1
|
McGlumphy S, Damai A, Salameh L, Corbin GB, Wang Q, Markiewicz J, Mosher JJ, Spitzer N, Quiñones R. Biocompatible antibiotic-coupled nickel-titanium nanoparticles as a potential coating material for biomedical devices. Heliyon 2024; 10:e31434. [PMID: 38831845 PMCID: PMC11145499 DOI: 10.1016/j.heliyon.2024.e31434] [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: 02/18/2024] [Revised: 05/04/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
The challenges facing metallic implants for reconstructive surgery include the leaching of toxic metal ions, a mismatch in elastic modulus between the implant and the treated tissue, and the risk of infection. These problems can be addressed by passivating the metal surface with an organic substrate and incorporating antibiotic molecules. Nitinol (NiTi), a nickel-titanium alloy, is used in devices for biomedical applications due to its shape memory and superelasticity. However, unmodified NiTi carries a risk of localized nickel toxicity and inadequately supports angiogenesis or neuroregeneration due to limited cell adhesion, poor biomineralization, and little antibacterial activity. To address these challenges, NiTi nanoparticles were modified using self-assembled phosphonic acid monolayers and functionalized with the antibiotics ceftriaxone and vancomycin via the formation of an amide. Surface modifications were monitored to confirm that phosphonic acid modifications were present on NiTi nanoparticles and 100% of the samples formed ordered films. Modifications were stable for more than a year. Elemental composition showed the presence of nickel, titanium, and phosphorus (1.9% for each sample) after surface modifications. Dynamic light scattering analysis suggested some agglomeration in solution. However, scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy confirmed a particle size distribution of <100 nm, the even distribution of nanoparticles on coverslips, and elemental composition before and after cell culture. B35 neuroblastoma cells exhibited no inhibition of survival and extended neurites of approximately 100 μm in total length when cultured on coverslips coated with only poly-l-lysine or with phosphonic acid-modified NiTi, indicating high biocompatibility. The ability to support neural cell growth and differentiation makes modified NiTi nanoparticles a promising coating for surfaces in metallic bone and nerve implants. NiTi nanoparticles functionalized with ceftriaxone inhibited Escherichia coli and Serratia marcescens (SM6) at doses of 375 and 750 μg whereas the growth of Bacillus subtilis was inhibited by a dose of only 37.5 μg. NiTi-vancomycin was effective against B. subtilis at all doses even after mammalian cell culture. These are common bacteria associated with infected implants, further supporting the potential use of functionalized NiTi in coating reconstructive implants.
Collapse
Affiliation(s)
- Sarah McGlumphy
- Department of Chemistry, Marshall University, Huntington, WV, 25755, USA
- Department of Biological Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Aakriti Damai
- Department of Chemistry, Marshall University, Huntington, WV, 25755, USA
- Department of Biological Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Lena Salameh
- Department of Chemistry, Marshall University, Huntington, WV, 25755, USA
| | - Gabriell B. Corbin
- Department of Biological Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Qiang Wang
- Shared Research Facilities, West Virginia University, Morgantown, WV, 25606, USA
| | - John Markiewicz
- Department of Chemistry, Marshall University, Huntington, WV, 25755, USA
| | - Jennifer J. Mosher
- Department of Biological Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Nadja Spitzer
- Department of Biological Sciences, Marshall University, Huntington, WV, 25755, USA
| | - Rosalynn Quiñones
- Department of Chemistry, Marshall University, Huntington, WV, 25755, USA
| |
Collapse
|
2
|
Gupta TT, Zumpano B, Opalinski J, Ritchey R, Winter N, Nodzo SR, Canty M. Cathodic voltage-controlled electrical stimulation and betadine decontaminate nosocomial pathogens from implant surfaces. mSphere 2024; 9:e0058323. [PMID: 38299852 PMCID: PMC10900904 DOI: 10.1128/msphere.00583-23] [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: 10/10/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
Periprosthetic joint infection (PJI) after total joint arthroplasty is a major concern requiring multiple surgeries and antibiotic interventions. Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli are the predominant causes of these infections. Due to biofilm formation, antibiotic treatment for patients with PJI can prolong resistance, further complicating the use of current treatments. Previous research has shown that cathodic voltage-controlled electrical stimulation (CVCES) is an effective technique to prevent/treat implant-associated biofilm infections on titanium (Ti) surfaces. This study thus evaluated the efficacy of CVCES via the use of 10% betadine alone and in combination with CVCES to eradicate lab-grown biofilms on cemented and cementless cobalt-chromium (CoCr) and Ti surfaces. CVCES treatment alone for 24 hours demonstrated no detectable CFU for E. coli and P. aeruginosa biofilms on cementless CoCr implants. In the presence of cement, E. coli biofilms had 106 CFUs/implant remaining after CVCES treatment alone; however, P. aeruginosa biofilms on cemented implants were reduced to below detectable limits. The use of 10% betadine treatment for 3 minutes followed by 24-hour CVCES treatment brought CFU levels to below detectable limits in E. coli and P. aeruginosa. The same was true for S. aureus biofilms on cementless patellofemoral implants as well as femoral and tibial implants. These treatment methods were not sufficient for eradication of S. aureus biofilms on cemented implants. These results suggest that CVCES alone and CVCES with 10% betadine are effective approaches to treating biofilms formed by certain bacterial species potentially leading to the treatment of PJI.IMPORTANCEPeriprosthetic joint infections (PJIs) are problematic due to requiring multiple surgeries and antibiotic therapies that are responsible for increased patient morbidity and healthcare costs. These infections become resistant to antibiotic treatment due to the formation of biofilms on the orthopedic surfaces. Cathodic voltage-controlled electrical stimulation (CVCES) has previously been shown to be an effective technique to prevent and treat biofilm infections on different surfaces. This study shows that CVCES can increase the efficacy of 10% betadine irrigation used in debridement, antibiotics, and implant retention by 99.9% and clear infection to below detection limits. PJI treatments are at times limited, and CVCES could be a promising technology to improve patient outcomes.
