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Ornowska M, Wittmann J, Reynolds S. Central venous access device locking practices in the adult critical care setting: a single-centre, observational study establishing duration of locking per catheter lumen. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S16-S25. [PMID: 36306232 DOI: 10.12968/bjon.2022.31.19.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE Central line complications remain a problem in critical care patient populations. Various interventions to prevent or treat complications, such as central line-associated bloodstream infection and occlusion, have been the focus of recent research. Although alternative catheter locking solutions have been shown to be effective in other patient populations, their applicability to the critical care setting remains unclear. Due to the high acuity of critical care patients, it is uncertain whether their central lines remain locked for a duration long enough for alternative locking solutions to provide any effect. METHODS This single-centre, prospective, observational study aimed to gather information about the length of time central line lumens remain in a locked state in the average critical care patient. Baseline rates of various central line complications were also tracked. RESULTS Results of this study indicate that the majority of central lines will have at least one lumen locked for an average of 36.6% of their time in situ. CONCLUSIONS It is anticipated that this length of time provides enough exposure for alternative locking solutions to potentially make a difference in central line complications in this patient population. Results of this study can be used for planning future multi-centre, randomized controlled trials investigating the efficacy of novel central line locking solutions to prevent central line complications in critically ill patients.
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Affiliation(s)
- Marlena Ornowska
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Jessica Wittmann
- Department of Critical Care, Royal Columbian Hospital, New Westminster, BC, V3L 3W7, Canada
| | - Steven Reynolds
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada; Department of Critical Care, Royal Columbian Hospital, New Westminster, BC, V3L 3W7, Canada
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2
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Somani M, Mukhopadhyay S, Gupta B. Functionalization of polyurethane for infection‐resistance surface. J Appl Polym Sci 2022. [DOI: 10.1002/app.52528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Manali Somani
- Department of Textile and Fibre Engineering Indian Institute of Technology New Delhi India
| | - Samrat Mukhopadhyay
- Department of Textile and Fibre Engineering Indian Institute of Technology New Delhi India
| | - Bhuvanesh Gupta
- Department of Textile and Fibre Engineering Indian Institute of Technology New Delhi India
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3
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Fornwalt RA, Brigham EP, Scott Stephens R. Critical Care of Hematopoietic Stem Cell Transplant Patients. Crit Care Clin 2020; 37:29-46. [PMID: 33190774 DOI: 10.1016/j.ccc.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Life-threatening complications are frequent after hematopoietic stem cell transplant (HSCT), and optimum critical care is essential to ensuring good outcomes. The immunologic consequences of HSCT result in a markedly different host response to critical illness. Infection is the most common cause of critical illness but noninfectious complications are frequent. Respiratory failure or sepsis are the typical presentations but the sequelae of HSCT can affect nearly any organ system. Pattern recognition can facilitate anticipation and early intervention in post-HSCT critical illness. HSCT critical care is a multidisciplinary endeavor. Continued investigation and focus on process improvement will continue to improve outcomes.
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Affiliation(s)
- Rachael A Fornwalt
- Oncology Intensive Care Unit, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Harry and Jeanette Weinberg Building, Pod 5C, 401 North Broadway, Baltimore, MD 21231, USA
| | - Emily P Brigham
- Oncology Intensive Care Unit, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21205, USA
| | - R Scott Stephens
- Oncology Intensive Care Unit, Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Oncology, Johns Hopkins University, 1800 Orleans Street, Suite 9121 Zayed Tower, Baltimore, MD 21287, USA.
