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Weber MD, Woods-Hill C, Resendiz K, Nelson E, Ryan M, Brennan L, Srinivasan A, Conlon T. Safety and Efficacy of Ethanol for Catheter Salvage and Central Line-Associated Bloodstream Infection Prophylaxis in Polyurethane Catheters in the PICU. Pediatr Crit Care Med 2024; 25:e232-e238. [PMID: 38695702 PMCID: PMC11268871 DOI: 10.1097/pcc.0000000000003454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
OBJECTIVES Ethanol lock therapy (ELT) is a potential method of central catheter salvage following central line-associated bloodstream infection (CLABSI) although there is potential risk of catheter damage in polyurethane catheters. Further, there is limited efficacy data across the spectrum of common pediatric catheters, and published ELT protocols describe dwell times that are not feasible for critically ill children. We sought to evaluate the safety and efficacy of ELT in polyurethane catheters using brief (30 min to 2 hr) dwell times in our PICU. DESIGN Investigational pilot study using historical control data. SETTING PICU in quaternary care, free-standing children's hospital. INTERVENTIONS ELT in polyurethane central venous catheters for catheter salvage. RESULTS ELT with brief dwell times was used in 25 patients, 22 of whom were bacteremic. Ultimately 11 patients, comprising 14 catheters, were diagnosed with a primary CLABSI. The catheter salvage rate in primary CLABSI patients receiving ELT was 92% (13/14) and significantly higher than the salvage rate in patients receiving antibiotics alone (non-ELT) (62%, 39/64; mean difference 0.32, 95% CI [0.14-0.50], p = 0.03). The rate of catheter fracture in all patients receiving ELT was 8% (2/25) while the rate of fracture in the non-ELT group was 13% (8/64; mean difference -0.05, 95% CI [-0.18 to 0.09], p = 0.72). The rate of tissue plasminogen activator (tPA) use in the ELT group was 8% (2/25), whereas the rate of tPA use in the non-ELT group was significantly higher at 42% (26/64; mean difference -0.34, 95% CI [-0.49 to -0.17], p = 0.002). CONCLUSIONS The use of ELT for catheter salvage and prophylaxis in the PICU is safe in a variety of polyurethane catheters. Dwell times ranging from 30 minutes to 2 hours were effective in sterilizing the catheters while allowing other therapies to continue. This approach may decrease the need for frequent line changes in a medically fragile pediatric population.
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Affiliation(s)
- Mark D. Weber
- Children’s Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, School of Nursing at the University of Pennsylvania, Philadelphia Pennsylvania
| | - Charlotte Woods-Hill
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karla Resendiz
- Children’s Hospital of Philadelphia, Department of Pharmacy, Philadelphia Pennsylvania
| | - Eileen Nelson
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Monica Ryan
- Children’s Hospital of Philadelphia, Department of Nursing, Philadelphia Pennsylvania
| | - Lauren Brennan
- Children’s Hospital of Philadelphia, Department of Patient Safety, Center for Healthcare Quality and Analytics
| | - Abhay Srinivasan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia Pennsylvania
| | - Thomas Conlon
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Martins Leal Schrekker C, Sokolovicz YCA, Raucci MG, Leal CAM, Ambrosio L, Lettieri Teixeira M, Meneghello Fuentefria A, Schrekker HS. Imidazolium Salts for Candida spp. Antibiofilm High-Density Polyethylene-Based Biomaterials. Polymers (Basel) 2023; 15:polym15051259. [PMID: 36904500 PMCID: PMC10007465 DOI: 10.3390/polym15051259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
The species of Candida present good capability to form fungal biofilms on polymeric surfaces and are related to several human diseases since many of the employed medical devices are designed using polymers, especially high-density polyethylene (HDPE). Herein, HDPE films containing 0; 0.125; 0.250 or 0.500 wt% of 1-hexadecyl-3-methylimidazolium chloride (C16MImCl) or its analog 1-hexadecyl-3-methylimidazolium methanesulfonate (C16MImMeS) were obtained by melt blending and posteriorly mechanically pressurized into films. This approach resulted in more flexible and less brittle films, which impeded the Candida albicans, C. parapsilosis, and C. tropicalis biofilm formation on their surfaces. The employed imidazolium salt (IS) concentrations did not present any significant cytotoxic effect, and the good cell adhesion/proliferation of human mesenchymal stem cells on the HDPE-IS films indicated good biocompatibility. These outcomes combined with the absence of microscopic lesions in pig skin after contact with HDPE-IS films demonstrated their potential as biomaterials for the development of effective medical device tools that reduce the risk of fungal infections.