Collapse
Affiliation(s)
| | | | | | - Riley Ritchey
- Garwood Medical Devices, LLC, Buffalo, New York, USA
| | - Nathan Winter
- Department of Orthopedics & Sports Medicine, University at Buffalo, Buffalo, New York, USA
| | - Scott R Nodzo
- Department of Orthopedics & Sports Medicine, University at Buffalo, Buffalo, New York, USA
| | - Mary Canty
- Garwood Medical Devices, LLC, Buffalo, New York, USA
| |
Collapse
|
3
|
Weeks K, Clark C, McDermott E, Mohanraj G, Tobias M, Titus A, Duquin T, Ehrensberger MT. In vitro and in vivo assessment of extended duration cathodic voltage-controlled electrical stimulation for treatment of orthopedic implant-associated infections. J Orthop Res 2023; 41:2756-2764. [PMID: 37203783 DOI: 10.1002/jor.25625] [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: 01/11/2023] [Revised: 03/21/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
Effective treatment of orthopedic implant-associated infections (IAIs) remains a clinical challenge. The in vitro and in vivo studies presented herein evaluated the antimicrobial effects of applying cathodic voltage-controlled electrical stimulation (CVCES) to titanium implants inoculated with preformed bacterial biofilms of methicillin-resistant Staphylococcus aureus (MRSA). The in vitro studies showed that combining vancomycin therapy (500 µg/mL) with application of CVCES at -1.75 V (all voltages are with respect to Ag/AgCl unless otherwise stated) for 24 h resulted in 99.98% reduction in the coupon-associated MRSA colony-forming units (CFUs) (3.38 × 103 vs. 2.14 × 107 CFU/mL, p < 0.001) and a 99.97% reduction in the planktonic CFU (4.04 × 104 vs. 1.26 × 108 CFU/mL, p < 0.001) as compared with the no treatment control samples. The in vivo studies utilized a rodent model of MRSA IAIs and showed a combination of vancomycin therapy (150 mg/kg twice daily) with CVCES of -1.75 V for 24 h had significant reductions in the implant associated CFU (1.42 × 101 vs. 1.2 × 106 CFU/mL, p < 0.003) and bone CFU (5.29 × 101 vs. 4.48 × 106 CFU/mL, p < 0.003) as compared with the untreated control animals. Importantly, the combined 24 h CVCES and antibiotic treatments resulted in no implant-associated MRSA CFU enumerated in 83% of the animals (five out of six animals) and no bone-associated MRSA CFU enumerated in 50% of the animals (three out of six animals). Overall, the outcomes of this study have shown that extended duration CVCES therapy is an effective adjunctive therapy to eradicate IAIs.
Collapse
Affiliation(s)
- Kyle Weeks
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Caelen Clark
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Eric McDermott
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Gowtham Mohanraj
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Menachem Tobias
- Department of Orthopaedic Surgery, University at Buffalo, Buffalo, New York, USA
| | - Albert Titus
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Thomas Duquin
- Department of Orthopaedic Surgery, University at Buffalo, Buffalo, New York, USA
| | - Mark T Ehrensberger
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
- Department of Orthopaedic Surgery, University at Buffalo, Buffalo, New York, USA
| |
Collapse
|
4
|
Clark CM, Ruszala BM, Anderson RM, Strom MJ, Ehrensberger MT. Electrochemical generation of hydrogen peroxide during cathodic polarization of metallic orthopedic biomaterials. J APPL ELECTROCHEM 2023. [DOI: 10.1007/s10800-022-01840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
5
|
Physical Approaches to Prevent and Treat Bacterial Biofilm. Antibiotics (Basel) 2022; 12:antibiotics12010054. [PMID: 36671255 PMCID: PMC9854850 DOI: 10.3390/antibiotics12010054] [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: 11/13/2022] [Revised: 12/11/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
Prosthetic joint infection (PJI) presents several clinical challenges. This is in large part due to the formation of biofilm which can make infection eradication exceedingly difficult. Following an extensive literature search, this review surveys a variety of non-pharmacological methods of preventing and/or treating biofilm within the body and how they could be utilized in the treatment of PJI. Special attention has been paid to physical strategies such as heat, light, sound, and electromagnetic energy, and their uses in biofilm treatment. Though these methods are still under study, they offer a potential means to reduce the morbidity and financial burden related to multiple stage revisions and prolonged systemic antibiotic courses that make up the current gold standard in PJI treatment. Given that these options are still in the early stages of development and offer their own strengths and weaknesses, this review offers an assessment of each method, the progress made on each, and allows for comparison of methods with discussion of future challenges to their implementation in a clinical setting.
