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Devesa A, Rashed E, Moss N, Robson PM, Pyzik R, Roldan J, Taimur S, Rana MM, Ashley K, Young A, Patel G, Mahmood K, Mitter SS, Lala A, Barghash M, Fox A, Correa A, Pirlamarla P, Contreras J, Parikh A, Mancini D, Jacobi A, Ghesani N, Gavane SC, Ghesani M, Itagaki S, Anyanwu A, Fayad ZA, Trivieri MG. 18F-FDG PET/CT in left ventricular assist device infections: In-depth characterization and clinical implications. J Heart Lung Transplant 2024; 43:529-538. [PMID: 37951322 DOI: 10.1016/j.healun.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/09/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Previous retrospective studies suggest a good diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) in left ventricular assist device (LVAD) infections. Our aim was to prospectively evaluate the role of PET/CT in the characterization and impact on clinical management of LVAD infections. METHODS A total of 40 patients (aged 58 [53-62] years) with suspected LVAD infection and 5 controls (aged 69 [64-71] years) underwent 18F-FDG-PET/CT. Four LVAD components were evaluated: exit site and subcutaneous driveline (peripheral), pump pocket, and outflow graft. The location with maximal uptake was considered the presumed site of infection. Infection was confirmed by positive culture (exit site or blood) and/or surgical findings. RESULTS Visual uptake was present in 40 patients (100%) in the infection group vs 4 (80%) control subjects. For each individual component, the presence of uptake was more frequent in the infection than in the control group. The location of maximal uptake was most frequently the pump pocket (48%) in the infection group and the peripheral components (75%) in the control group. Maximum standard uptake values (SUVmax) were higher in the infection than in the control group: SUVmax (average all components): 6.9 (5.1-8.5) vs 3.8 (3.7-4.3), p = 0.002; SUVmax (location of maximal uptake): 10.6 ± 4.0 vs 5.4 ± 1.9, p = 0.01. Pump pocket infections were more frequent in patients with bacteremia than without bacteremia (79% vs 31%, p = 0.011). Pseudomonas (32%) and methicillin-susceptible Staphylococcus aureus (29%) were the most frequent pathogens and were associated with pump pocket infections, while Staphylococcus epidermis (11%) was associated with peripheral infections. PET/CT affected the clinical management of 83% of patients with infection, resulting in surgical debridement (8%), pump exchange (13%), and upgrade in the transplant listing status (10%), leading to 8% of urgent transplants. CONCLUSIONS 18F-FDG-PET/CT enables the diagnosis and characterization of the extent of LVAD infections, which can significantly affect the clinical management of these patients.
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Affiliation(s)
- Ana Devesa
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Fuster Heart Hospital, New York, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Eman Rashed
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Noah Moss
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Renata Pyzik
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie Roldan
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Sarah Taimur
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meenakshi M Rana
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kimberly Ashley
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anna Young
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Gopi Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kiran Mahmood
- Mount Sinai Fuster Heart Hospital, New York, New York
| | | | - Anuradha Lala
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Maya Barghash
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Arieh Fox
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Ashish Correa
- Mount Sinai Fuster Heart Hospital, New York, New York
| | | | | | - Aditya Parikh
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Donna Mancini
- Mount Sinai Fuster Heart Hospital, New York, New York
| | - Adam Jacobi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nasrin Ghesani
- Division of Nuclear Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Somali C Gavane
- Division of Nuclear Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Munir Ghesani
- Division of Nuclear Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Giovanna Trivieri
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Fuster Heart Hospital, New York, New York.
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Sezen H, Şimşek Kuş N, Özdemir S, Tollu G. The Addition of Ketene to Olefins under Ultrasonic Conditions: Evaluation of the Biological Activities of Halobicyclic Lactone. ChemistrySelect 2023. [DOI: 10.1002/slct.202204042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Hazal Sezen
- Mersin University Faculty of Sciences Department of Chemistry TR-33343 Yenişehir Mersin Turkey
| | - Nermin Şimşek Kuş
- Mersin University Faculty of Sciences Department of Chemistry TR-33343 Yenişehir Mersin Turkey
| | - Sadin Özdemir
- Mersin University Food Processing Programme Technical Science Vocational School TR-33343 Yenişehir Mersin Turkey
| | - Gülşah Tollu
- Mersin University Technical Science Vocational School Department of Laboratory and Veterinary Health TR-33343 Yenişehir Mersin Turkey
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Chen W, Dilsizian V. Diagnosis and Image-guided Therapy of Cardiac Left Ventricular Assist Device Infections. Semin Nucl Med 2020; 51:357-363. [PMID: 33280782 DOI: 10.1053/j.semnuclmed.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Due to limited availability of donor hearts, more and more end stage heart failure patients are dependent on left ventricular assist device (LVAD) as their destination therapy rather than the original intended use as a bridge for heart transplantation. While LVADs improve life expectancy in these patients, infection emerges as one of the major adverse events. Early and accurate localization of LVAD infection is critical, as it can significantly influence clinical management decisions and ultimately impact patient outcome. Although the International Society of Heart and Lung Transplantation has defined 3 categories for LVAD infection: (1) LVAD-specific infection, (2) LVAD-related infection, and (3) non-LVAD infection, there is still lack of standardized criteria for diagnosing these 3 types of LVAD infections. Morphologically based imaging tools such as transesophageal echocardiogram and cardiac computed tomography (CT) or CT angiogram have limited roles in diagnosing LVAD infections due to their nonspecific findings, often affected by significant streaking and beam hardening artifacts from the metal device. In contrast, 18F-fluorodeoxyglucose (FDG) Positron Emission Tomography (PET)/CT has repeatedly shown a high sensitivity and specificity for LVAD infection diagnosis, albeit in small number of subjects. Beyond its accuracy for detecting infection, FDG PET/CT can predict clinical outcome based on the location of LVAD infection. As a functional imaging tool, FDG PET/CT can demonstrate the extent and severity of LVAD infection, as well as infectious embolism and potential extra-cardiac source of infection, which are all critical for providing optimal patient care, justifying its judicious and precise use in the workup of LVAD infection.
