sci Rep 2022; 12:22389. [PMID: 36575298 PMCID: PMC9794690 DOI: 10.1038/s41598-022-26560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022] Open
Abstract
Biofilm (BF) growth is believed to play a major role in the development of ventilator-associated pneumonia (VAP) in the intensive care unit. Despite concerted efforts to understand the potential implication of endotracheal tube (ETT)-BF dispersal, clinically relevant data are lacking to better characterize the impact of its mesostructure and microbiological singularity on the occurrence of VAP. We conducted a multicenter, retrospective observational study during the third wave of the COVID-19 pandemic, between March and May 2021. In total, 64 ETTs collected from 61 patients were included in the present BIOPAVIR study. Confocal microscopy acquisitions revealed two main morphological aspects of ETT-deposited BF: (1) a thin, continuous ribbon-shaped aspect, less likely monobacterial and predominantly associated with Enterobacter spp., Streptococcus pneumoniae or Viridans streptococci, and (2) a thicker, discontinuous, mushroom-shaped appearance, more likely characterized by the association of bacterial and fungal species in respiratory samples. The microbiological characterization of ETT-deposited BF found higher acquired resistance in more than 80% of analyzed BF phenotypes, compared to other colonization sites from the patient's environment. These findings reveal BF as a singular microbiological compartment, and are of added clinical value, with a view to future ETT-deposited BF-based antimicrobial stewardship in critically ill patients. Trial registration NCT04926493. Retrospectively registered 15 June 2021.
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8
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Spake CSL, Berns EM, Sahakian L, Turcu A, Clayton A, Glasser J, Barrett C, Barber D, Antoci V, Born CT, Garcia DR. In vitro visualization and quantitative characterization of Pseudomonas aeruginosa biofilm growth dynamics on polyether ether ketone. J Orthop Res 2022; 40:2448-2456. [PMID: 34935196 DOI: 10.1002/jor.25252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/08/2021] [Accepted: 12/19/2021] [Indexed: 02/04/2023]
Abstract
Prevention and treatment of orthopedic device-related infection (ODRI) is complicated by the formation of bacterial biofilms. Biofilm formation involves dynamic production of macromolecules that contribute to the structure of the biofilm over time. Limitations to clinically relevant and translational biofilm visualization and measurement hamper advances in this area of research. In this paper, we present a multimodal methodology for improved characterization of Pseudomonas aeruginosa grown on polyether ether ketone (PEEK) as a model for ODRI. PEEK discs were inoculated with P. aeruginosa, incubated for 4-48 h time intervals, and fixed with 10% neutral-buffered formalin. Samples were stained with fluorescent dyes to measure biofilm components, imaged with confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), and quantified. We were able to visualize and quantify P. aeruginosa biofilm growth on PEEK implants over 48 h. Based on imaging data, we propose a generalized growth cycle that can inform orthopedic diagnostic and treatment for this pathogen on PEEK. These results demonstrate the potential of using a combined CLSM and SEM approach for determining biofilm structure, composition, post-adherence development on orthopedic materials. This model may be used for quantitative biofilm analysis for other pathogens and other materials of orthopedic relevance for translational study of ODRI.
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Affiliation(s)
- Carole S L Spake
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ellis M Berns
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Lori Sahakian
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Adrian Turcu
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ahsia Clayton
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jillian Glasser
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Caitlin Barrett
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Douglas Barber
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher T Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Dioscaris R Garcia
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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9
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Di Domenico EG, Oliva A, Guembe M. The Current Knowledge on the Pathogenesis of Tissue and Medical Device-Related Biofilm Infections. Microorganisms 2022; 10:microorganisms10071259. [PMID: 35888978 PMCID: PMC9322301 DOI: 10.3390/microorganisms10071259] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Biofilm is the trigger for the majority of infections caused by the ability of microorganisms to adhere to tissues and medical devices. Microbial cells embedded in the biofilm matrix are highly tolerant to antimicrobials and escape the host immune system. Thus, the refractory nature of biofilm-related infections (BRIs) still represents a great challenge for physicians and is a serious health threat worldwide. Despite its importance, the microbiological diagnosis of a BRI is still difficult and not routinely assessed in clinical microbiology. Moreover, biofilm bacteria are up to 100–1000 times less susceptible to antibiotics than their planktonic counterpart. Consequently, conventional antibiograms might not be representative of the bacterial drug susceptibility in vivo. The timely recognition of a BRI is a crucial step to directing the most appropriate biofilm-targeted antimicrobial strategy.
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Affiliation(s)
- Enea Gino Di Domenico
- Department of Biology and Biotechnology “C. Darwin”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Correspondence: ; Tel.: +34-914-269-595
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10
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Sick-Samuels AC, Woods-Hill C. Diagnostic Stewardship in the Pediatric Intensive Care Unit. Infect Dis Clin North Am 2022; 36:203-218. [PMID: 35168711 PMCID: PMC8865365 DOI: 10.1016/j.idc.2021.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the pediatric intensive care unit (PICU), clinicians encounter complex decision making, balancing the need to treat infections promptly against the potential harms of antibiotics. Diagnostic stewardship is an approach to optimize microbiology diagnostic test practices to reduce unnecessary antibiotic treatment. We review the evidence for diagnostic stewardship of blood, endotracheal, and urine cultures in the PICU. Clinicians should consider 3 questions applying diagnostic stewardship: (1) Does the patient have signs or symptoms of an infectious process? (2) What is the optimal diagnostic test available to evaluate for this infection? (3) How should the diagnostic specimen be collected to optimize results?
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Affiliation(s)
- Anna C. Sick-Samuels
- The Johns Hopkins University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Baltimore, MD,The Johns Hopkins Hospital, Department of Hospital Epidemiology and Infection Control, Baltimore, MD
| | - Charlotte Woods-Hill
- Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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11
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Das P, Ghosh S, Nayak B. Phyto-fabricated Nanoparticles and Their Anti-biofilm Activity: Progress and Current Status. FRONTIERS IN NANOTECHNOLOGY 2021. [DOI: 10.3389/fnano.2021.739286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Biofilm is the self-synthesized, mucus-like extracellular polymeric matrix that acts as a key virulence factor in various pathogenic microorganisms, thereby posing a serious threat to human health. It has been estimated that around 80% of hospital-acquired infections are associated with biofilms which are found to be present on both biotic and abiotic surfaces. Antibiotics, the current mainstream treatment strategy for biofilms are often found to be futile in the eradication of these complex structures, and to date, there is no effective therapeutic strategy established against biofilm infections. In this regard, nanotechnology can provide a potential platform for the alleviation of this problem owing to its unique size-dependent properties. Accordingly, various novel strategies are being developed for the synthesis of different types of nanoparticles. Bio-nanotechnology is a division of nanotechnology which is gaining significant attention due to its ability to synthesize nanoparticles of various compositions and sizes using biotic sources. It utilizes the rich biodiversity of various biological components which are biocompatible for the synthesis of nanoparticles. Additionally, the biogenic nanoparticles are eco-friendly, cost-effective, and relatively less toxic when compared to chemically or physically synthesized alternatives. Biogenic synthesis of nanoparticles is a bottom-top methodology in which the nanoparticles are formed due to the presence of biological components (plant extract and microbial enzymes) which act as stabilizing and reducing agents. These biosynthesized nanoparticles exhibit anti-biofilm activity via various mechanisms such as ROS production, inhibiting quorum sensing, inhibiting EPS production, etc. This review will provide an insight into the application of various biogenic sources for nanoparticle synthesis. Furthermore, we have highlighted the potential of phytosynthesized nanoparticles as a promising antibiofilm agent as well as elucidated their antibacterial and antibiofilm mechanism.