Collapse
|
6
|
Su Y, Yrastorza JT, Matis M, Cusick J, Zhao S, Wang G, Xie J. Biofilms: Formation, Research Models, Potential Targets, and Methods for Prevention and Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2203291. [PMID: 36031384 PMCID: PMC9561771 DOI: 10.1002/advs.202203291] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/31/2022] [Indexed: 05/28/2023]
Abstract
Due to the continuous rise in biofilm-related infections, biofilms seriously threaten human health. The formation of biofilms makes conventional antibiotics ineffective and dampens immune clearance. Therefore, it is important to understand the mechanisms of biofilm formation and develop novel strategies to treat biofilms more effectively. This review article begins with an introduction to biofilm formation in various clinical scenarios and their corresponding therapy. Established biofilm models used in research are then summarized. The potential targets which may assist in the development of new strategies for combating biofilms are further discussed. The novel technologies developed recently for the prevention and treatment of biofilms including antimicrobial surface coatings, physical removal of biofilms, development of new antimicrobial molecules, and delivery of antimicrobial agents are subsequently presented. Finally, directions for future studies are pointed out.
Collapse
Affiliation(s)
- Yajuan Su
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jaime T. Yrastorza
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Mitchell Matis
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jenna Cusick
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Siwei Zhao
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Guangshun Wang
- Department of Pathology and MicrobiologyCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jingwei Xie
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
- Department of Mechanical and Materials EngineeringCollege of EngineeringUniversity of Nebraska‐LincolnLincolnNE68588USA
| |
Collapse
|
7
|
Costa RC, Bertolini M, Costa Oliveira BE, Nagay BE, Dini C, Benso B, Klein MI, Barāo VAR, Souza JGS. Polymicrobial biofilms related to dental implant diseases: unravelling the critical role of extracellular biofilm matrix. Crit Rev Microbiol 2022; 49:370-390. [PMID: 35584310 DOI: 10.1080/1040841x.2022.2062219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Biofilms are complex tri-dimensional structures that encase microbial cells in an extracellular matrix comprising self-produced polymeric substances. The matrix rich in extracellular polymeric substance (EPS) contributes to the unique features of biofilm lifestyle and structure, enhancing microbial accretion, biofilm virulence, and antimicrobial resistance. The role of the EPS matrix of biofilms growing on biotic surfaces, especially dental surfaces, is largely unravelled. To date, there is a lack of a broad overview of existing literature concerning the relationship between the EPS matrix and the dental implant environment and its role in implant-related infections. Here, we discuss recent advances in the critical role of the EPS matrix on biofilm growth and virulence on the dental implant surface and its effect on the etiopathogenesis and progression of implant-related infections. Similar to other biofilms associated with human diseases/conditions, EPS-enriched biofilms on implant surfaces promote microbial accumulation, microbiological shift, cross-kingdom interaction, antimicrobial resistance, biofilm virulence, and, consequently, peri-implant tissue damage. But intriguingly, the protagonism of EPS role on implant-related infections and the development of matrix-target therapeutic strategies has been neglected. Finally, we highlight the need for more in-depth analyses of polymicrobial interactions within EPS matrix and EPS-targeting technologies' rationale for disrupting the complex biofilm microenvironment with more outstanding translation to implant applications in the near future.
Collapse
Affiliation(s)
- Raphael C Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Martinna Bertolini
- Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, Farmington, CT, USA
| | | | - Bruna E Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Bruna Benso
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, CA, Chile
| | - Marlise I Klein
- Department of Dental Materials and Prosthodontics, São Paulo State University, São Paulo, Brazil
| | - Valentim A R Barāo
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Joāo Gabriel S Souza
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.,Dental Science School (Faculdade de Ciências Odontológicas - FCO), Montes Claros, Brazil.,Dental Research Division, Guarulhos University, Sāo Paulo, Brazil
| |
Collapse
|
8
|
Suttasattakrit K, Khamkeaw A, Tangwongsan C, Pavasant P, Phisalaphong M. Ionic Silver and Electrical Treatment for Susceptibility and Disinfection of Escherichia coli Biofilm-Contaminated Titanium Surface. Molecules 2021; 27:molecules27010180. [PMID: 35011409 PMCID: PMC8746777 DOI: 10.3390/molecules27010180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
In this work, surface disinfection and biofilm susceptibility were investigated by applying ionic silver of 0.4–1.6 µg/mL and cathodic voltage-controlled electrical treatment of 1.8 V and a current of 30 mA to Escherichia coli (E. coli) ATCC 25922 biofilm-contaminated titanium substrates. Herein, it is evident that the treatment exhibited the potential use to enhance the susceptibility of bacterial biofilms for surface disinfection. In vitro studies have demonstrated that the ionic silver treatment of 60 min significantly increased the logarithmic reduction (LR) of bacterial populations on disinfectant-treated substrates and the electrical treatment enhanced the silver susceptibility of E. coli biofilms. The LR values after the ionic silver treatments and the electric-enhanced silver treatments were in the ranges of 1.94–2.25 and 2.10–2.73, respectively. The treatment was also associated with morphological changes in silver-treated E. coli cells and biofilm-contaminated titanium surfaces. Nevertheless, the treatments showed no cytotoxic effects on the L929 mouse skin fibroblast cell line and only a slight decrease in pH was observed during the electrical polarization of titanium substrate.
