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Ali A, Zahra A, Kamthan M, Husain FM, Albalawi T, Zubair M, Alatawy R, Abid M, Noorani MS. Microbial Biofilms: Applications, Clinical Consequences, and Alternative Therapies. Microorganisms 2023; 11:1934. [PMID: 37630494 PMCID: PMC10459820 DOI: 10.3390/microorganisms11081934] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 08/27/2023] Open
Abstract
Biofilms are complex communities of microorganisms that grow on surfaces and are embedded in a matrix of extracellular polymeric substances. These are prevalent in various natural and man-made environments, ranging from industrial settings to medical devices, where they can have both positive and negative impacts. This review explores the diverse applications of microbial biofilms, their clinical consequences, and alternative therapies targeting these resilient structures. We have discussed beneficial applications of microbial biofilms, including their role in wastewater treatment, bioremediation, food industries, agriculture, and biotechnology. Additionally, we have highlighted the mechanisms of biofilm formation and clinical consequences of biofilms in the context of human health. We have also focused on the association of biofilms with antibiotic resistance, chronic infections, and medical device-related infections. To overcome these challenges, alternative therapeutic strategies are explored. The review examines the potential of various antimicrobial agents, such as antimicrobial peptides, quorum-sensing inhibitors, phytoextracts, and nanoparticles, in targeting biofilms. Furthermore, we highlight the future directions for research in this area and the potential of phytotherapy for the prevention and treatment of biofilm-related infections in clinical settings.
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Affiliation(s)
- Asghar Ali
- Clinical Biochemistry Lab, D/O Biochemistry, School of Chemical and Lifesciences, Jamia Hamdard, New Delhi 110062, India;
| | - Andaleeb Zahra
- Department of Botany, School of Chemical and Lifesciences, Jamia Hamdard, New Delhi 110062, India;
| | - Mohan Kamthan
- Clinical Biochemistry Lab, D/O Biochemistry, School of Chemical and Lifesciences, Jamia Hamdard, New Delhi 110062, India;
| | - Fohad Mabood Husain
- Department of Food Science and Nutrition, College of Food and Agriculture Sciences, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Thamer Albalawi
- Department of Biology, College of Science and Humanities in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia;
| | - Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia; (M.Z.); (R.A.)
| | - Roba Alatawy
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk 71491, Saudi Arabia; (M.Z.); (R.A.)
| | - Mohammad Abid
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India;
| | - Md Salik Noorani
- Department of Botany, School of Chemical and Lifesciences, Jamia Hamdard, New Delhi 110062, India;
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Garcia R. Moving Beyond Central Line-Associated Bloodstream Infections: Enhancement of the Prevention Process. JOURNAL OF INFUSION NURSING 2023; 46:217-222. [PMID: 37406336 DOI: 10.1097/nan.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The provision of medications and other treatments via intravenous (IV) therapy has provided millions of health care patients with extended benefits. IV therapy, however, is also associated with complications, such as associated bloodstream infections. Understanding the mechanisms of development and the factors that have contributed to the recent increases in such health care-acquired infections assists in formulating new preventive strategies that include the implementation of hospital-onset bacteremia, an innovative model that requires surveillance and prevention of bloodstream infections associated with all types of vascular access devices, expansion of vascular access service teams (VAST), and use of advanced antimicrobial dressings designed to reduce bacterial proliferation over the currently recommended time periods for maintenance of IV catheters.