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Alencar de Barros KM, Sardi JDCO, Maria-Neto S, Macedo AJ, Ramalho SR, Lourenço de Oliveira DG, Pontes GS, Weber SS, Ramalho de Oliveira CF, Macedo MLR. A new Kunitz trypsin inhibitor from Erythrina poeppigiana exhibits antimicrobial and antibiofilm properties against bacteria. Biomed Pharmacother 2021; 144:112198. [PMID: 34656058 DOI: 10.1016/j.biopha.2021.112198] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Erythrina poeppigiana belongs to Fabaceae family (subfamily Papillionoideae) and is commonly found in tropical and subtropical regions in Brazil. Herein, we described the purification and characterization of a new Kunitz-type inhibitor, obtained from E. poeppigiana seeds (EpTI). EpTI is composed by three isoforms of identical amino-terminal sequences with a molecular weight ranging from 17 to 20 kDa. The physicochemical features showed by EpTI are common to Kunitz inhibitors, including the dissociation constant (13.1 nM), stability against thermal (37-100 °C) and pH (2-10) ranging, and the presence of disulfide bonds stabilizing its reactive site. Furthermore, we investigated the antimicrobial, anti-adhesion, and anti-biofilm properties of EpTI against Gram-positive and negative bacteria. The inhibitor showed antimicrobial activity with a minimum inhibitory concentration (MIC, 5-10 µM) and minimum bactericidal concentration (MBC) of 10 µM for Enterobacter aerogenes, Enterobacter cloacae, Klebsiella pneumoniae, Staphylococcus aureus, and Staphylococcus haemolyticus. The combination of EpTI with ciprofloxacin showed a marked synergistic effect, reducing the antibiotic concentration by 150%. The increase in crystal violet uptake for S. aureus and K. pneumoniae strains was approximately 30% and 50%, respectively, suggesting that the bacteria plasma membrane is targeted by EpTI. Treatment with EpTI at 1x and 10 x MIC significantly reduced the biofilm formation and prompted the disruption of a mature biofilm. At MIC/2, EpTI decreased the bacterial adhesion to polystyrene surface within 2 h. Finally, EpTI showed low toxicity in animal model Galleria mellonella. Given its antimicrobial and anti-biofilm properties, the EpTI sequence might be used to design novel drug prototypes.
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Affiliation(s)
- Karina Margareti Alencar de Barros
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro Oeste, Universidade Federal do Mato Grosso do Sul, Brazil; Laboratório de Purificação de Proteínas e suas Funções Biológicas, Universidade Federal de Mato Grosso do Sul, Cidade Universitária S/N, Caixa Postal 549, Campo Grande, MS 79070-900, Brazil
| | - Janaina de Cássia Orlandi Sardi
- Laboratório de Purificação de Proteínas e suas Funções Biológicas, Universidade Federal de Mato Grosso do Sul, Cidade Universitária S/N, Caixa Postal 549, Campo Grande, MS 79070-900, Brazil
| | - Simone Maria-Neto
- Laboratório de Purificação de Proteínas e suas Funções Biológicas, Universidade Federal de Mato Grosso do Sul, Cidade Universitária S/N, Caixa Postal 549, Campo Grande, MS 79070-900, Brazil
| | | | - Suellen Rodrigues Ramalho
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro Oeste, Universidade Federal do Mato Grosso do Sul, Brazil
| | - Daniella Gorete Lourenço de Oliveira
- Laboratório de Purificação de Proteínas e suas Funções Biológicas, Universidade Federal de Mato Grosso do Sul, Cidade Universitária S/N, Caixa Postal 549, Campo Grande, MS 79070-900, Brazil
| | | | - Simone Schneider Weber
- Laboratório de Purificação de Proteínas e suas Funções Biológicas, Universidade Federal de Mato Grosso do Sul, Cidade Universitária S/N, Caixa Postal 549, Campo Grande, MS 79070-900, Brazil; Instituto de Ciências Exatas e Tecnologia (ICET), Universidade Federal do Amazonas, Itacoatiara, Amazonas, Brazil
| | | | - Maria Lígia Rodrigues Macedo
- Laboratório de Purificação de Proteínas e suas Funções Biológicas, Universidade Federal de Mato Grosso do Sul, Cidade Universitária S/N, Caixa Postal 549, Campo Grande, MS 79070-900, Brazil.
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Latorre MC, Pérez-Granda MJ, Savage PB, Alonso B, Martín-Rabadán P, Samaniego R, Bouza E, Muñoz P, Guembe M. Endotracheal tubes coated with a broad-spectrum antibacterial ceragenin reduce bacterial biofilm in an in vitro bench top model. J Antimicrob Chemother 2021; 76:1168-1173. [PMID: 33544817 DOI: 10.1093/jac/dkab019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Ventilator-associated pneumonia is one of the most common nosocomial infections, caused mainly by bacterial/fungal biofilm. Therefore, it is necessary to develop preventive strategies to avoid biofilm formation based on new compounds. OBJECTIVES We performed an in vitro study to compare the efficacy of endotracheal tubes (ETTs) coated with the ceragenin CSA-131 and that of uncoated ETTs against the biofilm of clinical strains of Pseudomonas aeruginosa (PA), Escherichia coli (EC) and Staphylococcus aureus (SA). METHODS We applied an in vitro bench top model using coated and uncoated ETTs that were treated with three different clinical strains of PA, EC and SA for 5 days. After exposure to biofilm, ETTs were analysed for cfu count by culture of sonicate and total number of cells by confocal laser scanning microscopy. RESULTS The median (IQR) cfu/mL counts of PA, EC and SA in coated and uncoated ETTs were, respectively, as follows: 1.00 × 101 (0.0-3.3 × 102) versus 3.32 × 109 (6.6 × 108-3.8 × 109), P < 0.001; 0.0 (0.0-5.4 × 103) versus 1.32 × 106 (2.3 × 103-5.0 × 107), P < 0.001; and 8.1 × 105 (8.5 × 101-1.4 × 109) versus 2.7 × 108 (8.6 × 106-1.6 × 1011), P = 0.058. The median (IQR) total number of cells of PA, EC and SA in coated and non-coated ETTs were, respectively, as follows: 11.0 [5.5-not applicable (NA)] versus 87.9 (60.5-NA), P = 0.05; 9.1 (6.7-NA) versus 62.6 (42.0-NA), P = 0.05; and 97.7 (94.6-NA) versus 187.3 (43.9-NA), P = 0.827. CONCLUSIONS We demonstrated significantly reduced biofilm formation in coated ETTs. However, the difference for SA was not statistically significant. Future clinical studies are needed to support our findings.