Collapse
Affiliation(s)
- Kritphudis Suttasattakrit
- Biomedical Engineering Program, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Arnon Khamkeaw
- Department of Chemical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Chanchana Tangwongsan
- Department of Electrical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Prasit Pavasant
- Center of Excellence for Regenerative Dentistry, Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Muenduen Phisalaphong
- Department of Chemical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok 10330, Thailand;
- Correspondence: ; Tel.: +662-218-6875
| |
Collapse
|
9
|
Clark CM, Vishnoi P, Swihart MT, Ehrensberger MT. The effect of cathodic voltage-controlled electrical stimulation of titanium on the surrounding microenvironment pH: An experimental and computational study. Electrochim Acta 2021. [DOI: 10.1016/j.electacta.2021.138853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Kim J, Ren D, Gilbert JL. Cytotoxic effect of galvanically coupled magnesium-titanium particles on Escherichia coli. J Biomed Mater Res B Appl Biomater 2021; 109:2162-2173. [PMID: 33979012 DOI: 10.1002/jbm.b.34864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 02/04/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
Orthopedic device-related infections (ODRIs) are difficult to control due to microbial biofilm formation and associated with high-level resistance to conventional antibiotics. In many cases, the only treatment option for ODRI is explantation. Previous studies have shown that application of cathodic potentials at the metal surface can eradicate biofilms, and Mg and Mg-Ti particles have the same effect as cathodic potentials. This study investigated the effects of Mg and Mg-Ti particles on established biofilms and planktonic cells E. coli. Bacterial cultures with developed biofilms or planktonic cells were treated with Mg or Mg-Ti particles, and the viability were assessed using flow cytometry or visual assessment methods (i.e., observation from SEM images and opacity of the solution). It was found that viability of biofilms treated with 16.67 mg/ml of Mg was 2.8 ± 0.96% at the end of 6-hr killing compared to untreated controls. This extent of killing was more significant compared to 24-hr grown biofilms treated with ofloxacin, an antibiotic known to be effective against these bacteria. Biofilms treated with 50 and 100 μg/ml of ofloxacin had 62 ± 4.6% and 52 ± 19.3% survival, respectively, where ofloxacin at these concentrations is known to kill planktonic counterparts very effectively. Inhibition zone tests revealed that biofilms within 2 mm of Mg or Mg-Ti particle clusters were effectively killed. These results demonstrated the potential of Mg or Mg-Ti particles in killing microbial biofilms and potential for controlling ODRI.
Collapse
Affiliation(s)
- Jua Kim
- Department of Biomedical and Chemical Engineering, College of Engineering and Computer Science, Syracuse University, Syracuse, New York, USA.,Syracuse Biomaterials Institute, College of Engineering and Computer Science, Syracuse University, Syracuse, New York, USA.,Shenzhen Key Laboratory of Biomimetic Materials and Cellular Immunomodulation, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Dacheng Ren
- Department of Biomedical and Chemical Engineering, College of Engineering and Computer Science, Syracuse University, Syracuse, New York, USA.,Syracuse Biomaterials Institute, College of Engineering and Computer Science, Syracuse University, Syracuse, New York, USA
| | - Jeremy L Gilbert
- Department of Biomedical and Chemical Engineering, College of Engineering and Computer Science, Syracuse University, Syracuse, New York, USA.,Syracuse Biomaterials Institute, College of Engineering and Computer Science, Syracuse University, Syracuse, New York, USA.,Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.,Clemson-Medical University of South Carolina Bioengineering Program, Charleston, South Carolina, USA
| |
Collapse
|
11
|
Jägersberg M, Feihl S, Ringel F. Future directions of postoperative spinal implant infections. JOURNAL OF SPINE SURGERY 2020; 6:814-819. [PMID: 33447687 DOI: 10.21037/jss-20-585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article outlines some promising future concepts against postoperative spinal implant infections on the basis of today available literature. The ever-adapting bacteria causing this common complication compel a corresponding continuous research about best effective treatment. The aim is to give a perspective on several future attack-points: surgical infection prevention strategies such as technical optimization of implants and surgical technique; faster diagnostic tools to detect infection, especially in the context of late infections with low-virulent germs and with regard to decision-making in the course of the surgical workflow; and combined surgical and medical treatment options against implant infections. The surgical treatment section will also state open issues concerning implant removal, and the medical treatment section will give an outlook to promising medical alternatives in a post-antibiotic era. To keep up in this field will be important to retain spine surgery in the future as the state-of-the-art treatment option for mandatory spinal interventions in the presence of tumor or trauma and even more so as an attractive option for patients with degenerative spinal disorder for improvement of their life quality.
Collapse
Affiliation(s)
- Max Jägersberg
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| | - Susanne Feihl
- Department of Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany
| |
Collapse
|
12
|
Overmann AL, Forsberg JA. The state of the art of osseointegration for limb prosthesis. Biomed Eng Lett 2020; 10:5-16. [PMID: 32175127 PMCID: PMC7046912 DOI: 10.1007/s13534-019-00133-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/28/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022] Open
Abstract
Osseointegration (OI) is the direct attachment of bone onto a titanium implant. Recently, the term is used to describe "transdermal" implants that allow an external prosthesis to be connected directly to the skeleton. This technology eliminates the challenges of conventional socket-based prostheses, such as skin breakdown and poor fit, which are common in patients with major extremity amputations. Osseointegration patients demonstrate encouraging improvements in quality of life and function. Patients report improvement in prosthetic use, prosthetic mobility, global health, and pain reduction on a variety of clinical assessment tools. Various implants have been developed for osseointegration for amputees. These implants use a variety of fixation strategies and surface augments to allow for successful integration into the host bone. Regardless of design, all OI implants face similar challenges, particularly infections. Other challenges include the inability to determine when integration has occurred and the inability to detect loss of integration. These challenges may be met by incorporating sensing systems into the implants. The percutaneous nature of the metal devices can be leveraged so that internal sensors need not be wireless, and can be interrogated by external monitoring systems, thus providing crucial, real-time information about the state of the implant. The purpose of this review is to (1) review the basic science behind osseointegration, (2) provide an overview of current implants, practice patterns, and clinical outcomes, and (3) preview sensor technologies which may prove useful in future generations of transdermal orthopaedic implants.