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Affiliation(s)
- Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vasken Dilsizian
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
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4
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Teelucksingh S, Schueler S, Crowley TP, Ragbir M. A novel problem, a tested solution: A case of an infected left ventricular titanium plug. J Card Surg 2020; 35:3179-3182. [PMID: 32789921 DOI: 10.1111/jocs.14936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Persistent infection of left ventricular-assisted devices are challenging to treat. We describe a case of a middle-aged man who presented with cardiogenic shock and profound heart failure from sarcoid myocarditis, necessitating the placement of a left ventricular assist device. After recovery of cardiac function, the device was decommissioned but complicated by infection in the implant bed, chest wall, and of the titanium plug left in situ. This to our knowledge is the first report of an infected titanium plug and we describe an option of using a latissimus dorsi flap using its vascularized tissues to treat the infected plug. This is another example where a multidisciplinary approach can yield rewarding results in cases such as these.
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Affiliation(s)
- Sachin Teelucksingh
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephen Schueler
- Department of Cardiac Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Timothy P Crowley
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Maniram Ragbir
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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6
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Methods Used for the Eradication of Staphylococcal Biofilms. Antibiotics (Basel) 2019; 8:antibiotics8040174. [PMID: 31590240 PMCID: PMC6963202 DOI: 10.3390/antibiotics8040174] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/27/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Staphylococcus aureus is considered one of the leading pathogens responsible for community and healthcare-associated infections. Among them, infections caused by methicillin-resistant strains (MRSA) are connected with ineffective or prolonged treatment. The therapy of staphylococcal infections faces many difficulties, not only because of the bacteria's resistance to antibiotics and the multiplicity of virulence factors it produces, but also due to its ability to form a biofilm. The present review focuses on several approaches used for the assessment of staphylococcal biofilm eradication. The methods described here are successfully applied in research on the prevention of biofilm-associated infections, as well as in their management. They include not only the evaluation of the antimicrobial activity of novel compounds, but also the methods for biomaterial functionalization. Moreover, the advantages and limitations of different dyes and techniques used for biofilm characterization are discussed. Therefore, this review may be helpful for those scientists who work on the development of new antistaphylococcal compounds.
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7
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Mehra MR, Woolley AE. Imaging the Crevasse of Left Ventricular Assist Device Infection. JACC Cardiovasc Imaging 2019; 13:1203-1205. [PMID: 31326493 DOI: 10.1016/j.jcmg.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Ann E Woolley
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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8
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A Review on Surface Modifications and Coatings on Implants to Prevent Biofilm. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019. [DOI: 10.1007/s40883-019-00116-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Shah P, Birk SE, Cooper LB, Psotka MA, Kirklin JK, Barnett SD, Katugaha SB, Phillips S, Looby MM, Pagani FD, Cowger JA. Stroke and death risk in ventricular assist device patients varies by ISHLT infection category: An INTERMACS analysis. J Heart Lung Transplant 2019; 38:721-730. [DOI: 10.1016/j.healun.2019.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/18/2019] [Accepted: 02/08/2019] [Indexed: 01/28/2023] Open
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10
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Abstract
This article reviews the diagnostic criteria for ventricular assist device (VAD) infection, pathogenesis, and microbiology as well as the diagnostic pathway when patients present with signs and symptoms concerning for VAD infection. Recommendations regarding infection prevention and management are reviewed as well.
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Affiliation(s)
- Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, 4510 Executive Drive, Suite P-725, MC 7745, San Diego, CA 92121, USA.
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11
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Abstract
Over half of the nearly two million healthcare-associated infections can be attributed to indwelling medical devices. In this review, we highlight the difficulty in diagnosing implantable device-related infection and how this leads to a likely underestimate of the prevalence. We then provide a length-scale conceptualization of device-related infection pathogenesis. Within this conceptualization we focus specifically on biofilm formation and the role of host immune and coagulation systems. Using this framework, we describe how current and developing preventative strategies target specific processes along the entire length-scale. In light of the significant time horizon for the development and translation of new preventative technologies, we also emphasize the need for parallel development of in situ treatment strategies. Specific examples of both preventative and treatment strategies and how they align with the length-scale conceptualization are described.
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12
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An ISHLT consensus document for prevention and management strategies for mechanical circulatory support infection. J Heart Lung Transplant 2017; 36:1137-1153. [DOI: 10.1016/j.healun.2017.06.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
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13
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Hidalgo LF, Shah KB, Cooke RH, Tang DG, Kasirajan V, Cooper HA, Aronow WS. Infections in Patients with a Total Artificial Heart Are Common but Rarely Fatal. ASAIO J 2017; 63:736-739. [PMID: 28319520 DOI: 10.1097/mat.0000000000000562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Patients who received a total artificial heart (TAH) at Virginia Commonwealth University (VCU) between January 1, 2010 and December 31, 2011 were identified from the VCU Mechanical Circulatory Support Clinical Database. Retrospective data extraction from the medical records was performed from the time of TAH implantation until heart transplantation or death. Infections were classified as confirmed or suspected. Twenty-seven men and five women, mean age 49.5 years (range 24-68 years) received a TAH. The mean duration of TAH support was 225 days (range 1-1,334 days). Of the 32 patients, 4 (12.5%) died and 28 (87.5 %) underwent heart transplantation. Causes of death were pneumonia (n = 1), TAH malfunction (n = 1), refractory cardiogenic shock (n = 1), and respiratory failure (n = 1). Seventy documented and 13 suspected infections developed in 25 patients (78%). The most common sources of infection were urinary tract (n = 26), respiratory tract (n = 18), and bloodstream (n = 11). There were five pump infections and two driveline infections. The number of infections per patient ranged from 0 to 10. Sixteen different pathogens were identified; the most common were: Klebsiella pneumoniae (n = 15), coagulase-negative Staphylococci (n = 10), Enterococcus species (n = 9), and Enterobacter species (n = 8). Mortality directly attributable to infection was infrequent.