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Affiliation(s)
- María Consuelo Latorre
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Jesús Pérez-Granda
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, USA
| | - Beatriz Alonso
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Pablo Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES, (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Rafael Samaniego
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Confocal Laser Scanning Microscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES, (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES, (CB06/06/0058), Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Cai YM, Zhang YD, Yang L. NO donors and NO delivery methods for controlling biofilms in chronic lung infections. Appl Microbiol Biotechnol 2021; 105:3931-3954. [PMID: 33937932 PMCID: PMC8140970 DOI: 10.1007/s00253-021-11274-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 12/18/2022]
Abstract
Nitric oxide (NO), the highly reactive radical gas, provides an attractive strategy in the control of microbial infections. NO not only exhibits bactericidal effect at high concentrations but also prevents bacterial attachment and disperses biofilms at low, nontoxic concentrations, rendering bacteria less tolerant to antibiotic treatment. The endogenously generated NO by airway epithelium in healthy populations significantly contributes to the eradication of invading pathogens. However, this pathway is often compromised in patients suffering from chronic lung infections where biofilms dominate. Thus, exogenous supplementation of NO is suggested to improve the therapeutic outcomes of these infectious diseases. Compared to previous reviews focusing on the mechanism of NO-mediated biofilm inhibition, this review explores the applications of NO for inhibiting biofilms in chronic lung infections. It discusses how abnormal levels of NO in the airways contribute to chronic infections in cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and primary ciliary dyskinesia (PCD) patients and why exogenous NO can be a promising antibiofilm strategy in clinical settings, as well as current and potential in vivo NO delivery methods. KEY POINTS : • The relationship between abnormal NO levels and biofilm development in lungs • The antibiofilm property of NO and current applications in lungs • Potential NO delivery methods and research directions in the future.
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Affiliation(s)
- Yu-Ming Cai
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Ying-Dan Zhang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518000, China
| | - Liang Yang
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518000, China.
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15
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Struyfs C, Cammue BPA, Thevissen K. Membrane-Interacting Antifungal Peptides. Front Cell Dev Biol 2021; 9:649875. [PMID: 33912564 PMCID: PMC8074791 DOI: 10.3389/fcell.2021.649875] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022] Open
Abstract
The incidence of invasive fungal infections is increasing worldwide, resulting in more than 1.6 million deaths every year. Due to growing antifungal drug resistance and the limited number of currently used antimycotics, there is a clear need for novel antifungal strategies. In this context, great potential is attributed to antimicrobial peptides (AMPs) that are part of the innate immune system of organisms. These peptides are known for their broad-spectrum activity that can be directed toward bacteria, fungi, viruses, and/or even cancer cells. Some AMPs act via rapid physical disruption of microbial cell membranes at high concentrations causing cell leakage and cell death. However, more complex mechanisms are also observed, such as interaction with specific lipids, production of reactive oxygen species, programmed cell death, and autophagy. This review summarizes the structure and mode of action of antifungal AMPs, thereby focusing on their interaction with fungal membranes.
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Affiliation(s)
- Caroline Struyfs
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
| | - Bruno P A Cammue
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
| | - Karin Thevissen
- Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
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16
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Sevdi MS, Demirgan S, Erkalp K, Akyol O, Ozcan FG, Guneyli HC, Tunali MC, Selcan A. Continuous Endotracheal Tube Cuff Pressure Control Decreases Incidence of Ventilator-Associated Pneumonia in Patients with Traumatic Brain Injury. J INVEST SURG 2021; 35:525-530. [PMID: 33583304 DOI: 10.1080/08941939.2021.1881190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a common cause of morbidity and mortality in intensive care unit (ICU), and among the several preventative strategies described to reduce the incidence of VAP, the most important is the endotracheal tube cuff (ETC) pressure. The present study was conducted on 60 patients who required mechanical ventilation (MV) in the ICU with traumatic brain injury (TBI). METHODS The patients were randomized into two groups of 30, in which ETC pressure was regulated using a smart cuff manager (SCM) (Group II), or manual measurement approach (MMA) (Group I). Demographic data, MV duration, length of ICU stay and mortality rates were recorded. The clinical pulmonary infection scores (CPISs), C-reactive protein (CRP) values, and the fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) values of the groups were compared at baseline, and at hours 48, 72 and 96. RESULTS In Group I, CPIS values significantly higher than Group II in 48th, 72nd and 96th hours (p < 0.05). In Group I, PEEP values and deep tracheal aspirate (DTA) culture growth rates significantly higher than Group II in 72nd and 96th hours (p < 0.05). CONCLUSION The continuous maintenance of ETC pressure using SCM reduced the incidence of VAP.