Collapse
Affiliation(s)
- A. L. Overmann
- Orthopaedics, USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - J. A. Forsberg
- Orthopaedics, USU-Walter Reed Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| |
Collapse
|
13
|
Ehrensberger MT, Clark CM, Canty MK, McDermott EP. Electrochemical methods to enhance osseointegrated prostheses. Biomed Eng Lett 2020; 10:17-41. [PMID: 32175128 PMCID: PMC7046908 DOI: 10.1007/s13534-019-00134-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 12/19/2022] Open
Abstract
Osseointegrated (OI) prosthetic limbs have been shown to provide an advantageous treatment option for amputees. In order for the OI prosthesis to be successful, the titanium implant must rapidly achieve and maintain proper integration with the bone tissue and remain free of infection. Electrochemical methods can be utilized to control and/or monitor the interfacial microenvironment where the titanium implant interacts with the biological system (host bone tissue or bacteria). This review will summarize the current understanding of how electrochemical modalities can influence bone tissue and bacteria with specific emphasis on applications where the metallic prosthesis itself can be utilized directly as a stimulating electrode for enhanced osseointegration and infection control. In addition, a summary of electrochemical impedance sensing techniques that could be used to potentially assess osseointegration and infection status of the metallic prosthesis is presented.
Collapse
Affiliation(s)
- Mark T. Ehrensberger
- Department of Biomedical Engineering, University at Buffalo, 445 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214 USA
- Department of Orthopaedics, University at Buffalo, Buffalo, NY USA
| | - Caelen M. Clark
- Department of Biomedical Engineering, University at Buffalo, 445 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214 USA
| | - Mary K. Canty
- Department of Biomedical Engineering, University at Buffalo, 445 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214 USA
- Department of Microbiology and Immunology, University at Buffalo, Buffalo, NY USA
| | - Eric P. McDermott
- Department of Biomedical Engineering, University at Buffalo, 445 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214 USA
| |
Collapse
|
14
|
Wang H, Tampio AJF, Xu Y, Nicholas BD, Ren D. Noninvasive Control of Bacterial Biofilms by Wireless Electrostimulation. ACS Biomater Sci Eng 2019; 6:727-738. [DOI: 10.1021/acsbiomaterials.9b01199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hao Wang
- Department of Biomedical and Chemical Engineering, Syracuse University, 329 Link Hall, Syracuse, New York 13244, United States
- Syracuse Biomaterials Institute, Syracuse University, 318 Bowne Hall, Syracuse, New York 13244, United States
| | - Alex J. F. Tampio
- Department of Otolaryngology, Upstate Medical University, 750 East Adams Street, 241 Campus West, Syracuse, New York 13210, United States
| | - Yikang Xu
- Department of Biomedical and Chemical Engineering, Syracuse University, 329 Link Hall, Syracuse, New York 13244, United States
- Syracuse Biomaterials Institute, Syracuse University, 318 Bowne Hall, Syracuse, New York 13244, United States
| | - Brian D. Nicholas
- Department of Otolaryngology, Upstate Medical University, 750 East Adams Street, 241 Campus West, Syracuse, New York 13210, United States
| | - Dacheng Ren
- Department of Biomedical and Chemical Engineering, Syracuse University, 329 Link Hall, Syracuse, New York 13244, United States
- Syracuse Biomaterials Institute, Syracuse University, 318 Bowne Hall, Syracuse, New York 13244, United States
- Department of Civil and Environmental Engineering, Syracuse University, 151 Link Hall, Syracuse, New York 13244, United States
- Department of Biology, Syracuse University, 110 Life Sciences Complex, 107 College Place, Syracuse, New York 13244, United States
| |
Collapse
|
15
|
Antibiotics Enhance Prevention and Eradication Efficacy of Cathodic-Voltage-Controlled Electrical Stimulation against Titanium-Associated Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms. mSphere 2019; 4:4/3/e00178-19. [PMID: 31043516 PMCID: PMC6495338 DOI: 10.1128/msphere.00178-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Periprosthetic joint infections (PJIs) develop clinically in the presence of antibiotic therapies and are responsible for increased patient morbidity and rising health care costs. Many of these infections involve bacterial biofilm formation on orthopedic hardware, and it has been well established that these biofilms are refractory to most antibiotic treatments. Recent studies have focused on novel methods to prevent and eradicate infection. Cathodic-voltage-controlled electrical stimulation (CVCES) has previously been shown to be effective as a method for prevention and eradication of Gram-positive and Gram-negative infections. The present study revealed that the utility of CVCES for prevention and eradication of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is enhanced in the presence of clinically relevant antibiotics. The synergistic effects of CVCES and antibiotics are effective in a magnitude-dependent manner. The results of this study indicate a promising alternative method to current PJI mitigation techniques. Periprosthetic joint infection (PJI) develops clinically, even with antibiotic treatment, and methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa are predominant causes of these infections. Due to biofilm formation, antibiotic treatment for patients with PJI can perpetuate resistance, further complicating the use of noninvasive treatments. This study evaluated cathodic-voltage-controlled electrical stimulation (CVCES) of titanium, in combination with a clinically relevant antibiotic, to synergistically prevent MRSA and P. aeruginosa PJIs by inhibiting bacterial adherence or as a treatment for eradicating established biofilms. CVCES of −1.0 V, −1.5 V, or −1.8 V (versus Ag/AgCl), with or without vancomycin for MRSA or gentamicin for P. aeruginosa, was applied to sterile titanium incubated with cultures to evaluate prevention of attachment or eradication of preestablished biofilms. Treatments were 24 h long and included open-circuit potential controls, antibiotic alone, CVCES, and CVCES plus antibiotic. Biofilm-associated and planktonic CFU were enumerated. In general, CVCES at −1.8 V alone or with antibiotic completely eradicated biofilm-associated