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Emonson NS, Dharmasiri B, Gordon EB, Borkar A, Newman B, Wickramasingha YA, Coia P, Harte T, Newton J, Allardyce BJ, Stojcevski F, Kaplan DL, Henderson LC. Biomedical Applications of Electro-Initiated Polymerisation on Ti6Al4 V Titanium Alloy using Silk Fibroin Coatings for Antibiotic Delivery and Improved Cell Metabolism. Chempluschem 2023:e202300555. [PMID: 38036452 DOI: 10.1002/cplu.202300555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/02/2023]
Abstract
Silk fibroin interactions with metallic surfaces can provide utility for medical materials and devices. Toward this goal, titanium alloy (Ti6Al4 V) was covalently grafted with polyacrylamide via electrochemically reducing 4-nitrobenzene diazonium salt in the presence of acrylamide. Analysis of the modified surfaces with FT-IR spectra, SEM and AFM were consistent with surface grafting. Functionalised titanium samples with a silk fibroin membrane, with and without impregnated therapeutics, were used to assess cytocompatibility and drug delivery. Initial cytocompatibility experiments using fibroblasts showed that the functionalised samples, both with and without silk fibroin coatings, supported significant increases between 72-136 % in cell metabolism, compared to the controls after 7 days. A 7-days release profiling showed consistent bacterial inhibition through gentamicin release with average inhibition zones of 239 mm2 . Over a 5-week period, silk fibroin coated samples, both with and without growth factors, supported better human mesenchymal stem cell metabolism with increases reaching 1031 % and 388 %, respectively, compared to samples without the silk fibroin coating with.
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Affiliation(s)
- Nicholas S Emonson
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Bhagya Dharmasiri
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Edward B Gordon
- Biomedical Engineering Department, Tufts University, Medford, MA, 02155, USA
| | - Ameya Borkar
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Ben Newman
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | | | - Piers Coia
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Timothy Harte
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Jazmyn Newton
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Benjamin J Allardyce
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - Filip Stojcevski
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
| | - David L Kaplan
- Biomedical Engineering Department, Tufts University, Medford, MA, 02155, USA
| | - Luke C Henderson
- Institute for Frontier Materials, Deakin University, Waurn Ponds, VIC, 3216, Australia
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Kluzik A, Tomczak H, Nowicki M, Grześkowiak M, Kusza K. Scanning Electron Microscope Examination as an Alternative to Classical Microbiology in the Diagnostics of Catheter-Related Sepsis? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5028. [PMID: 36981937 PMCID: PMC10049582 DOI: 10.3390/ijerph20065028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Central venous catheters are essential elements enabling the treatment of intensive care unit patients. However, these catheters are sometimes colonised by both bacteria and fungi, and thus, they may become a potential source of systemic infections-catheter-related bloodstream infections (CRBSI). The identification of the pathogen responsible for CRBSI is a time-consuming process. At the same time, the relationship between the quick identification of the pathogen and the implementation of targeted antibiotic therapy is of key importance for controlling the clinical symptoms of sepsis and septic shock in the patient. Quick diagnosis is of key importance to reduce morbidity and mortality in this group of patients. In our study, we attempted to create a catalogue of images of the most commonly cultured pathogens responsible for CRBSI. An FEI Quanta 250 FEG Scanning Electron Microscope (SEM) was used for measurements. SEM images obtained during the analysis were included in this study. Images of SEM are three-dimensional and comparable to the images seen with the human eye and are a tool used for research and measurement whenever it is necessary to analyse the state of the surface and assess its morphology. The method described in our study will not replace the current procedures recognised as the gold standard, i.e., pathogen culturing, determination of the count of microorganisms (CFU -colony forming units), and assessment of drug sensitivity. However, in some cases, the solution proposed in our study may aid the diagnosis of patients with suspected catheter-related bloodstream infections leading to sepsis and septic shock.
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Affiliation(s)
- Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
- Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 61-861 Poznan, Poland;
| | - Hanna Tomczak
- Central Microbiology Laboratory, Clinical Hospital at the Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Marek Nowicki
- Center for Advanced Technology, Adam Mickiewicz University, 61-614 Poznan, Poland;
| | - Małgorzata Grześkowiak
- Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 61-861 Poznan, Poland;
| | - Krzysztof Kusza
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
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Atomic force microscopy and scanning electron microscopy as alternative methods of early identification of pathogens causing catheter-related bloodstream infections of patients in ICU. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Vascular catheters are an indispensable element of the therapy of patients in intensive care. Their use is associated with the possibility of complications, including infectious. According to various sources, the incidence of catheter-related bloodstream infections (CRBSIs) ranges from 0.1 to 22.7 per 1,000 catheter days.