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Affiliation(s)
- Clarissa Martins Leal Schrekker
- Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite 500, Porto Alegre 90050-170, RS, Brazil
| | - Yuri Clemente Andrade Sokolovicz
- Laboratory of Technological Processes and Catalysis, Institute of Chemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Bento Gonçalves 9500, Porto Alegre 91501-970, RS, Brazil
| | - Maria Grazia Raucci
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy (IPCB-CNR), Viale John Fitzgerald Kennedy 54, Mostra d’Oltremare Padiglione 20, 80125 Naples, Italy
| | - Claudio Alberto Martins Leal
- Laboratory of Technological Processes and Catalysis, Institute of Chemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Bento Gonçalves 9500, Porto Alegre 91501-970, RS, Brazil
| | - Luigi Ambrosio
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy (IPCB-CNR), Viale John Fitzgerald Kennedy 54, Mostra d’Oltremare Padiglione 20, 80125 Naples, Italy
| | - Mário Lettieri Teixeira
- Laboratory of Biochemistry and Toxicology, Instituto Federal Catarinense (IFC), Rodovia SC 283—km 17, Concórdia 89703-720, SC, Brazil
| | - Alexandre Meneghello Fuentefria
- Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Sarmento Leite 500, Porto Alegre 90050-170, RS, Brazil
- Faculty of Pharmacy, Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Ipiranga 2752, Porto Alegre 90610-000, RS, Brazil
- Correspondence: (A.M.F.); (H.S.S.)
| | - Henri Stephan Schrekker
- Laboratory of Technological Processes and Catalysis, Institute of Chemistry, Universidade Federal do Rio Grande do Sul (UFRGS), Avenida Bento Gonçalves 9500, Porto Alegre 91501-970, RS, Brazil
- Correspondence: (A.M.F.); (H.S.S.)
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Atriwal T, Azeem K, Husain FM, Hussain A, Khan MN, Alajmi MF, Abid M. Mechanistic Understanding of Candida albicans Biofilm Formation and Approaches for Its Inhibition. Front Microbiol 2021; 12:638609. [PMID: 33995297 PMCID: PMC8121174 DOI: 10.3389/fmicb.2021.638609] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 12/18/2022] Open
Abstract
In recent years, the demand for novel antifungal therapies has increased several- folds due to its potential to treat severe biofilm-associated infections. Biofilms are made by the sessile microorganisms attached to the abiotic or biotic surfaces, enclosed in a matrix of exopolymeric substances. This results in new phenotypic characteristics and intrinsic resistance from both host immune response and antimicrobial drugs. Candida albicans biofilm is a complex association of hyphal cells that are associated with both abiotic and animal tissues. It is an invasive fungal infection and acts as an important virulent factor. The challenges linked with biofilm-associated diseases have urged scientists to uncover the factors responsible for the formation and maturation of biofilm. Several strategies have been developed that could be adopted to eradicate biofilm-associated infections. This article presents an overview of the role of C. albicans biofilm in its pathogenicity, challenges it poses and threats associated with its formation. Further, it discusses strategies that are currently available or under development targeting prostaglandins, quorum-sensing, changing surface properties of biomedical devices, natural scaffolds, and small molecule-based chemical approaches to combat the threat of C. albicans biofilm. This review also highlights the recent developments in finding ways to increase the penetration of drugs into the extracellular matrix of biofilm using different nanomaterials against C. albicans.