CFU for both strains, and these parameters were also highly effective against planktonic bacteria, resulting in a >6-log reduction in MRSA and no detectable planktonic P. aeruginosa. All CFU were reduced ∼3 to 5 logs from controls for prevention CVCES plus antibiotics at −1.0 V and −1.5 V against MRSA. Remarkably, there were no detectable P. aeruginosa CFU following prevention CVCES at −1.0 V or −1.5 V with gentamicin. Our results suggest that CVCES in combination with antibiotics may be an effective approach for prevention and treatment of PJI. IMPORTANCE Periprosthetic joint infections (PJIs) develop clinically in the presence of antibiotic therapies and are responsible for increased patient morbidity and rising health care costs. Many of these infections involve bacterial biofilm formation on orthopedic hardware, and it has been well established that these biofilms are refractory to most antibiotic treatments. Recent studies have focused on novel methods to prevent and eradicate infection. Cathodic-voltage-controlled electrical stimulation (CVCES) has previously been shown to be effective as a method for prevention and eradication of Gram-positive and Gram-negative infections. The present study revealed that the utility of CVCES for prevention and eradication of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa is enhanced in the presence of clinically relevant antibiotics. The synergistic effects of CVCES and antibiotics are effective in a magnitude-dependent manner. The results of this study indicate a promising alternative method to current PJI mitigation techniques.
Collapse
|
16
|
Ashrafi M, Novak-Frazer L, Morris J, Baguneid M, Rautemaa-Richardson R, Bayat A. Electrical stimulation disrupts biofilms in a human wound model and reveals the potential for monitoring treatment response with volatile biomarkers. Wound Repair Regen 2018; 27:5-18. [DOI: 10.1111/wrr.12679] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/08/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Mohammed Ashrafi
- Plastic & Reconstructive Surgery Research, Division of Musculoskeletal & Dermatological Sciences; School of Biological Sciences, University of Manchester; Manchester United Kingdom
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
- Bioengineering Group, School of Materials; University of Manchester; Manchester United Kingdom
| | - Lilyann Novak-Frazer
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine; School of Biological Sciences, The University of Manchester and Manchester University NHS Foundation Trust; Manchester United Kingdom
| | - Julie Morris
- Honorary Reader in Medical Statistics; Manchester University NHS Foundation Trust, Wythenshawe Hospital; Manchester United Kingdom
| | - Mohamed Baguneid
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
| | - Riina Rautemaa-Richardson
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Division of Infection, Immunity and Respiratory Medicine; School of Biological Sciences, The University of Manchester and Manchester University NHS Foundation Trust; Manchester United Kingdom
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Division of Musculoskeletal & Dermatological Sciences; School of Biological Sciences, University of Manchester; Manchester United Kingdom
- Manchester University NHS Foundation Trust; Wythenshawe Hospital; Manchester United Kingdom
| |
Collapse
|
17
|
Taha M, Abdelbary H, Ross FP, Carli AV. New Innovations in the Treatment of PJI and Biofilms-Clinical and Preclinical Topics. Curr Rev Musculoskelet Med 2018; 11:380-388. [PMID: 29926287 PMCID: PMC6105481 DOI: 10.1007/s12178-018-9500-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement. A main source for antibiotic tolerance and treatment failure is bacterial production of biofilm-a resilient barrier against antibiotics, immune system, and mechanical debridement. The purpose of this review is to explore some novel approaches to treat PJI and biofilm-related infections. RECENT FINDINGS Innovative treatment strategies of bacterial and biofilm infections revolve around (a) augmenting current therapies, such as improving the delivery and efficiency of conventional antibiotics and enhancing the efficacy of antiseptics and (b) administrating completely new therapeutic modalities, such as using immunotherapy, nanoparticles, lytic bacteriophages, photodynamic therapy, novel antibiotics, and antimicrobial peptides. Several promising treatment strategies for PJI are available to be tested further. The next requirement for most of the novel treatments is reproducing their effects in clinically representative animal models of PJI against clinical isolates of relevant bacteria.
Collapse
Affiliation(s)
- Mariam Taha
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Orthopedic Surgery Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Hesham Abdelbary
- Division of Orthopedic Surgery Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - F Patrick Ross
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Alberto V Carli
- Division of Orthopedic Surgery Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
| |
Collapse
|
18
|
Abstract
Microbial biofilms, which are elaborate and highly resistant microbial aggregates formed on surfaces or medical devices, cause two-thirds of infections and constitute a serious threat to public health. Immunocompromised patients, individuals who require implanted devices, artificial limbs, organ transplants, or external life support and those with major injuries or burns, are particularly prone to become infected. Antibiotics, the mainstay treatments of bacterial infections, have often proven ineffective in the fight against microbes when growing as biofilms, and to date, no antibiotic has been developed for use against biofilm infections. Antibiotic resistance is rising, but biofilm-mediated multidrug resistance transcends this in being adaptive and broad spectrum and dependent on the biofilm growth state of organisms. Therefore, the treatment of biofilms requires drug developers to start thinking outside the constricted "antibiotics" box and to find alternative ways to target biofilm infections. Here, we highlight recent approaches for combating biofilms focusing on the eradication of preformed biofilms, including electrochemical methods, promising antibiofilm compounds and the recent progress in drug delivery strategies to enhance the bioavailability and potency of antibiofilm agents.