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4
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Wang L, Erişen DE, Yang K, Zhang B, Guan H, Chen S. Anticoagulation and antibacterial functional coating on vascular implant interventional medical catheter. J Biomed Mater Res B Appl Biomater 2020; 108:2868-2877. [PMID: 32420689 DOI: 10.1002/jbm.b.34618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 03/30/2020] [Accepted: 04/13/2020] [Indexed: 01/12/2023]
Abstract
Vascular implant interventional medical catheter will contact with blood firstly after implantation. The anticoagulation and antibacterial functions of this device will determine the success or failure. Copper (Cu) has been verified to possess multi-biofunctions, but it was challenging to add the Cu metal to most materials. Take advantage of its functionality; Cu has been grafted on the material surface to improve the anticoagulation function and accelerate endothelialization. In this study, a Cu-bearing chitosan coating was prepared on the catheter to endow the anticoagulation and anti-infection functions. Besides, properties characterization and functional evaluation of the coated medical catheter were investigated. Dynamic blood clotting and platelet adhesion tests were carried out to evaluate the anticoagulation property. Besides this, the antibacterial test was used to estimate the anti-infection function. The surface energy and Cu ions release from the coating were detected and calculated by contact angles and immersion tests, respectively. The results of attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and X-ray photoelectron spectroscopy (XPS) revealed that Cu ions were grafted in the chitosan coating. Thermogravimetric analysis (TA) result showed the concentration of Cu ions in the coating. The results of dynamic blood clotting, platelet adhesion, and antibacterial tests revealed that Cu grafted in chitosan would improve the blood compatibility and anti-infection property. The surface properties and Cu ions release behavior of Cu-bearing coating revealed the reasons for multi-biofunctions. This study indicated that the Cu-bearing chitosan coating could endow the vascular implant interventional device anticoagulation and anti-infection functions, which has excellent potential for clinical application.
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Affiliation(s)
- Lirong Wang
- College of Chemistry, Liaoning University, Shenyang, China
| | - Deniz E Erişen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China.,University of Science and Technology of China, Hefei, China
| | - Ke Yang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Bingchun Zhang
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
| | - Hongyu Guan
- College of Chemistry, Liaoning University, Shenyang, China
| | - Shanshan Chen
- Institute of Metal Research, Chinese Academy of Sciences, Shenyang, China
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5
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Lorente L. [To reduce the current rates of catheter-related bacteremia after the implementation of the Zero programs: This is the challenge]. Med Intensiva 2019; 45:243-245. [PMID: 31615713 DOI: 10.1016/j.medin.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- L Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España.
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6
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Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings. Crit Care Med 2019; 46:1998-2009. [PMID: 30095499 DOI: 10.1097/ccm.0000000000003370] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To examine the proportion and rate of central venous access device failure and complications across central venous access device types in adult intensive care. DATA SOURCES A systematic search was undertaken in the electronic databases Cochrane Central Register of Controlled Trials, Embase, U.S. National Library of Medicine National Institutes of Health, and Cumulative Index to Nursing and Allied Health in September 2017. STUDY SELECTION Included studies were of observational (prospective and retrospective) or interventional design and reported central venous access device failure and complications in adult ICU settings. Studies were excluded if they were published prior to November 2006 or not reported in English. Two reviewers independently screened articles, assessed eligibility, extracted data, and assessed risk of bias. DATA EXTRACTION Data were extracted on the primary outcome, central venous access device failure, and secondary outcomes: central venous access device complications (central line-associated bloodstream infection, catheter-related bloodstream infection, catheter-related thrombosis, occlusion, catheter removal due to suspected infection, dislodgement, breakage, and local infection). Patient and device data and study details to assess the study quality were also extracted. DATA SYNTHESIS A total of 63 studies involving 50,000 central venous access devices (396,951 catheter days) were included. Central venous access device failure was 5% (95% CI, 3-6%), with the highest rates and proportion of failure in hemodialysis catheters. Overall central line-associated bloodstream infection rate was 4.59 per 1,000 catheter days (95% CI, 2.31-6.86), with the highest rate in nontunneled central venous access devices. Removal of central venous access device due to suspected infection was high (17%; 20.4 per 1,000 catheter days; 95% CI, 15.7-25.2). CONCLUSIONS Central venous access device complications and device failure is a prevalent and significant problem in the adult ICU, leading to substantial patient harm and increased healthcare costs. The high proportion of central venous access devices removed due to suspicion of infection, despite low overall central line-associated bloodstream infection and catheter-related bloodstream infection rates, indicates a need for robust practice guidelines to inform decision-making surrounding removal of central venous access devices suspected of infection.