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Affiliation(s)
- Robert Garcia
- Infection Prevention Consultant, Enhanced Epidemiology, Valley Stream, New York
- Robert Garcia, BS, MT(ASCP), CIC, FAPIC, has been an infection preventionist/consultant for 43 years and a member of the Association for Professionals in Infection Control & Epidemiology (APIC). He received a Bachelor of Science in Community Health from St. Joseph's College in 1982 and has been certified in infection control since 1984 by the Certification Board in Infection Control. Mr Garcia was elected in 2016 as a fellow in APIC 2016, a designation for experienced infection preventionists who have had significant contributions to the field of infection prevention. In addition, Mr Garcia has been an infection preventionist/director at 9 hospitals in New York, most recently as a senior instructional support specialist at the Healthcare Epidemiology Department, Stony Brook University Hospital (Stony Brook, NY). He is a principal national researcher on the effectiveness of silver-hydrogel urinary catheters, chlorhexidine skin antisepsis, and comprehensive oral care to prevent ventilator-associated pneumonia. Mr Garcia is an international speaker on infection prevention issues, such as health care-associated infections, microbiology, diagnostic and antibiotic stewardship, and environmental contamination
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Short Peripheral Venous Catheters Contamination and the Dangers of Bloodstream Infection in Portugal: An Analytic Study. Microorganisms 2023; 11:microorganisms11030709. [PMID: 36985281 PMCID: PMC10056756 DOI: 10.3390/microorganisms11030709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023] Open
Abstract
Peripheral venous catheters (PVCs) are the most used vascular access devices in the world. However, failure rates remain considerably high, with complications such as PVC-related infections posing significant threats to patients’ well-being. In Portugal, studies evaluating the contamination of these vascular medical devices and characterizing the associated microorganisms are scarce and lack insight into potential virulence factors. To address this gap, we analyzed 110 PVC tips collected in a large tertiary hospital in Portugal. Experiments followed Maki et al.’s semi-quantitative method for microbiological diagnosis. Staphylococcus spp. were subsequently studied for the antimicrobial susceptibility profile by disc diffusion method and based on the cefoxitin phenotype, were further classified into strains resistant to methicillin. Screening for the mecA gene was also done by a polymerase chain reaction and minimum inhibitory concentration (MIC)-vancomycin as determined by E-test, proteolytic and hemolytic activity on skimmed milk 1% plate and blood agar, respectively. The biofilm formation was evaluated on microplate reading through iodonitrotetrazolium chloride 95% (INT). Overall, 30% of PVCs were contaminated, and the most prevalent genus was Staphylococcus spp., 48.8%. This genus presented resistance to penicillin (91%), erythromycin (82%), ciprofloxacin (64%), and cefoxitin (59%). Thus, 59% of strains were considered resistant to methicillin; however, we detected the mecA gene in 82% of the isolates tested. Regarding the virulence factors, 36.4% presented α-hemolysis and 22.7% β-hemolysis, 63.6% presented a positive result for the production of proteases, and 63.6% presented a biofilm formation capacity. Nearly 36.4% were simultaneously resistant to methicillin and showed expression of proteases and/or hemolysins, biofilm formation, and the MIC to vancomycin were greater than 2 µg/mL. Conclusion: PVCs were mainly contaminated with Staphylococcus spp., with high pathogenicity and resistance to antibiotics. The production of virulence factors strengthens the attachment and the permanence to the catheter’s lumen. Quality improvement initiatives are needed to mitigate such results and enhance the quality and safety of the care provided in this field.
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Atomic force microscopy and scanning electron microscopy as alternative methods of early identification of pathogens causing catheter-related bloodstream infections of patients in ICU. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Vascular catheters are an indispensable element of the therapy of patients in intensive care. Their use is associated with the possibility of complications, including infectious. According to various sources, the incidence of catheter-related bloodstream infections (CRBSIs) ranges from 0.1 to 22.7 per 1,000 catheter days.
Materials and Methods
The central venous catheter tip culture samples were collected from 24 patients with suspected catheter-related bloodstream infection, from three intensive care units (ICUs). The results of microscopic examinations: atomic force microscope (AFM) and scanning electron microscope (SEM) were compared with the results of microbiological analysis of the central venous catheter tip and blood collected from the catheter.