Collapse
Affiliation(s)
- Heidi Wolfmeier
- Department of Microbiology and Immunology, Center for Microbial Diseases
and Immunity Research, University of British Columbia, Room 232, 2259
Lower Mall Research Station, Vancouver, British Columbia V6T 1Z4, Canada
| | - Daniel Pletzer
- Department of Microbiology and Immunology, Center for Microbial Diseases
and Immunity Research, University of British Columbia, Room 232, 2259
Lower Mall Research Station, Vancouver, British Columbia V6T 1Z4, Canada
| | - Sarah C. Mansour
- Department of Microbiology and Immunology, Center for Microbial Diseases
and Immunity Research, University of British Columbia, Room 232, 2259
Lower Mall Research Station, Vancouver, British Columbia V6T 1Z4, Canada
| | - Robert E. W. Hancock
- Department of Microbiology and Immunology, Center for Microbial Diseases
and Immunity Research, University of British Columbia, Room 232, 2259
Lower Mall Research Station, Vancouver, British Columbia V6T 1Z4, Canada
| |
Collapse
|
19
|
Ashrafi M, Baguneid M, Alonso-Rasgado T, Rautemaa-Richardson R, Bayat A. Cutaneous wound biofilm and the potential for electrical stimulation in management of the microbiome. Future Microbiol 2017; 12:337-357. [DOI: 10.2217/fmb-2016-0204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Infection contributes significantly to delayed cutaneous wound healing, which impacts patient care. External application of electrical stimulation (ES) has beneficial effects on wound repair and regeneration. The majority of studies to date have explored ES in relation to planktonic microorganisms, yet evidence indicates that bacteria in chronic wounds reside as antibiotic-resistant polymicrobial biofilms, which contribute to impairing wound healing. Culture-independent sequencing techniques have revolutionized our understanding of the skin microbiome and allowed a more accurate determination of microbial taxa and their relative abundance in wounds allowing a greater understanding of the host–microbial interface. Future studies combining the fields of ES, biofilm and microbiome research are necessary to fully elucidate the use of ES in the management of wound infection.
Collapse
Affiliation(s)
- Mohammed Ashrafi
- Plastic & Reconstructive Surgery Research, Centre for Dermatological Research, University of Manchester, Manchester, UK
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
- Bioengineering Group, School of Materials, University of Manchester, Manchester, UK
| | - Mohamed Baguneid
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Riina Rautemaa-Richardson
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Institute of Inflammation & Repair, University of Manchester, Manchester, UK
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Centre for Dermatological Research, University of Manchester, Manchester, UK
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
- Bioengineering Group, School of Materials, University of Manchester, Manchester, UK
| |
Collapse
|
20
|
Brooks EK, Ahn R, Tobias ME, Hansen LA, Luke-Marshall NR, Wild L, Campagnari AA, Ehrensberger MT. Magnesium alloy AZ91 exhibits antimicrobial properties in vitro but not in vivo. J Biomed Mater Res B Appl Biomater 2017; 106:221-227. [PMID: 28130825 DOI: 10.1002/jbm.b.33839] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/16/2016] [Accepted: 12/10/2016] [Indexed: 12/31/2022]
Abstract
Magnesium alloys hold great promise for developing orthopedic implants that are biocompatible, biodegradable, and mechanically similar to bone tissue. This study evaluated the in vitro and in vivo antimicrobial properties of magnesium-9%aluminum-1%zinc (AZ91) and commercially pure titanium (cpTi) against Acinetobacter baumannii (Ab307). The in vitro results showed that as compared to cpTi, incubation with AZ91 significantly reduced both the planktonic (cpTi = 3.45e8, AZ91 = 8.97e7, p < 0.001) colony forming units (CFU) and biofilm-associated (cpTi = 3.89e8, AZ91 = 1.78e7, p = 0.01) CFU of Ab307. However, in vivo results showed no significant differences in the CFU enumerated from the cpTi and AZ91 implants following a 1-week implantation in an established rodent model of Ab307 implant associated infection (cpTi = 5.23e3, AZ91 = 2.46e3, p = 0.29). It is proposed that the in vitro results were associated with an increased pH in the bacterial culture as a result of the AZ91 corrosion process. The robust in vivo buffering capacity likely diminished this corrosion associated pH antimicrobial effect. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 221-227, 2018.