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Affiliation(s)
- Luis F Hidalgo
- From the *Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, New York; †Department of Medicine, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia; and ‡Department of Surgery, Division of Cardiothoracic Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Kusne S, Staley L, Arabia F. Prevention and Infection Management in Mechanical Circulatory Support Device Recipients. Clin Infect Dis 2016; 64:222-228. [PMID: 27986679 DOI: 10.1093/cid/ciw698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/05/2016] [Indexed: 12/19/2022] Open
Abstract
There are currently no guidelines for the management of infection and its prevention in mechanical circulatory support (MCS) device recipients. The International Society of Heart and Lung Transplantation (ISHLT) has initiated a multidisciplinary collaboration for the creation of a consensus document to guide clinicians in infection prevention and management in MCS patients. Most medical centers use local protocols that are based on expert opinion. MCS recipients are debilitated and have some immunological dysfunction. Over the years there have been technical advancements with smaller devices and drivelines with improved durability. The pulsatile devices have been replaced with newer-generation continuous-flow devices. Patient are living longer with MCSs for bridge to transplant (BTT) and destination therapy (DT). MCS centers have improved patient management by introducing standardized driveline protocols, leading to reduced infection rates among MCS recipients.
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Affiliation(s)
| | - Linda Staley
- Cardiothoracic Surgery Division, Mayo Clinic, Phoenix, Arizona; and
| | - Francisco Arabia
- Cardiothoracic Surgery Division, Cedars-Sinai Medical Center, Los Angeles, California
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15
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Heart failure therapies: new strategies for old treatments and new treatments for old strategies. Cardiovasc Pathol 2016; 25:503-511. [PMID: 27619734 DOI: 10.1016/j.carpath.2016.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022] Open
Abstract
Heart failure, whether acute or chronic, remains a major health care crisis affecting almost 6 million Americans and over 23 million people worldwide. Roughly half of those affected will die within 5 years, and the annual cost exceeds $30 billion in the US alone. Although medical therapy has made some modest inroads in partially stemming the heart failure tsunami, there remains a significant population for whom medication is unsuccessful or has ceased being effective; such patients can benefit from heart transplantation or mechanical circulatory support. Indeed, in the past quarter century (and as covered in Cardiovascular Pathology over those years), significant improvements in pathologic understanding and in engineering design have materially enhanced the toolkit of options for such refractory patients. Mechanical devices, whether total artificial hearts or ventricular assist devices, have been reengineered to reduce complications and basic wear and tear. Transplant survival has also been extended through a better comprehension of and improved therapies for transplant vasculopathy and antibody-mediated rejection. Here we review the ideas and treatments from the last 25 years and highlight some of the new directions in nonpharmacologic heart failure therapy.
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Galli G, Barsi D, Martinelli E, Glisenti A, Finlay JA, Callow ME, Callow JA. Copolymer films containing amphiphilic side chains of well-defined fluoroalkyl-segment length with biofouling-release potential. RSC Adv 2016. [DOI: 10.1039/c6ra15104c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Novel methacrylate copolymers containing polysiloxane (SiMA) and mixed poly(ethyleneglycol)-perfluorohexyl side chains (MEF) were synthesised and dispersed as surface-active additives in crosslinked PDMS films.
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Affiliation(s)
- Giancarlo Galli
- Dipartimento di Chimica e Chimica Industriale and UdR Pisa INSTM
- Università di Pisa
- 56124 Pisa
- Italy
| | - David Barsi
- Dipartimento di Chimica e Chimica Industriale and UdR Pisa INSTM
- Università di Pisa
- 56124 Pisa
- Italy
| | - Elisa Martinelli
- Dipartimento di Chimica e Chimica Industriale and UdR Pisa INSTM
- Università di Pisa
- 56124 Pisa
- Italy
| | | | - John A. Finlay
- School of Biosciences
- University of Birmingham
- Birmingham B15 2TT
- UK
| | | | - James A. Callow
- School of Biosciences
- University of Birmingham
- Birmingham B15 2TT
- UK
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Trachtenberg BH, Cordero-Reyes A, Elias B, Loebe M. A review of infections in patients with left ventricular assist devices: prevention, diagnosis and management. Methodist Debakey Cardiovasc J 2015; 11:28-32. [PMID: 25793027 DOI: 10.14797/mdcj-11-1-28] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Since the advent of ventricular assist devices with smaller configurations and continuous-flow technology, survival rates for patients with end-stage heart failure have dramatically improved. While the burden of infectious complications is decreased in patients on continuous-flow ventricular assist devices compared to bulkier pulsatile-flow devices, infection remains one of the most common causes of morbidity and mortality. The majority of infections occur at the driveline exit site, beginning with a disruption or trauma to the barrier between the skin and driveline and sometimes spreading deeper. Once infections develop, they can be difficult to eradicate. Depending on the degree of infection, treatment options may include local wound care, antibiotics, or surgical treatment. Preventive strategies and careful surveillance are crucial to improve patient outcomes.