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Affiliation(s)
- Tanu Atriwal
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Kashish Azeem
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
| | - Fohad Mabood Husain
- Department of Food Science and Nutrition, College of Food and Agriculture Science, King Saud University, Riyadh, Saudi Arabia
| | - Afzal Hussain
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Muhammed Nadeem Khan
- Department of Tashreehul Badan, Faculty of Unani Medicine, Aligarh Muslim University, Aligarh, India
| | - Mohamed F Alajmi
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Abid
- Medicinal Chemistry Laboratory, Department of Biosciences, Jamia Millia Islamia, New Delhi, India
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Alonso B, Pérez-Granda MJ, Latorre MC, Rodríguez C, Sánchez-Carrillo C, Muñoz P, Guembe M. Is heparinized 40% ethanol lock solution efficient for reducing bacterial and fungal biofilms in an in vitro model? PLoS One 2019; 14:e0219098. [PMID: 31283786 PMCID: PMC6613681 DOI: 10.1371/journal.pone.0219098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/16/2019] [Indexed: 12/04/2022] Open
Abstract
Background We applied an in vitro model to evaluate the efficacy of a heparinized 40% ethanol-based lock solution in a wide variety of clinical isolates causing C-RBSI. Methods A total of 100 clinical strains were collected retrospectively from the blood of patients with C-RBSI. The reduction in biomass and metabolic activity of biofilms was measured using the crystal violet (CV) assay and XTT assay, respectively. Regrowth inhibition (RI) was measured within 24 hours and 72 hours of ethanol lock therapy. Percentage reduction of ≥ 85% in RI was considered to be successful. Results Ethanol lock was more effective in reducing metabolic activity than in reducing biomass (83% vs. 50%, respectively). Percentages of RI diminished as regrowth was prolonged (57% for 24 hours and 17% for 72 hours of regrowth). No statistically significant intraspecies differences were found in biofilm reduction or in RI (p>0.05). Conclusions The use of heparinized 40% ethanol lock solution for 72 hours significantly reduced biomass and metabolic activity in clinical isolates from patients with C-RBSI. However, as biofilm has an important regrowth rate, 40% ethanol solution was not able to fully eradicate biofilm in vitro.
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Affiliation(s)
- Beatriz Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- * E-mail: (MG); (BA)
| | - María Jesús Pérez-Granda
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - María Consuelo Latorre
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carmen Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Guembe
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- * E-mail: (MG); (BA)
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Aniort J, Piraud A, Adda M, Perreira B, Bouiller M, Fourcade J, Guerraoui A, Kalbacher E, Krumel T, Moragues HL, Thibaudin D, Vela CG, Vernin G, Weclawiak H, Bernard L, Heng AE, Souweine B. Evaluation of the efficacy of an interdialytic "ethanol 40% v/v - enoxaparin 1000 U/mL" lock solution to prevent tunnelled catheter infections in chronic hemodialysis patients: a multi-centre, randomized, single blind, parallel group study. BMC Nephrol 2019; 20:149. [PMID: 31039759 PMCID: PMC6492371 DOI: 10.1186/s12882-019-1338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tunnelled dialysis catheter (TC) infections are a major health complication and are associated with increased antibiotic consumption, hospital stays, health costs and mortality. Experimental data provide evidence that Ethenox, a mixture of enoxaparine 1000 U/mL in 40% v/v ethanol, could be a promising lock solution. The aim of the study is to compare an interdialytic lock solution of Ethenox with reference lock solutions, unfractionated heparin (UFH) or citrate 4% for the prevention of TCI in hemodialysis patients. METHOD This study will monitor a multicentre, prospective, single blind, randomized, controlled, parallel group trial. The main inclusion criteria are patients > 18 years old with end-stage renal disease, treated with chronic hemodialysis/hemodiafiltration three times a week, with incident or prevalent non-impregnated internal jugular TCs inserted for at least 2 weeks and able to give informed consent. Exclusion criteria are TCI in the previous 4 weeks and anti-infective treatment for TCI in the previous 2 weeks. Patients will be randomized to receive either study treatment Ethenox in the intervention group or reference solutions in the control group, unfractionated heparin (UFH) or citrate 4% w/v according to usual practice. The primary outcome measure will be time to first TCIs assessed by an endpoint adjudication committee blinded to the study arm according to predefined criteria. Patients will receive the study treatment for up to 12 months. Intention-to-treat analysis of the primary endpoint will be performed with a marginal Cox proportional hazard model. Prospective power calculations indicate that the study will have 90% statistical power to detect a clinical significant two-fold increase in median infection-free survival if 200 patients are recruited into each arm over a period of 24 months. DISCUSSION Firm evidence of the efficacy of the Ethenox lock in preventing TCI could be of major clinical benefit for patients. The results of this study will allow the development of new guidelines based on a high level of evidence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03083184 , date of registration March 17 2017 and European Clinical Trials Database Identifier: EudraCT 2016-A00180-51), date of registration July 11 2016.