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Affiliation(s)
- Mehmet Salih Sevdi
- Department of Anesthesiology and Reanimation, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Serdar Demirgan
- Department of Anesthesiology and Reanimation, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Kerem Erkalp
- Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Institute of Cardiology, Istanbul, Turkey
| | - Onat Akyol
- Department of Anesthesiology and Reanimation, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Funda Gumus Ozcan
- Department of Anesthesiology and Reanimation, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Hasan Cem Guneyli
- Department of Anesthesiology and Reanimation, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Can Tunali
- Department of Anesthesiology and Reanimation, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Aysin Selcan
- Department of Anesthesiology and Reanimation, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
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van der Hoeven S, Ball L, Constantino F, van Meenen DM, Pelosi P, Beenen LF, Schultz MJ, Paulus F. Effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of airway secretions in endotracheal tubes: substudy of a randomized clinical trial. Intensive Care Med Exp 2020; 8:71. [PMID: 33336283 PMCID: PMC7746420 DOI: 10.1186/s40635-020-00351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia. The aim of this preplanned substudy of the 'Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial' (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients. RESULTS In this single-center substudy of a national multicenter trial, patients were randomized to a strategy of routine nebulizations of acetylcysteine with salbutamol every 6 h until end of invasive ventilation, or to a strategy with on-demand nebulizations of acetylcysteine or salbutamol applied on strict clinical indications only. The primary endpoint, the maximum reduction in cross-sectional area (CSA) of the endotracheal tube was assessed with high-resolution computed tomography. Endotracheal tubes were collected from 72 patients, 36 from patients randomized to the routine nebulization strategy and 36 of patients randomized to the on-demand nebulization strategy. The maximum cross-sectional area (CSA) of the endotracheal tube was median 12 [6 to 15]% in tubes obtained from patients in the routine nebulization group, not different from median 9 [6 to 14]% in tubes obtained from patients in the on-demand nebulization group (P = 0.33). CONCLUSION In adult critically ill patients under invasive ventilation, routine nebulization of mucolytics and bronchodilators did not affect accumulation of airway secretions in the endotracheal tube. Trial registration Clinicaltrials.gov Identifier: NCT02159196.
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Affiliation(s)
- Sophia van der Hoeven
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Lorenzo Ball
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy, Genova, Italy
| | - Federico Constantino
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy, Genova, Italy
| | - David M van Meenen
- Department of Anesthesiology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscienze, Genova, Italy, Genova, Italy
| | - Ludo F Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Frederique Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands. .,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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18
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Thorarinsdottir HR, Kander T, Holmberg A, Petronis S, Klarin B. Biofilm formation on three different endotracheal tubes: a prospective clinical trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:382. [PMID: 32600373 PMCID: PMC7322705 DOI: 10.1186/s13054-020-03092-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and thereby contribute to development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface, it is difficult to eradicate. This clinical study aimed to compare biofilm formation on three widely used ETTs with different surface properties and to explore factors potentially predictive of biofilm formation. METHODS We compared the grade of biofilm formation on ETTs made of uncoated polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated with noble metals after > 24 h of mechanical ventilation in critically ill patients. The comparison was based on scanning electron microscopy of ETT surfaces, biofilm grading, surveillance and biofilm cultures, and occurrence of VAP. RESULTS High-grade (score ≥ 7) biofilm formation on the ETTs was associated with development of VAP (OR 4.17 [95% CI 1.14-15.3], p = 0.031). Compared to uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation (OR 0.18 [95% CI 0.06-0.59], p = 0.005, and OR 0.34 [95% CI 0.13-0.93], p = 0.036, respectively). No significant difference was observed between silicon-coated ETTs and noble-metal-coated ETTs (OR 0.54 [95% CI 0.17-1.65], p = 0.278). In 60% of the oropharyngeal cultures and 58% of the endotracheal cultures collected at intubation, the same microorganism was found in the ETT biofilm at extubation. In patients who developed VAP, the causative microbe remained in the biofilm in 56% of cases, despite appropriate antibiotic therapy. High-grade biofilm formation on ETTs was not predicted by either colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation. CONCLUSION High-grade biofilm formation on ETTs was associated with development of VAP. Compared to the uncoated PVC ETTs, the silicone-coated and noble-metal-coated PVC ETTs were independently associated with reduced high-grade biofilm formation. Further research on methods to prevent, monitor, and manage biofilm occurrence is needed. TRIAL REGISTRATION ClinicalTrials.gov NCT02284438 . Retrospectively registered on 21 October 2014.
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Affiliation(s)
- Hulda R Thorarinsdottir
- Department of Clinical Sciences, Lund University, Lund, Sweden. .,Division of Intensive and Perioperative Care, Skåne University Hospital, Getingevägen 4, SE-22185, Lund, Sweden.
| | - Thomas Kander
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Division of Intensive and Perioperative Care, Skåne University Hospital, Getingevägen 4, SE-22185, Lund, Sweden
| | - Anna Holmberg
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sarunas Petronis
- Chemistry, Biomaterials and Textiles, RISE Research Institutes of Sweden, Borås, Sweden
| | - Bengt Klarin
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Division of Intensive and Perioperative Care, Skåne University Hospital, Getingevägen 4, SE-22185, Lund, Sweden
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Assar A, Abdelraoof MI, Abdel-Maboud M, Shaker KH, Menshawy A, Swelam AH, Eid M, Khalid R, Mogahed M, Abushouk AI, Aleya L, Abdel-Daim M. Knowledge, attitudes, and practices of Egypt's future physicians towards antimicrobial resistance (KAP-AMR study): a multicenter cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:21292-21298. [PMID: 32270452 DOI: 10.1007/s11356-020-08534-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
Antimicrobial resistance (AMR) is a growing threat that causes over 700,000 deaths per year worldwide. The goal of the current multicenter, cross-sectional study was to identify the knowledge and practice gaps in antimicrobial stewardship among Egypt's undergraduate medical students. Nine-hundred and sixty-three participants (375 male) from 25 medical schools responded to our self-administered questionnaire. Overall, the majority of students (96%) exhibited fair/satisfactory knowledge and attitude scores towards AMR. However, the most common misconceptions were that skipping one or two antimicrobial doses does not contribute to AMR (43%) and that antimicrobials are the drug of choice for the treatment of sore throat (38.8%). About 36% of the students thought that bacteria cause common cold and influenza. In terms of practices, about 62% of the students reported taking antibiotics when they have cough or sore throat and saving the remaining antibiotic for the next time. About 48% of the students reported that when they start feeling better, they stop the antibiotic course, and 41% stated that they often/sometimes discard the remaining leftover or share the leftover antibiotics with their friends. Interestingly, males had more frequently poorer levels of knowledge than females (p = 0.02). Moreover, students in the clinical science years (p < 0.001), living in urban areas (p = 0.02) or Cairo (p < 0.01) reported better practices than their counterparts. Educational programs about antimicrobial stewardship and the role of healthcare professionals in preventing AMR should be introduced early in medical curricula. Further, active educational techniques as clinical scenarios that simulate clinical settings and interactive learning workshops would be more efficient teaching methods.