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Affiliation(s)
- Barry H Trachtenberg
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Andrea Cordero-Reyes
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Barbara Elias
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Matthias Loebe
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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18
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Eichenberger EM, Thaden JT, Sharma-Kuinkel B, Park LP, Rude TH, Ruffin F, Hos NJ, Seifert H, Rieg S, Kern WV, Lower SK, Fowler VG, Kaasch AJ. Polymorphisms in Fibronectin Binding Proteins A and B among Staphylococcus aureus Bloodstream Isolates Are Not Associated with Arthroplasty Infection. PLoS One 2015; 10:e0141436. [PMID: 26606522 PMCID: PMC4659655 DOI: 10.1371/journal.pone.0141436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 10/08/2015] [Indexed: 11/30/2022] Open
Abstract
Background Nonsynonymous single nucleotide polymorphisms (SNPs) in fibronectin binding protein A (fnbA) of Staphylococcus aureus are associated with cardiac device infections. However, the role of fnbA SNPs in S. aureus arthroplasty infection is unknown. Methods Bloodstream S. aureus isolates from a derivation cohort of patients at a single U.S. medical center with S. aureus bacteremia (SAB) and prosthetic hip or knee arthroplasties that were infected (PJI, n = 27) or uninfected (PJU, n = 43) underwent sequencing of fnbA and fnbB. A validation cohort of S. aureus bloodstream PJI (n = 12) and PJU (n = 58) isolates from Germany also underwent fnbA and fnbB sequencing. Results Overall, none of the individual fnbA or fnbB SNPs were significantly associated with the PJI or PJU clinical groups within the derivation cohort. Similarly, none of the individual fnbA or fnbB SNPs were associated with PJI or PJU when the analysis was restricted to patients with either early SAB (i.e., bacteremia occurring <1 year after placement or manipulation of prostheses) or late SAB (i.e., bacteremia >1 year after placement or manipulation of prostheses). Conclusions In contrast to cardiac device infections, there is no association between nonsynonymous SNPs in fnbA or fnbB of bloodstream S. aureus isolates and arthroplasty infection. These results suggest that initial steps leading to S. aureus infection of cardiovascular and orthopedic prostheses may arise by distinct processes.
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MESH Headings
- Adhesins, Bacterial/chemistry
- Adhesins, Bacterial/genetics
- Adhesins, Bacterial/metabolism
- Adult
- Aged
- Aged, 80 and over
- Amino Acid Sequence
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Bacteremia/microbiology
- Biofilms
- Female
- Gene Expression
- Genetic Association Studies
- Humans
- Male
- Middle Aged
- Molecular Sequence Data
- Polymorphism, Single Nucleotide
- Prosthesis-Related Infections/microbiology
- Sequence Analysis, DNA
- Staphylococcal Infections/microbiology
- Staphylococcus aureus/genetics
- Staphylococcus aureus/isolation & purification
- Young Adult
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Affiliation(s)
- Emily M. Eichenberger
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Joshua T. Thaden
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Batu Sharma-Kuinkel
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Lawrence P. Park
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
- Duke Global Health Institute, Duke University, Durham, NC 27710, United States of America
| | - Thomas H. Rude
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Felicia Ruffin
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
| | - Nina J. Hos
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
- German Centre for Infection Research (DZIF), Bonn-Cologne, University of Cologne, Albertus-Magnus-Platz, 50923 Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Winfried V. Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Steven K. Lower
- Division of Natural and Mathematical Sciences, Ohio State University, Columbus, OH 43210, United States of America
| | - Vance G. Fowler
- Division of Infectious Diseases & International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America
- * E-mail:
| | - Achim J. Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany
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Complex wound management in ventricular assist device (VAD) patients: the role of aggressive debridement and vascularized soft tissue coverage. Ann Plast Surg 2015; 73 Suppl 2:S165-70. [PMID: 25393384 DOI: 10.1097/sap.0000000000000228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infections and complex wounds after ventricular assist device (VAD) placement can result in significant morbidity and mortality. The purpose of this study was to evaluate complex wound management in the VAD patient, and to describe a treatment protocol for these challenging and potentially mortal complications. METHODS A retrospective study was performed to examine all patients who underwent continuous flow, second-generation VAD placement at the Hospital of the University of Pennsylvania between March 2008 and April 2013. RESULTS Overall, 150 VADs were placed, with 12 (8%) patients requiring 15 operative interventions by the plastic surgery services. The most common indication for operative intervention was a complicated wound with VAD exposure (5/12, 41.7%). All patients underwent aggressive operative debridement, and 11/12 (92%) underwent vascularized soft tissue coverage. Flaps commonly utilized included rectus abdominus myocutaneous (n = 4), rectus abdominus muscle (n = 4), pectoralis major (n = 3), and omentum (n = 3). Three patients experienced complications which required a return to the operating room, including 1 flap loss, 1 hematoma, and 1 wound dehiscence requiring further soft tissue coverage. Salvage was achieved, yet a 50% mortality rate in follow-up was noted. CONCLUSION Complex wound management in VAD patients can be achieved with aggressive debridement and vascularized soft tissue coverage, most commonly utilizing well-vascularized rectus abdominus muscle or omental flaps. Plastic surgeons should be familiar with the armamentarium at their disposal when approaching these challenging cases as VAD wound complications stand to become an increasingly prevalent issue.