Results
The microscopic examination and microbiological analysis of both the blood and central venous catheter samples confirmed the presence of microorganisms in 16 cases (double positive result). Our study was conducted in a short period of time (up to 6 hours) and it gave an initial answer to the question about the type of microorganisms colonising the central venous catheter. In one patient the infection was not caused by removal of the central venous catheter. However, not all results were fully consistent within the two diagnostic methods. The colonisation of the central venous catheter with Pseudomonas aeruginosa and Staphylococcus epidermidis was microbiologically confirmed, but it was not confirmed by the microscopic examination of the sample collected from patient No. 20. However, the examination enabled preliminary assessment of the microorganism colonising the catheter, which may have caused the blood infection. It cannot be ruled out that Pseudomonas aeruginosa bacilli were grown on the catheter that came into contact with blood from another source of infection, e.g. the respiratory, nervous or urinary systems. Information on the presence of cocci-shaped bacteria forming characteristic clusters or rods may enable initial diagnosis of catheter-related bloodstream infection if it is accompanied by typical clinical symptoms. Alternative diagnostics also provides valuable information on the presence of biofilm, which is a factor hindering the body’s response to infection and penetration of antibiotics.
Conclusions
Our pilot study presents new diagnostic possibilities of microscopic imaging with the atomic force microscope (AFM) and scanning electron microscope (SEM) to identify pathogens on routinely used disposable medical devices, such as the central venous catheter. On the other hand, this range of diagnostics reveals the potential to constantly improve medical materials which come into direct contact with patients’ tissues. It is important to create a database of microscopic images, which would be a repeatable diagnostic pattern and fully correlated with the results of microbiological analysis, because it would facilitate initial quick diagnosis of a potential CRBSI.
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Abstract
Despite the advantages of extracorporeal membrane oxygenation (ECMO), secondary catheter infection remains a major concern during ECMO support. In this study, to clarify the mechanism of ECMO catheter-related infection, we evaluated the impact of infection on biofilm formation on the surfaces of ECMO catheters, and we investigated clinical factors associated with biofilm formation. Catheters used for ECMO were prospectively collected aseptically from the femoral vein, internal jugular vein, and femoral artery of 81 patients with acute cardiorespiratory failure between January 2015 and October 2016. Prepared catheter sections were investigated by fluorescence microscopy, confocal scanning laser microscopy, transmission electron microscopy, and using semiquantitative culture methods. Of the 81 patients, 51 were assigned to the infection group and 30 to a control group. Biofilms were identified in 43.1% patients in the infection group, and in 20% controls (p = 0.034). Extracorporeal membrane oxygenation flow, systemic infection, and carbapenem-resistant Acinetobacter baumannii (CRAB) infection were associated with biofilm formation in a univariate analysis (odds ratio [OR]: 1.00, 95% confidence interval [CI]: 1.00-1.00, p = 0.007; OR: 3.03, 95% CI: 1.06-8.69, p = 0.039; OR: 9.60, 95% CI: 2.94-31.30, p < 0.001, respectively). However, of these factors, only CRAB infection was found to independently predict the presence of a biofilm by a multivariate logistic regression analysis (OR: 9.60, 95% CI: 2.94-31.30; p < 0.001). Biofilms were more prevalent in patients with an infection than in uninfected controls. Carbapenem-resistant A. baumannii infection was identified as an independent risk factor for biofilm formation on ECMO catheters.
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Parasuraman P, Anju VT, Sruthil Lal SB, Sharan A, Busi S, Kaviyarasu K, Arshad M, Dawoud TMS, Syed A. Synthesis and antimicrobial photodynamic effect of methylene blue conjugated carbon nanotubes on E. coli and S. aureus. Photochem Photobiol Sci 2019; 18:563-576. [DOI: 10.1039/c8pp00369f] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The methylene blue and CNT nanoconjugate effectively produced singlet oxygen via photoactivation using a diode laser. It was employed for aPDT against pathogenic bacteria.