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Viola GM, Rosenblatt J, Raad II. Drug eluting antimicrobial vascular catheters: Progress and promise. Adv Drug Deliv Rev 2017; 112:35-47. [PMID: 27496702 DOI: 10.1016/j.addr.2016.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/14/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Abstract
Vascular catheters are critical tools in modern healthcare yet present substantial risks of serious bloodstream infections that exact significant health and economic burdens. Drug-eluting antimicrobial vascular catheters have become important tools in preventing catheter-related bloodstream infections and their importance is expected to increase as significant initiatives are expanded to eliminate and make the occurrence of these infections unacceptable. Here we review clinically significant and emerging drug-eluting antimicrobial catheters within the categories of antibiotic, antiseptic, novel bioactive agents and energy-enhanced drug eluting antimicrobial catheters. Important representatives of each category are reviewed from the standpoints of mechanisms of action, physical-chemical properties, safety, in vitro and clinical effectiveness.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Lorente L, Lecuona M, Jiménez A, Cabrera J, Santacreu R, Lorenzo L, Raja L, Mora ML. Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy. Am J Infect Control 2016; 44:1526-1529. [PMID: 27378009 DOI: 10.1016/j.ajic.2016.04.236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study. METHODS This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy. RESULTS Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day ($3.78 ± $7.43 vs $3.31 ± $2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001). CONCLUSIONS The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.
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Affiliation(s)
- Leonardo Lorente
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
| | - María Lecuona
- Department of Microbiology and Infection Control, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Alejandro Jiménez
- Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Judith Cabrera
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Ruth Santacreu
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Lisset Lorenzo
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Lorena Raja
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - María L Mora
- Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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9
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Moureau N, Chopra V. Indications for Peripheral, Midline, and Central Catheters: Summary of the Michigan Appropriateness Guide for Intravenous Catheters Recommendations. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.java.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access; those requiring multiple attempts; and those who are obese, have diabetes, or have other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In clinical settings, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access. Selection of the most appropriate VAD is necessary to avoid the potentially serious complications of infection and/or thrombosis. An international panel of experts convened to establish a guide for indications and appropriate use for VADs. This article summarizes the work and recommendations of the panel that created the Michigan Appropriateness Guide for Intravenous Catheters.
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Affiliation(s)
- Nancy Moureau
- Griffith University, Brisbane, Australia
- PICC Excellence, Inc, Greenville, SC
- Greenville Memorial Hospital, Greenville, SC
| | - Vineet Chopra
- School of Medicine, University of Michigan, Ann Arbor, MI
- Ann Arbor VA Medical Center, Ann Arbor, MI
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Barbour ME, Maddocks SE, Grady HJ, Roper JA, Bass MD, Collins AM, Dommett RM, Saunders M. Chlorhexidine hexametaphosphate as a wound care material coating: antimicrobial efficacy, toxicity and effect on healing. Nanomedicine (Lond) 2016; 11:2049-57. [DOI: 10.2217/nnm-2016-0084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aim: In this study, chlorhexidine hexametaphosphate (CHX-HMP) is investigated as a persistent antimicrobial coating for wound care materials. Materials & methods: CHX-HMP was used as a wound care material coating and compared with chlorhexidine digluconate materials with respect to antimicrobial efficacy, toxicity and wound closure. Results: Antimicrobial efficacy at day 1, 3 and 7 was observed with experimental and commercial materials. CHX-HMP coated materials had less toxic effect on human placental cells than commercial chlorhexidine dressings. CHX-HMP in pluronic gel did not delay healing but reduced wound colonization by E. faecalis. Conclusion: CHX-HMP could become a useful component of wound care materials with sustained antimicrobial efficacy, lower toxicity than chlorhexidine digluconate materials, and reduction in wound colonization without affecting closure.