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Affiliation(s)
- Ahmed Assar
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Ibrahim Abdelraoof
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abdel-Maboud
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Kerollos H Shaker
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, South Valley University, Qena, Egypt
| | - Amr Menshawy
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Asia Hamdy Swelam
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Benha University, Benha, Egypt
| | - Muhammad Eid
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Radwa Khalid
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Mohamed Mogahed
- International Federation of Medical Students' Associations - Egypt (IFMSA - Egypt), Alexandria, Egypt
- Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | | | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, F-25030 11, Besançon Cedex, France
| | - Mohamed Abdel-Daim
- Department of Pharmacology, Suez Canal University, Ismailia, Egypt
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
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20
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de Mélo Silva IS, do Amorim Costa Gaspar LM, Rocha AMO, da Costa LP, Tada DB, Franceschi E, Padilha FF. Encapsulation of Red Propolis in Polymer Nanoparticles for the Destruction of Pathogenic Biofilms. AAPS PharmSciTech 2020; 21:49. [PMID: 31900606 DOI: 10.1208/s12249-019-1576-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022] Open
Abstract
Microbial biofilms, structured communities of microorganisms, have been often associated to the infection and bacterial multiresistance problem. Conventional treatment of infection involves the use of antibiotics, being an alternative approach is the use of red propolis, a natural product, to prepare polymer nanoparticles. The aim of the present study was to encapsulate red propolis extract in poly(lactic-co-glycolic acid) (PLGA) nanoparticles for destruction in vitro of pathogenic biofilms. Poly(lactic-co-glycolic acid) nanoparticles (PLGA NPs) containing red propolis hydroethanolic extract (2 mg/mL) were produced by emulsification solvent diffusion method. The extract and developed nanoparticles were analyzed for antimicrobial activity and inhibition of bacterial biofilm formation in vitro against Staphylococcus aureus and Pseudomonas aeruginosa. Transmission electron microscopy images confirmed spherical nanoparticles in the range size from 42.4 nm (PLGA NPs) to 69.2 nm (HERP PLGA NPs), with encapsulation efficiencies of 96.99%. The free extract and encapsulated in polymer nanoparticle presented antimicrobial potential, with a minimum inhibitory concentration from 15.6 to 125 μg mL-1 and from 100 to 1560 μg mL-1 to inhibit biofilm formation for the Staphylococcus aureus and Pseudomonas aeruginosa, respectively.
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21
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Ruiz J, Sanjuan E, Amaro C, Gordon M, Villarreal E, Castellanos-Ortega Á, Ramirez P. In vitro study of antimicrobial activity on Klebsiella Pneumoniae biofilms in endotracheal tubes. J Chemother 2019; 31:202-208. [PMID: 30990368 DOI: 10.1080/1120009x.2019.1601801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Effective treatment approaches for biofilms in endotracheal tubes (ETTs) are lacking. In this study, we evaluated the in vitro effects of five antimicrobials against biofilms formed by Klebsiella pneumoniae in ETTs. K. pneumoniae was added to minimal mucin medium prior to inoculation in microtiter plates containing ETT fragments. Biofilm susceptibility was assessed by crystal violet staining. At 24 h, the antimicrobials significantly reduced biofilm formation. At 48 h, all of the antimicrobial agents exhibited significant reductions in biofilm formation, even at concentrations above the minimum inhibitory concentration (MIC). Tigecycline and fosfomycin showed the greatest inhibition capacity, with good activity at concentrations twofold greater than the MIC. K. pneumoniae exhibited excellent biofilm formation ability, with formation in the first 24 h and significantly reduced antimicrobial activity. These results contribute to the establishment of new antibiotic breakpoints for the adequate management of infections associated with biofilm formation. Abbreviations ETT Endotracheal tube MIC Minimum inhibitory concentration MBIC Minimum biofilm inhibitory concentration OD Optical density PBS Phosphate-buffered saline VAP Ventilator-associated pneumonia.
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Affiliation(s)
- Jesus Ruiz
- a Intensive Care Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Eva Sanjuan
- b ERI Biotecmed , University of Valencia , Valencia , Spain
| | - Carmen Amaro
- b ERI Biotecmed , University of Valencia , Valencia , Spain
| | - Monica Gordon
- a Intensive Care Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | - Esther Villarreal
- a Intensive Care Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
| | | | - Paula Ramirez
- a Intensive Care Unit, Hospital Universitario y Politécnico La Fe , Valencia , Spain
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22
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Antibacterial Properties and Efficacy of a Novel SPLUNC1-Derived Antimicrobial Peptide, α4-Short, in a Murine Model of Respiratory Infection. mBio 2019; 10:mBio.00226-19. [PMID: 30967458 PMCID: PMC6456746 DOI: 10.1128/mbio.00226-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The rise of superbugs underscores the urgent need for novel antimicrobial agents. Antimicrobial peptides (AMPs) have the ability to kill superbugs regardless of resistance to traditional antibiotics. However, AMPs often display a lack of efficacy in vivo. Sequence optimization and engineering are promising but may result in increased host toxicity. We report here the optimization of a novel AMP (α4-short) derived from the multifunctional respiratory protein SPLUNC1. The AMP α4-short demonstrated broad-spectrum activity against superbugs as well as in vivo efficacy in the P. aeruginosa pneumonia model. Further exploration for clinical development is warranted. Multidrug resistance (MDR) by bacterial pathogens constitutes a global health crisis, and resistance to treatment displayed by biofilm-associated infections (e.g., cystic fibrosis, surgical sites, and medical implants) only exacerbates a problem that is already difficult to overcome. Antimicrobial peptides (AMPs) are a promising class of therapeutics that may be useful in the battle against antibiotic resistance, although certain limitations have hindered their clinical development. The goal of this study was to examine the therapeutic potential of novel AMPs derived from the multifunctional respiratory host defense protein SPLUNC1. Using standard growth inhibition and antibiofilm assays, we demonstrated that a novel structurally optimized AMP, α4-short, was highly effective against the most common group of MDR bacteria while showing broad-spectrum bactericidal and antibiofilm activities. With negligible hemolysis and toxicity to white blood cells, the new peptide also demonstrated in vivo efficacy when delivered directly into the airway in a murine model of Pseudomonas aeruginosa-induced respiratory infection. The data warrant further exploration of SPLUNC1-derived AMPs with optimized structures to assess the potential application to difficult-to-cure biofilm-associated infections.
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23
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Ben Braïek O, Merghni A, Smaoui S, Mastouri M. Enterococcus lactis Q1 and 4CP3 strains from raw shrimps: Potential of antioxidant capacity and anti-biofilm activity against methicillin-resistant Staphylococcus aureus strains. Lebensm Wiss Technol 2019. [DOI: 10.1016/j.lwt.2018.11.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Torres A, Motos A, Battaglini D, Li Bassi G. Inhaled amikacin for severe Gram-negative pulmonary infections in the intensive care unit: current status and future prospects. Crit Care 2018; 22:343. [PMID: 30558658 PMCID: PMC6297966 DOI: 10.1186/s13054-018-1958-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/16/2018] [Indexed: 11/25/2022] Open
Abstract
Recently, the use of nebulized antibiotics in the intensive care unit, in particular amikacin, has been the subject of much discussion, owing to unconvincing results from the latest randomized clinical trials. Here, we examine and reappraise the evidence in favor and against this therapeutic strategy; we then discuss the potential factors that might have played a role in the negative findings of recent clinical trials. Also, we call attention to several factors that are seldom considered by study developers and regulatory agencies, to promote translational research in this field and improve the design of future randomized clinical trials.