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Affiliation(s)
| | - V. T Anju
- Department of Microbiology
- School of Life Sciences
- Pondicherry University
- Puducherry
- India
| | - SB Sruthil Lal
- Department of Physics
- School of Physical
- Chemical & Applied Sciences
- Pondicherry University
- Puducherry
| | - Alok Sharan
- Department of Physics
- School of Physical
- Chemical & Applied Sciences
- Pondicherry University
- Puducherry
| | - Siddhardha Busi
- Department of Microbiology
- School of Life Sciences
- Pondicherry University
- Puducherry
- India
| | - K. Kaviyarasu
- UNESCO-UNISA Africa Chair in Nanosciences/Nanotechnology Laboratories
- College of Graduate Studies
- University of South Africa (UNISA)
- Pretoria
- South Africa
| | - Mohammed Arshad
- Clinical Laboratory Sciences Department
- College of Applied Medical Science
- King Saud University
- Riyadh 11451
- Saudi Arabia
| | - Turki M. S. Dawoud
- Department of Botany and Microbiology
- College of Science
- King Saud University
- Riyadh
- Saudi Arabia
| | - Asad Syed
- Department of Botany and Microbiology
- College of Science
- King Saud University
- Riyadh
- Saudi Arabia
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Comparative Analysis of Bacterial Community Composition and Structure in Clinically Symptomatic and Asymptomatic Central Venous Catheters. mSphere 2017; 2:mSphere00146-17. [PMID: 28959736 PMCID: PMC5615130 DOI: 10.1128/msphere.00146-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/17/2017] [Indexed: 01/03/2023] Open
Abstract
Totally implanted venous access ports (TIVAPs) are commonly used catheters for the management of acute or chronic pathologies. Although these devices improve health care, repeated use of this type of device for venous access over long periods of time is also associated with risk of colonization and infection by pathogenic bacteria, often originating from skin. However, although the skin microbiota is composed of both pathogenic and nonpathogenic bacteria, the extent and the consequences of TIVAP colonization by nonpathogenic bacteria have rarely been studied. Here, we used culture-dependent and 16S rRNA gene-based culture-independent approaches to identify differences in bacterial colonization of TIVAPs obtained from two French hospitals. To explore the relationships between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection, we analyzed the bacterial community parameters between TIVAPs suspected (symptomatic) or not (asymptomatic) of infection. Although we did not find a particular species assemblage or community marker to distinguish infection risk on an individual sample level, we identified differences in bacterial community composition, diversity, and structure between clinically symptomatic and asymptomatic TIVAPs that could be explored further. This study therefore provides a new view of bacterial communities and colonization patterns in intravascular TIVAPs and suggests that microbial ecology approaches could improve our understanding of device-associated infections and could be a prognostic tool to monitor the evolution of bacterial communities in implants and their potential susceptibility to infections. IMPORTANCE Totally implanted venous access ports (TIVAPs) are commonly used implants for the management of acute or chronic pathologies. Although their use improves the patient's health care and quality of life, they are associated with a risk of infection and subsequent clinical complications, often leading to implant removal. While all TIVAPs appear to be colonized, only a fraction become infected, and the relationship between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection is unknown. We explored bacteria present on TIVAPs implanted in patients with or without signs of TIVAP infection and identified differences in phylum composition and community structure. Our data suggest that the microbial ecology of intravascular devices could be predictive of TIVAP infection status and that ultimately a microbial ecological signature could be identified as a tool to predict TIVAP infection susceptibility and improve clinical management.
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Lijuan C, Xing Y, Minxi W, Wenkai L, Le D. Development of an aptamer-ampicillin conjugate for treating biofilms. Biochem Biophys Res Commun 2017; 483:847-854. [PMID: 28069377 DOI: 10.1016/j.bbrc.2017.01.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Biofilm formation involves the development of extracellular matrix and initially depends on adherence and tropism by flagellar movement. With the widespread development of antibiotic resistance and tolerance of biofilms, there is a growing need for novel anti-infective strategies. No currently approved medications specifically target biofilms. Aptamers are single-stranded nucleic acid molecules that may bind to their targets with high affinity and affect the target functions. We developed a bifunctional conjugate by linking an aptamer targeting bacterial flagella with ampicillin. We investigated its influence on biofilm prevention and dissolution by ultraviolet-visible spectrophotometry, inverted microscopy, and atomic force microscopy. This conjugate had distinctive antibacterial activity. Notably, the conjugate was more active than either component, and thus had a synergistic effect against biofilms.