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Affiliation(s)
- Julien Aniort
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, 54 rue Montalembert, BP69, 63003 Clermont-Ferrand, Cedex 1, France
| | - Aurélien Piraud
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, 54 rue Montalembert, BP69, 63003 Clermont-Ferrand, Cedex 1, France
| | - Mireille Adda
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Bruno Perreira
- Biostatistics Unit (DRCI), University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Bouiller
- Nephrology and Dialysis Department, Emile Roux Hospital, Le Puy en Velay, France
| | - Jacques Fourcade
- Nephrology and Dialysis Department, Metropole-Savoie Hospital, Chambery, France
| | | | - Emilie Kalbacher
- Nephrology and Dialysis Department, Edouard Herriot University Hospital, Lyon, France
| | - Thierry Krumel
- Nephrology and Dialysis Department, University Hospital, Strasbourg, France
| | | | - Damien Thibaudin
- Nephrology and Dialysis Department, University Hospital, Saint Etienne, France
| | | | | | - Hugo Weclawiak
- Nephrology and Dialysis Department, Médipole Saint-Roch Clinic, Cabestany, France
| | - Lise Bernard
- Pharmacy department, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Anne Elisabeth Heng
- Nephrology, Dialysis and Transplantation Department, Gabriel Montpied University Hospital, 54 rue Montalembert, BP69, 63003 Clermont-Ferrand, Cedex 1, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
- CNRS UMR 6023, Laboratoire Microorganismes: Génome et Environnement, Université Clermont-Auvergne, Clermont-Ferrand, France
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Phua AIH, Hon KY, Holt A, O'Callaghan M, Bihari S. Candida catheter-related bloodstream infection in patients on home parenteral nutrition - Rates, risk factors, outcomes, and management. Clin Nutr ESPEN 2019; 31:1-9. [PMID: 31060825 DOI: 10.1016/j.clnesp.2019.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Catheter-related bloodstream infections (CRBSIs) are life-threatening complications for home parenteral nutrition (HPN) patients. This review clarifies Candida CRBSI rates by species, risk factors, outcomes, and management to improve effectiveness of HPN programs. METHODS A review of Candida CRBSIs in HPN patients was conducted around the following questions: 1. How often do adult and paediatric HPN patients contract Candida CRBSIs? 2. What is the proportion of different Candida species? 3. What are the risk factors? 4. How are outcomes in Candida versus other CRBSIs? 5. What are current guidelines to manage Candida CRBSIs? Specifically, should catheters be removed? What antimicrobial therapy is indicated? Are catheter lock techniques effective? RESULTS 20 studies were included - six paediatric and 14 adult. Candida represented 9.8% of paediatric CRBSIs and 11.7% of adult CRBSIs. Paediatric candidal CRBSIs featured these species: C. albicans (46.2%), C. parapsilosis (34.6%), Candida guilliermondii (11.5%), Candida tropicalis (3.8%), and mixed or other types of Candida (3.8%). Adult candidal CRBSIs featured these species: C. albicans (37.3%), C. glabrata (33.3%), C. parapsilosis (22.4%), mixed or other types of Candida (5.7%), and C. tropicalis (1.3%). Risk factors for paediatric HPN CRBSIs include underlying haematological disease and previous fungaemia. Candida infection is associated with mortality rates around 30%. In Candida CRBSIs, major guidelines advocate catheter removal prior to systemic antifungal treatment (fluconazole, amphotericin B, echinocandins), ideally until 14 days after the first negative blood culture; some studies suggest the possibility of systemic therapy while catheters remain in-situ to preserve crucial line access. Various catheter lock solutions are effective as treatment and prophylaxis, but are not yet firmly established. CONCLUSIONS Candida CRBSI is a significant danger to HPN patients causing high mortality; gold standard treatment is catheter removal and antifungal treatment, although treatments with catheters in-situ and catheter locks as prophylaxis appear to be gaining traction.