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Affiliation(s)
- Antoni Torres
- Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Calle Villarroel 170, Barcelona, 08036, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain. .,University of Barcelona, Barcelona, Spain.
| | - Anna Motos
- Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Calle Villarroel 170, Barcelona, 08036, Spain
| | - Denise Battaglini
- Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Calle Villarroel 170, Barcelona, 08036, Spain.,University of Genoa, Genoa, Italy
| | - Gianluigi Li Bassi
- Department of Pulmonary and Critical Care Medicine, Hospital Clinic, Calle Villarroel 170, Barcelona, 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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25
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Roscetto E, Contursi P, Vollaro A, Fusco S, Notomista E, Catania MR. Antifungal and anti-biofilm activity of the first cryptic antimicrobial peptide from an archaeal protein against Candida spp. clinical isolates. Sci Rep 2018; 8:17570. [PMID: 30514888 PMCID: PMC6279838 DOI: 10.1038/s41598-018-35530-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/29/2018] [Indexed: 01/20/2023] Open
Abstract
Candida species cause cutaneous and systemic infections with a high mortality rate, especially in immunocompromised patients. The emergence of resistance to the most common antifungal drugs, also due to biofilm formation, requires the development of alternative antifungal agents. The antimicrobial peptide VLL-28, isolated from an archaeal transcription factor, shows comparable antifungal activity against 10 clinical isolates of Candida spp. Using a fluoresceinated derivative of this peptide, we found that VLL-28 binds to the surface of planktonic cells. This observation suggested that it could exert its antifungal activity by damaging the cell wall. In addition, analyses performed on biofilms via confocal microscopy revealed that VLL-28 is differentially active on all the strains tested, with C. albicans and C. parapsilosis being the most sensitive ones. Notably, VLL-28 is the first example of an archaeal antimicrobial peptide that is active towards Candida spp. Thus, this points to archaeal microorganisms as a possible reservoir of novel antifungal agents.
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Affiliation(s)
- Emanuela Roscetto
- Section of Clinical Microbiology, Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Patrizia Contursi
- Department of Biology, University of Naples Federico II, Campus of Monte S. Angelo, Via Cinthia, 80126, Naples, Italy.
| | - Adriana Vollaro
- Section of Clinical Microbiology, Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Salvatore Fusco
- Department of Biology, University of Naples Federico II, Campus of Monte S. Angelo, Via Cinthia, 80126, Naples, Italy
| | - Eugenio Notomista
- Department of Biology, University of Naples Federico II, Campus of Monte S. Angelo, Via Cinthia, 80126, Naples, Italy
| | - Maria Rosaria Catania
- Section of Clinical Microbiology, Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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26
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Wang Y, Zhang R, Liu W. Distribution and drug resistance of pathogenic bacteria in ventilator-associated pneumonia at a local hospital of North-eastern China. Infect Drug Resist 2018; 11:2249-2255. [PMID: 30519063 PMCID: PMC6239098 DOI: 10.2147/idr.s172598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the distribution of pathogenic bacteria in ventilator-associated pneumonia (VAP), and epidemiological characteristics of extended-spectrum β lactamase (ESBL)-producing bacteria. Patients and methods Lower respiratory tract secretions from 156 patients with mechanical ventilation were collected using a protective specimen brush (PSB), with quantitative bacterial culture carried out and antibiotic sensitivity measured. ESBLs produced by Gram-negative bacilli were detected using the double disk diffusion method and monitored by plasmid profiles. Results Gram-negative bacilli accounted for 78.9% of VAP pathogens, with Acinetobacter baumannii (25%), Pseudomonas aeruginosa (19.7%), and Klebsiella pneumoniae (14.5%) as the most common strains. There were 12 Gram-positive strains detected (15.8%); mostly methicillin-resistant. Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus. There were also four strains of Candida albicans detected (5.26%). Most Gram-negative bacilli are sensitive to imipenem, but A. baumannii is serious resistant. ESBLs were detected in nine strains of Gram-negative bacilli; mainly produced by K. pneumoniae and Escherichia coli, to different degrees of multidrug resistance. Five strains of K. pneumoniae-producing ESBLs were from the same clonal origin, as confirmed by plasmid restriction endonuclease analysis. Conclusion VAP was mainly caused by Gram-negative bacteria, with high antibiotic resistance rates. Plasmids played an important role in the spread of antibiotic resistance among bacteria.
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Affiliation(s)
- Yu Wang
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University, Heping District, Shenyang, Liaoning Province 110004, People's Republic of China,
| | - Rong Zhang
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University, Heping District, Shenyang, Liaoning Province 110004, People's Republic of China,
| | - Wei Liu
- Department of Emergency, Shengjing Hospital Affiliated to China Medical University, Heping District, Shenyang, Liaoning Province 110004, People's Republic of China,
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27
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Lopes LKO, Costa DM, Tipple AFV, Watanabe E, Castillo RB, Hu H, Deva AK, Vickery K. Complex design of surgical instruments as barrier for cleaning effectiveness, favouring biofilm formation. J Hosp Infect 2018; 103:e53-e60. [PMID: 30423413 DOI: 10.1016/j.jhin.2018.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/02/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Inadequately reprocessed reusable surgical instruments (RSIs) may harbour infectious agents which may then be transferred to a suitable site for replication. AIM To determine the cumulative effect of 20 cycles of contamination, cleaning (manual or manual followed by automated) and steam sterilization on high-complex-design RSIs used for orthopaedic surgery. METHODS New flexible medullary reamers and depth gauges were contaminated by soaking in tryptone soya broth, containing 5% sheep blood and 109 cfu/mL of Staphylococcus aureus (ATCC 25923), for 5 min. To mimic a worse-case scenario, RSIs were dried 7 h and subjected to either (a) rinsing in distilled water, (b) manual cleaning or (c) manual plus automated cleaning (reference standard), and steam sterilization. The contamination, cleaning, and sterilization cycle was repeated 20 times. Adenosine triphosphate (ATP) was measured after cleaning procedures; microbial load and residual protein were measured following the 10th and 20th reprocessing, in triplicate. Scanning electron microscopy (SEM) was used to confirm soil and biofilm presence on the RSIs after the 20th reprocessing. FINDINGS Manual and manual plus automated cleaning significantly reduced the amount of ATP and protein residues for all RSIs. Viable bacteria were not detected following sterilization. However, SEM detected soil after automated cleaning, and soil, including biofilms, after manual cleaning. CONCLUSION Soil and/or biofilms were evident on complex-design RSIs following 20 cycles of contamination and reprocessing, even using the reference standard method of cleaning. Although the depth gauges could be disassembled, biological residues and biofilm accumulated in its lumen. The current design of these RSIs prevents removal of all biological soil and this may have an adverse effect on patient outcome.