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Affiliation(s)
- Cheng Lijuan
- Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, 410081, China; Department of Biochemistry and Molecular Biology, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, China
| | - Yan Xing
- Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, 410081, China
| | - Wu Minxi
- Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, 410081, China
| | - Li Wenkai
- Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, 410081, China; Department of Biochemistry, The State Key Laboratory of Medical Genetics & School of Life Science, Central South University, Changsha, Hunan, 410013, China
| | - Deng Le
- Department of Microbiology, College of Life Science, Hunan Normal University, Changsha, Hunan, 410081, China.
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Muscedere J, Maslove D, Boyd JG, O'Callaghan N, Lamontagne F, Reynolds S, Albert M, Hall R, McGolrick D, Jiang X, Day AG. Prevention of nosocomial infections in critically ill patients with lactoferrin (PREVAIL study): study protocol for a randomized controlled trial. Trials 2016; 17:474. [PMID: 27681799 PMCID: PMC5041570 DOI: 10.1186/s13063-016-1590-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/02/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Nosocomial infections remain an important source of morbidity, mortality, and increased health care costs in hospitalized patients. This is particularly problematic in intensive care units (ICUs) because of increased patient vulnerability due to the underlying severity of illness and increased susceptibility from utilization of invasive therapeutic and monitoring devices. Lactoferrin (LF) and the products of its breakdown have multiple biological effects, which make its utilization of interest for the prevention of nosocomial infections in the critically ill. METHODS/DESIGN This is a phase II randomized, multicenter, double-blinded trial to determine the effect of LF on antibiotic-free days in mechanically ventilated, critically ill, adult patients in the ICU. Eligible, consenting patients will be randomized to receive either LF or placebo. The treating clinician will remain blinded to allocation during the study; blinding will be maintained by using opaque syringes and containers. The primary outcome will be antibiotic-free days, defined as the number of days alive and free of antibiotics 28 days after randomization. Secondary outcomes will include: antibiotic utilization, adjudicated diagnosis of nosocomial infection (longer than 72 h of admission to ICU), hospital and ICU length of stay, change in organ function after randomization, hospital and 90-day mortality, incidence of tracheal colonization, changes in gastrointestinal permeability, and immune function. Outcomes to inform the conduct of a larger definitive trial will also be evaluated, including feasibility as determined by recruitment rates and protocol adherence. DISCUSSION The results from this study are expected to provide insight into a potential novel therapeutic use for LF in critically ill adult patients. Further, analysis of study outcomes will inform a future, large-scale phase III randomized controlled trial powered on clinically important outcomes related to the use of LF. TRIAL REGISTRATION The trial was registered at www.ClinicalTrials.gov on 18 November 2013. TRIAL REGISTRATION NUMBER NCT01996579 .
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Affiliation(s)
- John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada. .,Kingston General Hospital, Room 5-411, Angada 4, 76 Stuart Street, Kingston, ON, K7L 2 V3, Canada.
| | - David Maslove
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - John Gordon Boyd
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Nicole O'Callaghan
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Francois Lamontagne
- Centre de recherché du CHU de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Steven Reynolds
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Albert
- Centre de Recherche de l'Hôpital du Sacré-Coeur de Montréal, Division of Critical Care Medicine, Critical Care and Medicine Departments, Université de Montréal, Montréal, QC, Canada
| | - Rick Hall
- Department of Critical Care Medicine, Dalhousie University and the Nova Scotia Health Authority, Halifax, NS, Canada
| | - Danielle McGolrick
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Xuran Jiang
- Kingston General Hospital, Room 5-411, Angada 4, 76 Stuart Street, Kingston, ON, K7L 2 V3, Canada
| | - Andrew G Day
- Kingston General Hospital, Room 5-411, Angada 4, 76 Stuart Street, Kingston, ON, K7L 2 V3, Canada
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