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Affiliation(s)
| | - Kay Yee Hon
- The Queen Elizabeth Hospital, SA Health, Australia
| | - Andrew Holt
- College of Medicine and Public Health, Flinders University of South, Australia; South Australian Home Parenteral Nutrition Unit
| | | | - Shailesh Bihari
- College of Medicine and Public Health, Flinders University of South, Australia; Intensive and Critical Care Unit, Flinders Medical Centre, SA Health, Australia
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Lopes BC, Borges PSGN, Gallindo RM, Tenório TBS, Machado LB, Orange FA. Ethanol Lock Therapy for the Prevention of Nontunneled Catheter‐Related Bloodstream Infection in Pediatric Patients. JPEN J Parenter Enteral Nutr 2019; 43:1044-1052. [DOI: 10.1002/jpen.1508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/13/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Bellisa Caldas Lopes
- Division of Pediatric SurgeryInstituto de Medicina Integral Prof. Fernando Figueira (IMIP) Recife Pernambuco Brazil
| | | | - Rodrigo Melo Gallindo
- Division of Pediatric SurgeryInstituto de Medicina Integral Prof. Fernando Figueira (IMIP) Recife Pernambuco Brazil
| | | | - Lara Barreto Machado
- Division of Pediatric SurgeryInstituto de Medicina Integral Prof. Fernando Figueira (IMIP) Recife Pernambuco Brazil
| | - Flávia Augusta Orange
- Division of Anesthesiology and Postgraduate Program in Palliative CareIMIP Recife Pernambuco Brazil
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Clinical Implications of Candida Biofilms. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Schrekker CML, Sokolovicz YCA, Raucci MG, Selukar BS, Klitzke JS, Lopes W, Leal CAM, de Souza IOP, Galland GB, Dos Santos JHZ, Mauler RS, Kol M, Dagorne S, Ambrosio L, Teixeira ML, Morais J, Landers R, Fuentefria AM, Schrekker HS. Multitask Imidazolium Salt Additives for Innovative Poly(l-lactide) Biomaterials: Morphology Control, Candida spp. Biofilm Inhibition, Human Mesenchymal Stem Cell Biocompatibility, and Skin Tolerance. ACS APPLIED MATERIALS & INTERFACES 2016; 8:21163-21176. [PMID: 27486827 DOI: 10.1021/acsami.6b06005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Candida species have great ability to colonize and form biofilms on medical devices, causing infections in human hosts. In this study, poly(l-lactide) films with different imidazolium salt (1-n-hexadecyl-3-methylimidazolium chloride (C16MImCl) and 1-n-hexadecyl-3-methylimidazolium methanesulfonate (C16MImMeS)) contents were prepared, using the solvent casting process. Poly(l-lactide)-imidazolium salt films were obtained with different surface morphologies (spherical and directional), and the presence of the imidazolium salt in the surface was confirmed. These films with different concentrations of the imidazolium salts C16MImCl and C16MImMeS presented antibiofilm activity against isolates of Candida tropicalis, Candida parapsilosis, and Candida albicans. The minor antibiofilm concentration assay enabled one to determine that an increasing imidazolium salt content promoted, in general, an increase in the inhibition percentage of biofilm formation. Scanning electron microscopy micrographs confirmed the effective prevention of biofilm formation on the imidazolium salt containing biomaterials. Lower concentrations of the imidazolium salts showed no cytotoxicity, and the poly(l-lactide)-imidazolium salt films presented good cell adhesion and proliferation percentages with human mesenchymal stem cells. Furthermore, no acute microscopic lesions were identified in the histopathological evaluation after contact between the films and pig ear skin. In combination with the good morphological, physicochemical, and mechanical properties, these poly(l-lactide)-based materials with imidazolium salt additives can be considered as promising biomaterials for use in the manufacturing of medical devices.