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Affiliation(s)
- Michele E Barbour
- Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, UK
| | | | - Helena J Grady
- Oral Nanoscience, School of Oral & Dental Sciences, University of Bristol, UK
- Bristol Centre for Functional Nanomaterials, University of Bristol, UK
| | | | - Mark D Bass
- Centre for Membrane Interactions & Dynamics, Department of Biomedical Science, University of Sheffield, UK
| | - Andrew M Collins
- Bristol Centre for Functional Nanomaterials, University of Bristol, UK
| | | | - Margaret Saunders
- Bioengineering, Innovation & Research Hub (BIRCH), University Hospitals Bristol, UK
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11
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La Greca A, Biasucci DG, Pittiruti M, Scoppettuolo G. Antimicrobial-coated catheters and catheter-over-guidewire exchange in patients with severe catheter-related bloodstream infection: Old procedure, new indications? Am J Infect Control 2016; 44:616-7. [PMID: 26831274 DOI: 10.1016/j.ajic.2015.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
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12
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Lorente L. What is new for the prevention of catheter-related bloodstream infections? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:119. [PMID: 27127772 DOI: 10.21037/atm.2016.03.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
After the publication in 2011 of latest guidelines of the Centers for Disease Control and Prevention (CDC) for the prevention of catheter-related bloodstream infections (CRBSI) some interesting findings have been published in that field. There has been published that skin disinfection with chlorhexidine alcohol reduced the risk of CRBSI compared to skin disinfection with povidone iodine alcohol, that the implementation of quality improvement interventions reduced the incidence of CRBSI, that the use of chlorhexidine impregnated dressing compared to standard dressings reduced the risk of CRBSI and catheter related cost in an health economic model, and that the use of antimicrobial/antiseptic impregnated catheters reduced the incidence of CRBSI and catheter related cost in clinical studies.
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Affiliation(s)
- Leonardo Lorente
- Department of Critical Care, Hospital Universitario de Canarias, Ofra s/n, La Laguna 38320, Santa Cruz de Tenerife, Spain
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13
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Moureau N, Chopra V. Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations. ACTA ACUST UNITED AC 2016; 25:S15-24. [DOI: 10.12968/bjon.2016.25.8.s15] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Nancy Moureau
- Registered Nurse, Adjunct Associate Professor, Griffith University, Brisbane, Australia; Chief Executive Officer, PICC Excellence, Inc and Vascular Access Specialist, Greenville Memorial Hospital, Greenville, South Carolina
| | - Vineet Chopra
- Doctor of Medicine, Assistant Professor of Medicine and Research Scientist, School of Medicine, University of Michigan, and Ann Arbor VA Medical Center, Ann Arbor, Michigan
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Miquel S, Lagrafeuille R, Souweine B, Forestier C. Anti-biofilm Activity as a Health Issue. Front Microbiol 2016; 7:592. [PMID: 27199924 PMCID: PMC4845594 DOI: 10.3389/fmicb.2016.00592] [Citation(s) in RCA: 131] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/11/2016] [Indexed: 12/13/2022] Open
Abstract
The formation and persistence of surface-attached microbial communities, known as biofilms, are responsible for 75% of human microbial infections (National Institutes of Health). Biofilm lifestyle confers several advantages to the pathogens, notably during the colonization process of medical devices and/or patients’ organs. In addition, sessile bacteria have a high tolerance to exogenous stress including anti-infectious agents. Biofilms are highly competitive communities and some microorganisms exhibit anti-biofilm capacities such as bacterial growth inhibition, exclusion or competition, which enable them to acquire advantages and become dominant. The deciphering and control of anti-biofilm properties represent future challenges in human infection control. The aim of this review is to compare and discuss the mechanisms of natural bacterial anti-biofilm strategies/mechanisms recently identified in pathogenic, commensal and probiotic bacteria and the main synthetic strategies used in clinical practice, particularly for catheter-related infections.
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Affiliation(s)
- Sylvie Miquel
- Laboratoire Microorganismes : Génome et Environnement - UMR, CNRS 6023, Université Clermont Auvergne Clermont-Ferrand, France
| | - Rosyne Lagrafeuille
- Laboratoire Microorganismes : Génome et Environnement - UMR, CNRS 6023, Université Clermont Auvergne Clermont-Ferrand, France
| | - Bertrand Souweine
- Laboratoire Microorganismes : Génome et Environnement - UMR, CNRS 6023, Université Clermont AuvergneClermont-Ferrand, France; Service de Réanimation Médicale Polyvalente, CHU de Clermont-Ferrand, Clermont-FerrandFrance
| | - Christiane Forestier
- Laboratoire Microorganismes : Génome et Environnement - UMR, CNRS 6023, Université Clermont Auvergne Clermont-Ferrand, France
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