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Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2733] [Impact Index Per Article: 303.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
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Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Baronetto A, Centofanti P, Attisani M, La Torre M, Ricci D, Rinaldi M. VAD infections: the lead, the graft and the pump. Ann Cardiothorac Surg 2014; 3:505-6. [PMID: 25452911 DOI: 10.3978/j.issn.2225-319x.2014.08.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/19/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Andrea Baronetto
- Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Turin, Turin 10126, Italy
| | - Paolo Centofanti
- Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Turin, Turin 10126, Italy
| | - Matteo Attisani
- Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Turin, Turin 10126, Italy
| | - Michele La Torre
- Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Turin, Turin 10126, Italy
| | - Davide Ricci
- Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Turin, Turin 10126, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Turin, Turin 10126, Italy
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Hos NJ, Rieg S, Kern WV, Jonas D, Fowler VG, Higgins PG, Seifert H, Kaasch AJ. Amino acid alterations in fibronectin binding protein A (FnBPA) and bacterial genotype are associated with cardiac device related infection in Staphylococcus aureus bacteraemia. J Infect 2014; 70:153-9. [PMID: 25246358 DOI: 10.1016/j.jinf.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/26/2014] [Accepted: 09/15/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Staphylococcus aureus initiates cardiac device-related infection (CDI) by binding of fibronectin binding protein A (FnBPA) to the device's surface. In FnBPA, specific "binding enhancing" amino acid alterations are associated with CDI. However, no study has investigated whether these mutations also occur in geographically different regions and whether they arise during infection or are inherent properties of the infecting isolate. METHODS We analysed bacterial isolates from 34 patients with S. aureus bacteraemia and implanted cardiac devices for association with CDI, FnBPA sequence, classification into a clonal complex (CC), and binding to fibronectin (Fn). RESULTS We confirmed that amino acid alterations at positions 652, 782, and 786 in FnBPA were associated with CDI (p = 0.005). Furthermore, CC15 and CC45 isolates were associated with CDI (p = 0.004). All isolates within a CC exhibited a characteristic mutation pattern, with major changes occurring in CC45 including a duplication of D1 and an altered immunogenic epitope in the D3 repeat. Isolates harbouring the "binding enhancing" mutations showed a slightly increased Fn binding capability, whereas Fn binding was decreased in CC45 isolates, according to a microtiter plate assay. CONCLUSIONS FnBPA sequence variations are lineage specific and display inherent properties of the infecting isolate. Sequence analysis of FnBPA, as well as the bacterial genotype, may be used to predict the risk for device-related infection.
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Affiliation(s)
- Nina J Hos
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
| | - Siegbert Rieg
- Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
| | - Winfried V Kern
- Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
| | - Daniel Jonas
- Department of Environmental Health Sciences, University Hospital of Freiburg, Germany
| | - Vance G Fowler
- Department of Medicine, Duke University, Durham, NC, USA
| | - Paul G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany; German Centre for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany.
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Antimicrobial effect of the triterpene 3β,6β,16β-trihydroxylup-20(29)-ene on planktonic cells and biofilms from Gram positive and Gram negative bacteria. BIOMED RESEARCH INTERNATIONAL 2014; 2014:729358. [PMID: 25093179 PMCID: PMC4100443 DOI: 10.1155/2014/729358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/10/2014] [Indexed: 11/17/2022]
Abstract
This study evaluated the antimicrobial effect of 3β,6β,16β-trihydroxylup-20(29)-ene (CLF1), a triterpene isolated from Combretum leprosum Mart., in inhibiting the planktonic growth and biofilms of Gram positive bacteria Streptococcus mutans and S. mitis. The antimicrobial activity was assessed by determining the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The antibiofilm potential was determined by quantifying total biomass and enumerating biofilm-entrapped viable bacteria. In addition, the acute toxicity of CLF1 on Artemia sp. nauplii was also determined. The results showed that CLF1 was able in inhibiting the growth of S. mutans and S. mitis with MIC and MBC of 7.8 μg/mL and 15.6 μg/mL, respectively. CLF1 was highly effective on biofilms of both bacteria. Only 7.8 μg/mL CLF1 was enough to inhibit by 97% and 90% biomass production of S. mutans and S. mitis, respectively. On the other hand, such effects were not evident on Gram negative Pseudomonas aeruginosa and Klebsiella oxytoca. The toxicity tests showed that the LC50 of CLF1 was 98.19 μg/mL. Therefore, CLF1 isolated from C. leprosum may constitute an important natural agent for the development of new therapies for caries and other infectious diseases caused by S. mutans and S. mitis.
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Maly J, Szarszoi O, Netuka I, Dorazilova Z, Pirk J. Fungal infections associated with long-term mechanical circulatory support-diagnosis and management. J Card Surg 2013; 29:95-100. [PMID: 24279890 DOI: 10.1111/jocs.12258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Left ventricular assist devices (LVADs) are increasingly used as a treatment option for advanced heart failure. Fungal infections present a serious concern given the high association with major adverse events including death in this group of patients. The objective of this review is to summarize the incidence, risk factors, method for diagnosis, complication rate, and outcomes in patients with VADs who develop fungal infections.
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Affiliation(s)
- Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Abstract
Left ventricular assist devices have been proven to be superior to medical therapy for advanced heart failure patients awaiting heart transplantation and viable alternatives to transplantation for destination therapy patients. Improvements in the design of ventricular assist devices have been rewarded by a decrease in adverse events and an increase in survival. Despite significant progress, even the latest generation left ventricular assist devices are burdened by a significant long-term adverse events profile that will increasingly challenge physicians as patients survive longer on implantable mechanical circulatory support. In this review, we analyze the impact of long-term adverse events on clinical outcomes in the major trials of continuous flow left ventricular assist devices. We discuss several of the more pertinent and interesting adverse events, examine their potential causes, and explore their future implications.