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Affiliation(s)
| | | | - Maria G Raucci
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy , Naples, Italy
| | | | | | | | | | | | | | | | | | - Moshe Kol
- School of Chemistry, Tel Aviv University , Tel Aviv, Israel
| | - Samuel Dagorne
- Laboratoire DECOMET, Institut de Chimie de Strasbourg, CNRS-Université de Strasbourg , Strasbourg, France
| | | | - Mário L Teixeira
- Laboratory of Biochemistry and Toxicology, Instituto Federal Catarinense , Concórdia, SC, Brazil
| | | | - Richard Landers
- Institute of Physics "Gleb Wataghin", Universidade Estadual de Campinas-UNICAMP , Campinas, SP, Brazil
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Compatibility of Injectable Anticoagulant Agents in Ethanol; In Vitro Antibiofilm Activity and Impact on Polyurethane Catheters of Enoxaparin 400 U/mL in 40% v/v Ethanol. PLoS One 2016; 11:e0159475. [PMID: 27441664 PMCID: PMC4956118 DOI: 10.1371/journal.pone.0159475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives Interdialytic lock solutions should maintain catheter patency and prevent catheter infections. We aimed to determine in which conditions injectable anticoagulant agents (IAAs) combined with ethanol are compatible and to assess the antibiofilm activity of the selected combination and its effects on dialysis catheters (DC). Methods The solubility and compatibility of unfractionated heparin (UFH), low molecular weight heparins (LMWHs), heparinoids and fondaparinux (50 to 2,500 U/mL) in 30 to 70% ethanol were determined by visual observation. The stability of enoxaparin in ethanol and the ethanol content were assessed by high performance liquid chromatography (HPLC) and titrimetric control, respectively. The bactericidal effect was determined on 24h-old biofilms embedded in silicone-DC. The integrity of polyurethane-DC immersed in anticoagulant-ethanol was assessed by gas chromatography-mass spectrometry (GC-MS) and compared with previously published results. Results The compatibility of IAAs and ethanol varied according to IAA type and concentration, and ethanol content. UFH in 40% ethanol was not compatible, whatever the UFH concentration used. Established limits of compatibility of enoxaparin, nadroparin, dalteparin and tinzaparin in 40% ethanol were 1350, 575, 307 and 207 U/ml, respectively, and up to 300 U/ml for danaparoid and 1 mg/mL for fondaparinux. Enoxaparin 400 U/mL in 40% ethanol (Enox/Eth) eradicated biofilm after 4 hours of exposure for Staphylococcus epidermidis, Pseudomonas aeruginosa and Candida albicans and after 24 hours for Klebsiella pneumoniae and S. aureus. Aliphatic carbonate and alcohol compounds were released by polyurethane-DC after Enox/Eth exposure, as after 40% ethanol or saline exposure. There was no significant difference between the amounts released after 30 minutes of exposure to Enox/Eth and 15 days to saline. Conclusions A 40% ethanol solution can be combined with all IAAs but UFH. Enox/Eth was effective as an anti-biofilm agent with minor impacts on DC integrity and could be a useful interdialytic lock solution.
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Girardot M, Imbert C. Novel strategies against Candida biofilms: interest of synthetic compounds. Future Microbiol 2015; 11:69-79. [PMID: 26673571 DOI: 10.2217/fmb.15.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A biofilm is a consortium of microbial cells that are attached to a substratum or an interface. It should be considered a reservoir that may induce serious infections. Indeed, Candidaspp. biofilms may be involved in the persistence or worsening of some chronic inflammatory diseases as well as in systemic infections, which may lead to high morbidity and mortality rates. New strategies are currently being explored, utilizing several synthetic compounds to prevent or fight these Candida biofilms. This article focuses on active synthetic compounds classified with regards to their modes of action: inhibition of early adherence phase, inhibition or control of biofilm maturation and finally elimination of already formed biofilms. Some of them show promise in fighting biofilm.
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Affiliation(s)
- Marion Girardot
- EBI, UMR CNRS 7267, Université de Poitiers, Bâtiment D1, 6 rue de la Milétrie, TSA 51115, 86073 POITIERS Cedex 9, France
| | - Christine Imbert
- EBI, UMR CNRS 7267, Université de Poitiers, Bâtiment D1, 6 rue de la Milétrie, TSA 51115, 86073 POITIERS Cedex 9, France
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Calvet L, Piot M, Lartigue C, Souweine B, Tardy-Poncet B. Anticoagulant properties of enoxaparin 400 IU/mL-40 % ethanol catheter lock solution. SPRINGERPLUS 2015; 4:746. [PMID: 26693105 PMCID: PMC4666847 DOI: 10.1186/s40064-015-1533-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022]
Abstract