Collapse
Affiliation(s)
- Emily K Brooks
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, New York
| | - Richard Ahn
- Department of Orthopedics, State University of New York at Buffalo, Buffalo, New York
| | - Menachem E Tobias
- Department of Orthopedics, State University of New York at Buffalo, Buffalo, New York
| | - Lisa A Hansen
- Department of Microbiology and Immunology, State University of New York at Buffalo, Buffalo, New York
| | - Nicole R Luke-Marshall
- Department of Microbiology and Immunology, State University of New York at Buffalo, Buffalo, New York
| | - Linda Wild
- Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Anthony A Campagnari
- Department of Microbiology and Immunology, State University of New York at Buffalo, Buffalo, New York
| | - Mark T Ehrensberger
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, New York.,Department of Orthopedics, State University of New York at Buffalo, Buffalo, New York
| |
Collapse
|
21
|
Canty M, Luke-Marshall N, Campagnari A, Ehrensberger M. Cathodic voltage-controlled electrical stimulation of titanium for prevention of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii biofilm infections. Acta Biomater 2017; 48:451-460. [PMID: 27890730 DOI: 10.1016/j.actbio.2016.11.056] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 12/19/2022]
Abstract
Antibiotic resistance of bacterial biofilms limits available treatment methods for implant-associated orthopaedic infections. This study evaluated the effects of applying cathodic voltage-controlled electrical stimulations (CVCES) of -1.5V and -1.8V (vs. Ag/AgCl) to coupons of commercially pure titanium (cpTi) incubated in cultures of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii (A. baumannii) as a method of preventing bacterial attachment. Stimulations were applied for 2, 4, and 8h and coupon-associated and planktonic colony-forming units (CFU) were enumerated following stimulation. Compared to open circuit potential (OCP) controls, CVCES for 4h at -1.8V significantly reduced coupon-associated MRSA CFU by 99.9% (1.30×104vs. 4.45×107, p=0.047) and A. baumannii coupon-associated CFU by 99.9% (1.64×104vs. 5.93×107, p=0.001) and reduced planktonic CFU below detectable levels for both strains. CVCES at -1.8V for 8h also reduced coupon-associated and planktonic CFU below detectable levels for each strain. CVCES at -1.5V for 4 and 8h, and -1.8V for 2h did not result in clinically relevant reductions. For 4 and 8h stimulations, the current density was significantly higher for -1.8V than -1.5V, an effect directly related to the rate of water and oxygen reduction on the cpTi surface. This significantly increased the pH, a suspected influence in decreased CFU viability. The voltage-dependent electrochemical properties of cpTi likely contribute to the observed antimicrobial effects of CVCES. This study revealed that CVCES of titanium could prevent coupon-associated and planktonic CFU of Gram-positive MRSA and Gram-negative A. baumannii from reaching detectable levels in a magnitude-dependent and time-dependent manner. STATEMENT OF SIGNIFICANCE Periprosthetic joint infection is a devastating outcome of total joint arthroplasty and has led to increased patient morbidity and rising healthcare costs. Current treatments are limited by the growing prevalence of antimicrobial resistant biofilms. Therefore, there is a growing interest in the prevention of bacterial colonization of implants. Previous work has shown that cathodic voltage-controlled electrical stimulation (CVCES) of titanium is effective both in vitro and in vivo as an antimicrobial strategy to eradicate established implant-associated biofilm infections. The present study revealed that CVCES of titanium coupons also has utility in preventing coupon-associated and planktonic colony-forming units of Gram-positive methicillin-resistant Staphylococcus aureus and Gram-negative Acinetobacter baumannii from reaching detectable levels in a magnitude-dependent and time-dependent manner.
Collapse
|
22
|
Eradication of Pseudomonas aeruginosa biofilms and persister cells using an electrochemical scaffold and enhanced antibiotic susceptibility. NPJ Biofilms Microbiomes 2016. [PMID: 28649396 PMCID: PMC5460242 DOI: 10.1038/s41522-016-0003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Biofilms in chronic wounds are known to contain a persister subpopulation that exhibits enhanced multidrug tolerance and can quickly rebound after therapeutic treatment. The presence of these “persister cells” is partly responsible for the failure of antibiotic therapies and incomplete elimination of biofilms. Electrochemical methods combined with antibiotics have been suggested as an effective alternative for biofilm and persister cell elimination, yet the mechanism of action for improved antibiotic efficacy remains unclear. In this work, an electrochemical scaffold (e-scaffold) that electrochemically generates a constant concentration of H2O2 was investigated as a means of enhancing tobramycin susceptibility in pre-grown Pseudomonas aeruginosa PAO1 biofilms and attacking persister cells. Results showed that the e-scaffold enhanced tobramycin susceptibility in P. aeruginosa PAO1 biofilms, which reached a maximum susceptibility at 40 µg/ml tobramycin, with complete elimination (7.8-log reduction vs control biofilm cells, P ≤ 0.001). Moreover, the e-scaffold eradicated persister cells in biofilms, leaving no viable cells (5-log reduction vs control persister cells, P ≤ 0.001). It was observed that the e-scaffold induced the intracellular formation of hydroxyl free radicals and improved membrane permeability in e-scaffold treated biofilm cells, which possibly enhanced antibiotic susceptibility and eradicated persister cells. These results demonstrate a promising advantage of the e-scaffold in the treatment of persistent biofilm infections. Using an electrically conductive fabric to generate hydrogen peroxide could eradicate persistent biofilms in chronically infected wounds. Electrochemical scaffolds (e-scaffolds) are thin networks of conductive material such as carbon fiber used to generate chemical responses in media they are in contact with. Haluk Beyenal and colleagues at Washington State University, USA, investigated the effect of a carbon fabric e-scaffold on cultured biofilms of the bacterium Pseudomonas aeruginosa. The procedure enhanced the susceptibility of this troublesome multidrug-resistant bacterium to the antibiotic tobramycin. Crucially, it eradicated so-called persister cells that can evade antibiotic treatment to reform biofilms in chronic wounds. The research suggests that the effect involves the production of hydroxyl free radicals from hydrogen peroxide and increased permeability of the bacterial cell membranes. The potential of e-scaffolds for treating infected wounds warrants further exploration.
Collapse
|