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Fortunati E, Mattioli S, Visai L, Imbriani M, Fierro JLG, Kenny JM, Armentano I. Combined effects of Ag nanoparticles and oxygen plasma treatment on PLGA morphological, chemical, and antibacterial properties. Biomacromolecules 2013; 14:626-36. [PMID: 23360180 DOI: 10.1021/bm301524e] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to investigate the combined effects of oxygen plasma treatments and silver nanoparticles (Ag) on PLGA in order to modulate the surface antimicrobial properties through tunable bacteria adhesion mechanisms. PLGA nanocomposite films, produced by solvent casting with 1 wt % and 7 wt % of Ag nanoparticles were investigated. The PLGA and PLGA/Ag nanocomposite surfaces were treated with oxygen plasma. Surface properties of PLGA were investigated by field emission scanning electron microscopy (FESEM), atomic force microscopy (AFM), static contact angle (CA), and high resolution X-ray photoelectron spectroscopy (XPS). Antibacterial tests were performed using an Escherichia coli RB (a Gram negative) and Staphylococcus aureus 8325-4 (a Gram positive). The PLGA surface becomes hydrophilic after the oxygen treatment and its roughness increases with the treatment time. The surface treatment and the Ag nanoparticle introduction have a dominant influence on the bacteria adhesion and growth. Oxygen-treated PLGA/Ag systems promote higher reduction of the bacteria viability in comparison to the untreated samples and neat PLGA. The combination of Ag nanoparticles with the oxygen plasma treatment opens new perspectives for the studied biodegradable systems in biomedical applications.
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Affiliation(s)
- Elena Fortunati
- Materials Engineering Center, UdR INSTM, University of Perugia , Str. Pentima 4, 05100 Terni, Italy
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Feldman D, Pamboukian SV, Teuteberg JJ, Birks E, Lietz K, Moore SA, Morgan JA, Arabia F, Bauman ME, Buchholz HW, Deng M, Dickstein ML, El-Banayosy A, Elliot T, Goldstein DJ, Grady KL, Jones K, Hryniewicz K, John R, Kaan A, Kusne S, Loebe M, Massicotte MP, Moazami N, Mohacsi P, Mooney M, Nelson T, Pagani F, Perry W, Potapov EV, Eduardo Rame J, Russell SD, Sorensen EN, Sun B, Strueber M, Mangi AA, Petty MG, Rogers J. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: Executive summary. J Heart Lung Transplant 2013; 32:157-87. [DOI: 10.1016/j.healun.2012.09.013] [Citation(s) in RCA: 850] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/14/2012] [Indexed: 02/08/2023] Open
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Other Cardiovascular Devices. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sharma V, Deo SV, Stulak JM, Durham LA, Daly RC, Park SJ, Baddour LM, Mehra K, Joyce LD. Driveline Infections in Left Ventricular Assist Devices: Implications for Destination Therapy. Ann Thorac Surg 2012; 94:1381-6. [DOI: 10.1016/j.athoracsur.2012.05.074] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/15/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
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Abstract
Infectious diseases can be difficult to cure, especially if the pathogen forms a biofilm. After decades of extensive research into the morphology, physiology and genomics of biofilm formation, attention has recently been directed toward the analysis of the cellular metabolome in order to understand the transformation of a planktonic cell to a biofilm. Metabolomics can play an invaluable role in enhancing our understanding of the underlying biological processes related to the structure, formation and antibiotic resistance of biofilms. A systematic view of metabolic pathways or processes responsible for regulating this 'social structure' of microorganisms may provide critical insights into biofilm-related drug resistance and lead to novel treatments. This review will discuss the development of NMR-based metabolomics as a technology to study medically relevant biofilms. Recent advancements from case studies reviewed in this manuscript have shown the potential of metabolomics to shed light on numerous biological problems related to biofilms.
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Affiliation(s)
- Bo Zhang
- Department of Chemistry, University of Nebraska-Lincoln, 722 Hamilton Hall, Lincoln, NE 68588-0304, USA
| | - Robert Powers
- Department of Chemistry, University of Nebraska-Lincoln, 722 Hamilton Hall, Lincoln, NE 68588-0304, USA
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Abstract
Cardiovascular devices such as coronary artery stents, ventricular assist devices, pacemakers, automated implantable cardioverter-defibrillators and septal closure devices are life saving and improve quality of life for millions of patients each year. Complications of these devices include thrombosis/thromboembolism, infection, structural failure and adverse material-tissue interactions. These findings should be sought when these devices are encountered on the surgical pathology bench or at autopsy.