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Affiliation(s)
- L K O Lopes
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil; Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - D M Costa
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil; Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A F V Tipple
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
| | - E Watanabe
- School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - R B Castillo
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - H Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A K Deva
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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28
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Muramatsu K, Matsuo K, Kawai Y, Yamamoto T, Hara Y, Shimomura Y, Yamashita C, Nishida O. Comparison of wiping and rinsing techniques after oral care procedures in critically ill patients during endotracheal intubation and after extubation: A prospective cross-over trial. Jpn J Nurs Sci 2018; 16:80-87. [PMID: 29947119 DOI: 10.1111/jjns.12217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 03/07/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
AIM Endotracheal intubation of critically ill patients increases the risk of aspiration pneumonia, which can be reduced by regular oral care. However, the rinsing of the residual oral contaminants after mechanical cleaning carries the risk of aspirating the residue during the intubation period. Removing the contaminants by wiping with mouth wipes could be an alternative to rinsing with water because of no additional fluid. This study tested: (i) the amount of oral bacteria during endotracheal intubation and after extubation; and (ii) the changes in the bacterial count during oral care procedures. METHODS Thirty-five mechanically ventilated patients in the intensive care unit were enrolled. The amount of bacteria on the dorsal tongue surface was counted before and following oral care and then after the elimination of contaminants either by rinsing with water and suctioning or by wiping with mouth wipes. The oral bacterial amount was compared statistically between the intubation and extubation status and among set time points during the oral care procedure. RESULTS The oral bacterial count was significantly decreased after extubation. During the oral care procedure, the oral bacterial amount was significantly lower after eliminating the contaminants either by rinsing or wiping, with no remarkable difference between the elimination techniques. CONCLUSIONS The findings suggest that the oral bacterial amount is elevated during endotracheal intubation, which could increase the risk of aspiration pneumonia. The significant reduction in the bacterial count by wiping indicates that it might be a suitable alternative to rinsing for mechanically ventilated patients.
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Affiliation(s)
- Keita Muramatsu
- Department of Intensive Care Unit Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University, Toyoake, Japan
| | - Yusuke Kawai
- Department of Intensive Care Unit Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Tsukasa Yamamoto
- Department of Intensive Care Unit Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshitaka Hara
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Japan
| | - Yasuyo Shimomura
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Japan
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29
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Endotracheal Tube Biofilm and its Impact on the Pathogenesis of Ventilator-Associated Pneumonia. ACTA ACUST UNITED AC 2018; 4:50-55. [PMID: 30581995 PMCID: PMC6294989 DOI: 10.2478/jccm-2018-0011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/30/2018] [Indexed: 01/18/2023]
Abstract
Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection in mechanically ventilated patients and results in high mortality, prolonged intensive care unit- (ICU) and hospital-length of stay and increased costs. In order to reduce its incidence, it is imperative to better understand the involved mechanisms and to identify the source of infection. The role of the endotracheal tube (ET) in VAP pathogenesis became more prominent over the last decades, along with extensive research dedicated to medical device-related infections and biofilms. ET biofilm formation is an early and constant process in intubated patients. New data regarding its temporal dynamics, composition, germ identification and consequences enhance knowledge about VAP occurrence, microbiology, treatment response and recurrence. This paper presents a structured analysis of the medical literature to date, in order to outline the role of ET biofilm in VAP pathogenesis and to review recommended methods to identify ET biofilm microorganisms and to prevent or decrease VAP incidence.
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30
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31
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Pérez-Granda MJ, Latorre MC, Alonso B, Hortal J, Samaniego R, Bouza E, Guembe M. Eradication of P. aeruginosa biofilm in endotracheal tubes based on lock therapy: results from an in vitro study. BMC Infect Dis 2017; 17:746. [PMID: 29202722 PMCID: PMC5715999 DOI: 10.1186/s12879-017-2856-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/26/2017] [Indexed: 02/08/2023] Open
Abstract
Background Despite the several strategies available for the management of biofilm-associated ventilator-associated pneumonia, data regarding the efficacy of applying antibiotics to the subglottic space (SS) are scarce. We created an in vitro model to assess the efficacy of antibiotic lock therapy (ALT) applied in the SS for eradication of Pseudomonas aeruginosa biofilm in endotracheal tubes (ETTs). Methods We applied 2 h of ALT to a P. aeruginosa biofilm in ETTs using a single dose (SD) and a 5-day therapy model (5D). We used sterile saline lock therapy (SLT) as the positive control. We compared colony count and the percentage of live cells between both models. Results The median (IQR) cfu counts/ml and percentage of live cells in the SD-ALT and SD-SLT groups were, respectively, 3.12 × 105 (9.7 × 104-0) vs. 8.16 × 107 (7.0 × 107-0) (p = 0.05) and 53.2% (50.9%-57.2%) vs. 91.5% (87.3%-93.9%) (p < 0.001). The median (IQR) cfu counts/ml and percentage of live cells in the 5D-ALT and 5D-SLT groups were, respectively, 0 (0-0) vs. 3.2 × 107 (2.32 × 107-0) (p = 0.03) and 40.6% (36.6%-60.0%) vs. 90.3% (84.8%-93.9%) (p < 0.001). Conclusion We demonstrated a statistically significant decrease in the viability of P. aeruginosa biofilm after application of 5D-ALT in the SS. Future clinical studies to assess ALT in patients under mechanical ventilation are needed.
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Affiliation(s)
- María Jesús Pérez-Granda
- Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | | | - Beatriz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Hortal
- Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Rafael Samaniego
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Confocal Laser Scanning Microscopy Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario "Gregorio Marañón", C/. Dr. Esquerdo, 46, 28007, Madrid, Spain.