Unfractionated heparin (UFH) is the most widely used interdialytic lock solution but has no anti-infectious properties. Ethanol at a content ≥40 %v/v eradicates experimental biofilm but has no anticoagulant properties. In contrast to UFH, enoxaparin (Enox) can be combined with 40 % ethanol without precipitation. Enoxaparin 400 UI/mL–40 % ethanol (Enox/Eth) has antibiofilm properties and therefore has promise as an alternative lock solution. This study assessed the anticoagulant properties of Enox/Eth. Enox and Enox/Eth were diluted in whole blood at a final Enox concentration of 0.5, 1 (N = 6 samples), 1.5 (N = 4) and 2 (N = 6) IU/mL. Anti-Xa activity was determined by chromogenic assay and the inhibition of endogenous thrombin potential (ETP) by thrombinography. Quantitative data were compared by the Mann-Withney U test. For Enox concentrations of 0.5, 1, 1.5 and 2 UI/mL in whole blood samples, the mean ± SD values of the anti-Xa activity were 0.68 ± 0.09, 1.26 ± 0.14, 1.73 ± 0.30, 2.35 ± 0.32 UI/mL for Enox/Eth and 0.94 ± 0.15, 1.80 ± 0.22, 2.74 ± 0.23, 3.54 ± 0.44 UI/mL for Enox (P = 0.03, P = 0.03, P = 0.13, P = 0.03); and of the percentage of ETP inhibition was 17.36 ± 9.65, 30.27 ± 17.06, 36.5 ± 17.06, 57.82 ± 15.42 for Enox/Eth, and 42.96 ± 15.68, 68.93 ± 10.01, 83.5 ± 8.81, 91.19 ± 4.67 for Enox (P = 0.03, P = 0.03, P = 0.13, P = 0.03), respectively. The median and IQR values of Enox concentration inhibiting 50 % of ETP (IC50 ETP) were 1.8 [1.1–2.4] IU/mL for Enox/Eth and 0.7 [0.3–0.9] IU/mL for Enox, P = 0.03. Enox/Eth has strong anticoagulant activity, albeit lower than that of Enox, but with an extremely low IC50 ETP compared to the Enox concentration of non-diluted Enox/Eth.
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Affiliation(s)
- Laure Calvet
- Service de Réanimation Médicale Polyvalente CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Michèle Piot
- Université de Lyon, 42023 Saint-Etienne, France ; Groupe de Recherche sur la Thrombose, EA 3065, 42023 Saint-Etienne, France
| | - Claire Lartigue
- Laboratoire Chimie Analytique et Spectrométrie de masse UMR 990 Inserm-UdA, Clermont-Ferrand, France
| | - Bertrand Souweine
- Service de Réanimation Médicale Polyvalente CHU de Clermont-Ferrand, Clermont-Ferrand, France ; Laboratoire Microorganismes: Génome Environnement (LMGE), Clermont Université, UMR CNRS 6023, Université d'Auvergne, Clermont-Ferrand, France ; Hôpital Gabriel Montpied, Service de Réanimation Médicale Polyvalente, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand Cedex 01, France
| | - Brigitte Tardy-Poncet
- Université de Lyon, 42023 Saint-Etienne, France ; Groupe de Recherche sur la Thrombose, EA 3065, 42023 Saint-Etienne, France ; Laboratoire d'Hématologie, CHU Saint-Etienne, Hôpital Nord, 42055 Saint-Etienne, France
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Qu Y, Locock K, Verma-Gaur J, Hay ID, Meagher L, Traven A. Searching for new strategies against polymicrobial biofilm infections: guanylated polymethacrylates kill mixed fungal/bacterial biofilms. J Antimicrob Chemother 2015; 71:413-21. [PMID: 26490013 DOI: 10.1093/jac/dkv334] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/14/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Biofilm-related human infections have high mortality rates due to drug resistance. Cohabitation of diverse microbes in polymicrobial biofilms is common and these infections present additional challenges for treatment compared with monomicrobial biofilms. Here, we address this therapeutic gap by assessing the potential of a new class of antimicrobial agents, guanylated polymethacrylates, in the treatment of polymicrobial biofilms built by two prominent human pathogens, the fungus Candida albicans and the bacterium Staphylococcus aureus. METHODS We used imaging and quantitative methods to test the antibiofilm efficacy of guanylated polymethacrylates, a new class of drugs that structurally mimic antimicrobial peptides. We further compared guanylated polymethacrylates with first-line antistaphylococcal and anti-Candida agents used as combinatorial therapy against polymicrobial biofilms. RESULTS Guanylated polymethacrylates were highly effective as a sole agent, killing both C. albicans and S. aureus when applied to established polymicrobial biofilms. Furthermore, they outperformed multiple combinations of current antimicrobial drugs, with one of the tested compounds killing 99.98% of S. aureus and 82.2% of C. albicans at a concentration of 128 mg/L. The extracellular biofilm matrix provided protection, increasing the MIC of the polymethacrylates by 2-4-fold when added to planktonic assays. Using the C. albicans bgl2ΔΔ mutant, we implicate matrix polysaccharide β-1,3 glucan in the mechanism of protection. Data for two structurally distinct polymers suggest that this mechanism could be minimized through chemical optimization of the polymer structure. Finally, we demonstrate that a potential application for these polymers is in antimicrobial lock therapy. CONCLUSIONS Guanylated polymethacrylates are a promising lead for the development of an effective monotherapy against C. albicans/S. aureus polymicrobial biofilms.