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Affiliation(s)
- Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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32
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Biofilm growth on implants: bacteria prefer plasma coats. Int J Artif Organs 2012; 34:811-7. [PMID: 22094560 DOI: 10.5301/ijao.5000061] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE Bacterial biofilm formation on prostheses or devices used for osteosynthesis is increasingly recognized as cause of persistent infections, an entity known as implant-associated posttraumatic osteomyelitis. Biofilm formation is a very complex, multistep process with adhesion as the first and decisive step. The most prevalent pathogens found are staphylococci species, especially S. aureus, presumably due to a preference to non-biological materials, such as metal. Adherence is influenced by several factors, including the microenvironment, in which blood proteins from serum or plasma might influence adhesion and maybe biofilm formation. The aim of the present study was to test and to compare adherence of S. aureus and P. aeruginosa to different biological and non-biological surfaces in vitro. The question was addressed if coating of the surface by plasma or serum proteins influences bacterial adherence. METHODS Adherence of radiolabeled bacteria to different surfaces in the presence or absence or serum/plasma proteins was measured over time. RESULTS When testing adherence of S. aureus to plastic, titanium or to monolayers of epithelial cells (A549) or fibroblasts (Colo800) a clear-cut preference for non-biological surfaces, especially for titanium was seen. Using P. aeruginosa species a similar pattern without a significant difference was revealed. When mimicking the in vivo situation by pre-coating of titanium with human serum or plasma adherence was increased, especially when titanium was coated ("opsonized") by plasma. CONCLUSIONS Bacterial adherence to surfaces is determined by a variety of factors such as temperature, the presence of nutrients, the absence of host defense systems and the configuration of the covered surface. In vivo, adherence to non-biological surfaces is also influenced by the microenvironment, especially plasma proteins, promoting biofilm formation.
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Califano S, Pagani FD, Malani PN. Left Ventricular Assist Device–Associated Infections. Infect Dis Clin North Am 2012; 26:77-87. [DOI: 10.1016/j.idc.2011.09.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Xu LC, Siedlecki CA. Effects of Plasma Proteins on <i>Staphylococcus epidermidis</i> RP62A Adhesion and Interaction with Platelets on Polyurethane Biomaterial Surfaces. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jbnb.2012.324050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Padera RF, Mitchell RN. The Intervened Heart: Cardiac Hardware in the Forensic Suite. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Cardiovascular interventions—in the form of bypass grafts, stents, prosthetic valves, and ventricular assist devices—are increasingly common for the typical citizen of the industrialized world. While these certainly contribute to longevity and improved quality of life, they can also be a source of morbidity and mortality. In most cases, a handful of predictable pathogenic pathways underlie the eventual degeneration or failure of the various interventions, and may be implicated as a cause of death. Much less frequently, an untoward and unexpected complication can be the culprit. The objectives of this manuscript are to describe the more common cardiac interventions (both mechanical and surgical), highlight the typical failure modes, and present approaches to evaluate devices and grafts when encountered in the forensic autopsy suite.
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Affiliation(s)
- Robert F. Padera
- Pathologist at Brigham and Women's Hospital and Pathology at Harvard Medical School in Boston, Massachusetts
| | - Richard N. Mitchell
- Department of Pathology Boston, Massachusetts, and Harvard Medical School -Department of Pathology Boston, Massachusetts (RM)
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37
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Hannan MM, Husain S, Mattner F, Danziger-Isakov L, Drew RJ, Corey GR, Schueler S, Holman WL, Lawler LP, Gordon SM, Mahon NG, Herre JM, Gould K, Montoya JG, Padera RF, Kormos RL, Conte JV, Mooney ML. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant 2011; 30:375-84. [PMID: 21419995 DOI: 10.1016/j.healun.2011.01.717] [Citation(s) in RCA: 267] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 01/28/2011] [Indexed: 01/22/2023] Open
Affiliation(s)
- Margaret M Hannan
- Division of Cardiac Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Rizzello L, Sorce B, Sabella S, Vecchio G, Galeone A, Brunetti V, Cingolani R, Pompa PP. Impact of nanoscale topography on genomics and proteomics of adherent bacteria. ACS NANO 2011; 5:1865-76. [PMID: 21344880 DOI: 10.1021/nn102692m] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Bacterial adhesion onto inorganic/nanoengineered surfaces is a key issue in biotechnology and medicine, because it is one of the first necessary steps to determine a general pathogenic event. Understanding the molecular mechanisms of bacteria-surface interaction represents a milestone for planning a new generation of devices with unanimously certified antibacterial characteristics. Here, we show how highly controlled nanostructured substrates impact the bacterial behavior in terms of morphological, genomic, and proteomic response. We observed by atomic force microscopy (AFM) and scanning electron microscopy (SEM) that type-1 fimbriae typically disappear in Escherichia coli adherent onto nanostructured substrates, as opposed to bacteria onto reference glass or flat gold surfaces. A genetic variation of the fimbrial operon regulation was consistently identified by real time qPCR in bacteria interacting with the nanorough substrates. To gain a deeper insight into the molecular basis of the interaction mechanisms, we explored the entire proteomic profile of E. coli by 2D-DIGE, finding significant changes in the bacteria adherent onto the nanorough substrates, such as regulations of proteins involved in stress processes and defense mechanisms. We thus demonstrated that a pure physical stimulus, that is, a nanoscale variation of surface topography, may play per se a significant role in determining the morphological, genetic, and proteomic profile of bacteria. These data suggest that in depth investigations of the molecular processes of microorganisms adhering to surfaces are of great importance for the design of innovative biomaterials with active biological functionalities.