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32
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Dibartola AC, Swearingen MC, Granger JF, Stoodley P, Dusane DH. Biofilms in orthopedic infections: a review of laboratory methods. APMIS 2017; 125:418-428. [DOI: 10.1111/apm.12671] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 01/06/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | - Matthew C. Swearingen
- Department of Microbial Infection and Immunity; The Ohio State University; Columbus OH USA
| | | | - Paul Stoodley
- Department of Microbial Infection and Immunity; The Ohio State University; Columbus OH USA
- Department of Orthopaedics; The Ohio State University; Columbus OH USA
- National Centre for Advanced Tribology; Faculty of Engineering and the Environment; University of Southampton; Southampton UK
| | - Devendra H. Dusane
- Department of Microbial Infection and Immunity; The Ohio State University; Columbus OH USA
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33
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Ramasamy M, Lee J. Recent Nanotechnology Approaches for Prevention and Treatment of Biofilm-Associated Infections on Medical Devices. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1851242. [PMID: 27872845 PMCID: PMC5107826 DOI: 10.1155/2016/1851242] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/13/2016] [Indexed: 11/23/2022]
Abstract
Bacterial colonization in the form of biofilms on surfaces causes persistent infections and is an issue of considerable concern to healthcare providers. There is an urgent need for novel antimicrobial or antibiofilm surfaces and biomedical devices that provide protection against biofilm formation and planktonic pathogens, including antibiotic resistant strains. In this context, recent developments in the material science and engineering fields and steady progress in the nanotechnology field have created opportunities to design new biomaterials and surfaces with anti-infective, antifouling, bactericidal, and antibiofilm properties. Here we review a number of the recently developed nanotechnology-based biomaterials and explain underlying strategies used to make antibiofilm surfaces.
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Affiliation(s)
| | - Jintae Lee
- School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
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34
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Tutelyan AV, Gaponov AM, Pisarev VM, El-Registan GI. [Microbial dormancy and prevention of healthcare-associated infections]. TERAPEVT ARKH 2016; 87:103-108. [PMID: 26821426 DOI: 10.17116/terarkh20158711103-109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Healthcare-associated infections (HCAI) remain one of the most challenges of modern health care and assume increasing social and medical significance. The specific features of HCAI are frequent recurrences and inefficiency of antibiotic therapy, a reason for which is antibiotic resistance in microorganisms. The review discusses antibiotic resistance, a form of antibiotic tolerance (AT), and its role in the development of HCAI. It also describes essential differences between AT and antibiotic tolerance at the cellular and molecular genetic levels. Relationships between AT and dormancy of microorganisms, pathogens of HCAI, are discussed. The paper gives the data available in the literature on how AT occurs in HCAI pathogens and discusses the diagnosis of this condition. It also analyzes the literature data on pharmacological attempts to overcome AT and discusses novel approaches to antibiotic therapy for HCAI.
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Affiliation(s)
- A V Tutelyan
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A M Gaponov
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; V.A.Negovsky Research Institute of General Reanimatology, Federal Agency of Research Organizations of Russia, Moscow, Russia
| | - V M Pisarev
- Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Dmitry Rogachev Federal Research-and-Clinical Center for Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow, Russia; V.A.Negovsky Research Institute of General Reanimatology, Federal Agency of Research Organizations of Russia, Moscow, Russia
| | - G I El-Registan
- S.N. Vinogradsky Institute of Microbiology, Russian Academy of Sciences, Moscow, Russia
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Miranda AF, Lia EN, Carvalho TM, Piau CGBDC, Costa PP, Bezerra ACB. Oral health promotion in patients with chronic renal failure admitted in the Intensive Care Unit. Clin Case Rep 2016; 4:26-31. [PMID: 26783430 PMCID: PMC4706386 DOI: 10.1002/ccr3.437] [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: 07/08/2015] [Revised: 08/31/2015] [Accepted: 09/28/2015] [Indexed: 11/07/2022] Open
Abstract
Oral hygiene deficiency is common in patients treated in ICUs and it enables biofilm colonization by microorganisms that lead to respiratory infections. A 30‐year‐old female patient with chronic renal failure was hospitalized. Dental procedures were performed in the ICU and contributed to the patient's health after a few days.
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Affiliation(s)
- Alexandre Franco Miranda
- Department of Preventive Dentistry Post Graduation Program in Health Sciences University of Brasilia Brasilia Brazil
- Department of Dentistry for Special Patients Catholic University of Brasilia Brasilia Brazil
| | - Erica Negrini Lia
- Department of Preventive and Pediatric Dentistry University of Brasília Brasilia Brazil
| | - Tatiane Maciel Carvalho
- University Paulista – UNIP Brasilia Brazil
- Post Graduation in Temporomandibular Dysfunction Sl Mandic Campinas São Paulo Brazil
| | - Cinthia Gonçalves Barbosa de Castro Piau
- Department of Preventive Dentistry Post Graduation Program in Health Sciences University of Brasilia Brasilia Brazil
- Department of Pediatric Dentistry Catholic University of Brasilia Brasilia Brazil
| | | | - Ana Cristina Barreto Bezerra
- Department of Preventive Dentistry Post Graduation Program in Health Sciences University of Brasilia Brasilia Brazil
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Sharma D, Saharan BS, Kapil S. Biosurfactants of Probiotic Lactic Acid Bacteria. SPRINGERBRIEFS IN MICROBIOLOGY 2016. [DOI: 10.1007/978-3-319-26215-4_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Schuurmans MM, Palheiros Marques M, Freitag L, Zinkernagel AS, Achermann Y. Biofilm Formation in a Permanent Tracheal Stent Implanted for Twenty-Five Years. Respiration 2015; 90:327-8. [PMID: 26351844 DOI: 10.1159/000439312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Percival SL, Suleman L, Vuotto C, Donelli G. Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control. J Med Microbiol 2015; 64:323-334. [PMID: 25670813 DOI: 10.1099/jmm.0.000032] [Citation(s) in RCA: 427] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/23/2015] [Indexed: 01/30/2023] Open
Abstract
Biofilms are of great importance in infection control and healthcare-associated infections owing to their inherent tolerance and 'resistance' to antimicrobial therapies. Biofilms have been shown to develop on medical device surfaces, and dispersal of single and clustered cells implies a significant risk of microbial dissemination within the host and increased risk of infection. Although routine microbiological testing assists with the diagnosis of a clinical infection, there is no 'gold standard' available to reveal the presence of microbial biofilm from samples collected within clinical settings. Furthermore, such limiting factors as viable but non-culturable micro-organisms and small-colony variants often prevent successful detection. In order to increase the chances of detection and provide a more accurate diagnosis, a combination of microbiological culture techniques and molecular methods should be employed. Measures such as antimicrobial coating and surface alterations of medical devices provide promising opportunities in the prevention of biofilm formation on medical devices.
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Affiliation(s)
- Steven L Percival
- Scapa Healthcare, Manchester, UK.,Surface Science Research Centre, University of Liverpool, Liverpool, UK.,Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Louise Suleman
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Claudia Vuotto
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy
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