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Affiliation(s)
- Yue Qu
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC 3800, Australia Department of Microbiology, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC 3800, Australia Department of Infectious Diseases, The Alfred Hospital and Monash University, Melbourne, VIC 3000, Australia
| | | | - Jiyoti Verma-Gaur
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC 3800, Australia
| | - Iain D Hay
- Department of Microbiology, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC 3800, Australia
| | - Laurence Meagher
- CSIRO Manufacturing Flagship, Clayton, VIC 3168, Australia Department of Materials Science and Monash Institute of Medical Engineering, Monash University, Clayton, VIC 3800, Australia
| | - Ana Traven
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC 3800, Australia
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Sanitizing Effect of Ethanol Against Biofilms Formed by Three Gram-Negative Pathogenic Bacteria. Curr Microbiol 2015; 71:70-5. [PMID: 25941023 DOI: 10.1007/s00284-015-0828-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
Sanitizing effect of ethanol on a Yersinia enterocolitica biofilm was evaluated in terms of biomass removal and bactericidal activity. We found that 40 % ethanol was most effective for biofilm biomass removal; however, no significant difference was observed in bactericidal activity between treatment with 40 and 70 % ethanol. This unexpected low ethanol concentration requirement for biomass removal was confirmed using biofilms of two additional pathogenic bacteria, Aeromonas hydrophila and Xanthomonas oryzae. Although only three pathogenic Gram-negative bacteria were tested and the biofilm in nature was different from the biofilm in this study, the results in this study suggested the possible re-evaluation of the effective sanitizing ethanol concentration 70 %, which is the concentration commonly employed for sanitization, on bacteria in a biofilm.
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Liao Y, Zhao H, Lu X, Yang S, Zhou J, Yang R. Efficacy of Ethanol against Trichosporon asahii Biofilm in vitro. Med Mycol 2015; 53:396-404. [DOI: 10.1093/mmy/myv006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chaudhary M, Bilal MF, Du W, Chu R, Rajpurkar M, McGrath EJ. The impact of ethanol lock therapy on length of stay and catheter salvage in pediatric catheter-associated bloodstream infection. Clin Pediatr (Phila) 2014; 53:1069-76. [PMID: 24807976 DOI: 10.1177/0009922814533591] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ethanol lock therapy (ELT) with systemic antimicrobial therapy (SAT) is a treatment for catheter-associated bloodstream infections (CABSI). However, its impact on hospital length of stay (LOS) is unknown. OBJECTIVES Assess the impact of ELT on LOS, LOS attributable to CABSI (ALOS), and catheter salvage in pediatric hematology, oncology, stem cell transplant (HOSCT) CABSI. METHODS Retrospective review of HOSCT CABSI from January 2009 to July 2011. RESULTS A total of 124 CABSI episodes were reviewed in 66 patients. Mean LOS with ELT after 1 positive blood culture (BC) was 7.1 versus 12.3 days after ≥2 positive BC (P = .014). Mean ALOS was 1.6 days with ELT versus 2.9 days without ELT (P = .018). Mean ALOS with ELT after 1 positive BC was 3.75 days versus 5.8 days after ≥2 positive BC (P = .022). Catheter salvage rate: 41 of 48 (85%) with ELT versus 49 of 68 (72%) without ELT (P = .169). CONCLUSION Earlier initiation of ELT may decrease ALOS.
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Affiliation(s)
- Manu Chaudhary
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Wei Du
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | - Roland Chu
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | - Madhvi Rajpurkar
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
| | - Eric J McGrath
- Wayne State University School of Medicine; Children's Hospital of Michigan, Detroit, MI, USA
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