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Affiliation(s)
- Loris Rizzello
- Italian Institute of Technology, Center for Bio-Molecular Nanotechnology, Via Barsanti-73010 Arnesano, Lecce, Italy
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Thermoplastic modification of medical grade polyvinyl chloride with various antibiotics: effect of antibiotic chemical structure on mechanical, antibacterial properties, and release activity. Polym Bull (Berl) 2011. [DOI: 10.1007/s00289-011-0474-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Contreras-García A, Bucio E, Brackman G, Coenye T, Concheiro A, Alvarez-Lorenzo C. Biofilm inhibition and drug-eluting properties of novel DMAEMA-modified polyethylene and silicone rubber surfaces. BIOFOULING 2011; 27:123-135. [PMID: 21213154 DOI: 10.1080/08927014.2010.548115] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Poly(2-(dimethylaminoethyl) methacrylate) (pDMAEMA) was grafted to low density polyethylene (LDPE) and silicone rubber (SR) in order to make them less susceptible to microbial biofilm formation. The direct grafting of DMAEMA using γ-rays was an efficient and fast procedure for obtaining modified materials, which could be quaternized in a second step using methyl iodide. Raman spectroscopy showed that the grafting occurred only at the surface of the LDPE, but both at the surface and in the bulk of the SR. Consequently, the grafted chains caused changes in the surface-related features of the LDPE (water contact angle and viscoelastic behavior in the dry state) and in the bulk-related properties of the SR (swelling and viscoelasticity in the swollen state). The microbiological assays revealed that the grafted DMAEMA reduced Candida albicans biofilm formation (almost no biofilm on SR), while the quaternized surfaces inhibited C. albicans and Staphylococcus aureus biofilm by more than 99% compared to pristine materials. Modified LDPE and SR were capable of holding considerable amounts of nalidixic acid, an anionic antimicrobial drug, and sustained the release for several hours. In addition, the grafted materials were cytocompatible (fibroblast cell survival > 70%). In conclusion, these materials have the ability to inhibit microbial biofilm formation and at the same time act as drug-eluting systems, and for that reason may hold great promise for anti-biofouling applications.
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Affiliation(s)
- Angel Contreras-García
- Departamento de Quimica de Radiaciones y Radioquimica, Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, Circuito Exterior, Ciudad Universitaria, Mexico, Mexico
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Polypropylene grafted with NIPAAm and APMA for creating hemocompatible surfaces that load/elute nalidixic acid. REACT FUNCT POLYM 2010. [DOI: 10.1016/j.reactfunctpolym.2010.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Toba FA, Akashi H, Arrecubieta C, Lowy FD. Role of biofilm in Staphylococcus aureus and Staphylococcus epidermidis ventricular assist device driveline infections. J Thorac Cardiovasc Surg 2010; 141:1259-64. [PMID: 20709333 DOI: 10.1016/j.jtcvs.2010.07.016] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/22/2010] [Accepted: 07/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Infections, especially those involving drivelines, are among the most serious complications that follow ventricular assist device implantation. Staphylococci are the most common causes of these infections. Once driveline infections are established, they can remain localized or progress as an ascending infection to cause metastatic seeding of other tissue sites. Although elaboration of biofilm appears to be critical in prosthetic device infections, its role as a facilitator of staphylococcal infection and migration along the driveline and other prosthetic devices is unclear. METHODS A murine model of driveline infection was used to investigate staphylococcal migration along the driveline. A biofilm-producing strain of Staphylococcus epidermidis and a Staphylococcus aureus strain and its intercellular adhesion gene cluster (ica)-negative (biofilm-deficient) isogenic mutant were used in these studies. Bacterial density on the driveline and the underlying tissue was measured over time. Scanning electron microscopy was used to examine the morphology of S epidermidis biofilm formation as the infection progressed. RESULTS The biofilm-deficient S aureus mutant was less effective at infecting and migrating along the driveline than the wild-type strain over time. However, the ica mutation had no effect on the ability of the strain to infect underlying tissue. S aureus exhibited more rapid migration than S epidermidis. Scanning electron microscopy revealed the deposition of host matrix on the Dacron material after implantation. This was followed by elaboration of a bacterial biofilm that correlated with more rapid migration along the driveline. CONCLUSIONS Biofilm formation is a critical virulence determinant that facilitates the progression of drivelines infections.
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Affiliation(s)
- Faustino A Toba
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Mauclaire L, Egli M. Effect of simulated microgravity on growth and production of exopolymeric substances ofMicrococcus luteusspace and earth isolates. ACTA ACUST UNITED AC 2010; 59:350-6. [DOI: 10.1111/j.1574-695x.2010.00683.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Factors controlling bacterial attachment and biofilm formation on medium-chain-length polyhydroxyalkanoates (mcl-PHAs). Colloids Surf B Biointerfaces 2010; 76:104-11. [DOI: 10.1016/j.colsurfb.2009.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 09/27/2009] [Accepted: 10/12/2009] [Indexed: 11/23/2022]
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Pavithra D, Doble M. Biofilm formation, bacterial adhesion and host response on polymeric implants—issues and prevention. Biomed Mater 2008; 3:034003. [DOI: 10.1088/1748-6041/3/3/034003] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Díaz C, Schilardi P, de Mele MFL. Influence of surface sub-micropattern on the adhesion of pioneer bacteria on metals. Artif Organs 2008; 32:292-8. [PMID: 18370943 DOI: 10.1111/j.1525-1594.2008.00545.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Most of the implantable medical devices are prone to infection caused by microorganisms that form biofilms. Pseudomonads are frequently used as model species for studying bacterial adhesion. The initial stages of biofilm formation are influenced by different factors including, among others, the chemistry of the surface, the roughness, and topography. The aim of this work was to assess the early stages of Pseudomonas fluorescens biofilm formation on sub-microstructured surfaces (SMS) that are in tune with bacterial size. Copper and gold were used as the substrata. It was concluded that SMS influenced bacterial length, alignment, and distribution, whereas the chemistry of the surfaces affected bacterial length and distribution. However, the effect of the SMS was the most significant. The shape of the bacterial colonies and the polymeric substances production were also influenced by SMS and the chemistry of the surface and both factors may be considered to reduce the susceptibility of a surface to biofilm formation.
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Affiliation(s)
- Carolina Díaz
- Instituto de Investigaciones Fisicoquimicas Teoricas y Aplicadas, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
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