Materials and Methods
The central venous catheter tip culture samples were collected from 24 patients with suspected catheter-related bloodstream infection, from three intensive care units (ICUs). The results of microscopic examinations: atomic force microscope (AFM) and scanning electron microscope (SEM) were compared with the results of microbiological analysis of the central venous catheter tip and blood collected from the catheter.
Results
The microscopic examination and microbiological analysis of both the blood and central venous catheter samples confirmed the presence of microorganisms in 16 cases (double positive result). Our study was conducted in a short period of time (up to 6 hours) and it gave an initial answer to the question about the type of microorganisms colonising the central venous catheter. In one patient the infection was not caused by removal of the central venous catheter. However, not all results were fully consistent within the two diagnostic methods. The colonisation of the central venous catheter with Pseudomonas aeruginosa and Staphylococcus epidermidis was microbiologically confirmed, but it was not confirmed by the microscopic examination of the sample collected from patient No. 20. However, the examination enabled preliminary assessment of the microorganism colonising the catheter, which may have caused the blood infection. It cannot be ruled out that Pseudomonas aeruginosa bacilli were grown on the catheter that came into contact with blood from another source of infection, e.g. the respiratory, nervous or urinary systems. Information on the presence of cocci-shaped bacteria forming characteristic clusters or rods may enable initial diagnosis of catheter-related bloodstream infection if it is accompanied by typical clinical symptoms. Alternative diagnostics also provides valuable information on the presence of biofilm, which is a factor hindering the body’s response to infection and penetration of antibiotics.
Conclusions
Our pilot study presents new diagnostic possibilities of microscopic imaging with the atomic force microscope (AFM) and scanning electron microscope (SEM) to identify pathogens on routinely used disposable medical devices, such as the central venous catheter. On the other hand, this range of diagnostics reveals the potential to constantly improve medical materials which come into direct contact with patients’ tissues. It is important to create a database of microscopic images, which would be a repeatable diagnostic pattern and fully correlated with the results of microbiological analysis, because it would facilitate initial quick diagnosis of a potential CRBSI.
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Ielapi N, Nicoletti E, Lorè C, Guasticchi G, Avenoso T, Barbetta A, de Franciscis S, Andreucci M, Sapienza P, Serra R. The Role of Biofilm in Central Venous Catheter Related Bloodstream Infections: Evidence-based Nursing and Review of the Literature. Rev Recent Clin Trials 2021; 15:22-27. [PMID: 31656155 DOI: 10.2174/1574887114666191018144739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 10/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Biofilm is a fundamental component in the pathogenesis of infections related to the use of the central venous catheter (CVC,) which can represent an important health issue in everyday practice of nursing and medical staff. OBJECTIVE The objective of the following review is to analyze the components of biofilm and their role in catheter-related infection determinism in an evidencebased nursing perspective in such a way as to give health professionals useful suggestions in the prevention and management of these complications. METHODS The following databases were consulted for the bibliographic search: Medline, Scopus, Science Direct. Biofilm can be the cause of CVC extraction and can lead to serious haematogenic infectious complications that can increase the morbidity and mortality of affected patients. RESULTS Updated pathophysiologic knowledge of biofilm formation and appropriate diagnostic methodology are pivotal in understanding and detecting CVC-related infections. Lock therapy appears to be a useful, preventive, and therapeutic aid in the management of CVCrelated infections. New therapies attempting to stop bacterial adhesion on the materials used could represent new frontiers for the prevention of CVC-related infections. CONCLUSION The correct evidence-based nursing methods, based on the use of guidelines, provides the opportunity to minimize the risks of infection through the implementation of a series of preventive measures both during the CVC positioning phase and in the subsequent phase, for example, during device management which is performed by medical and nursing staff.
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Affiliation(s)
- Nicola Ielapi
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Emergency, Vibo Valentia Hospital, Vibo Valentia (VV), Italy
| | | | | | - Giorgio Guasticchi
- Department of Medicine, Media Valle del Tevere Hospital, Todi (PG), Italy
| | - Tiziana Avenoso
- Department of Ophtalmology. Pugliese - Ciaccio - Hospital, Catanzaro (CZ), Italy
| | - Andrea Barbetta
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Casimero C, Ruddock T, Hegarty C, Barber R, Devine A, Davis J. Minimising Blood Stream Infection: Developing New Materials for Intravascular Catheters. MEDICINES (BASEL, SWITZERLAND) 2020; 7:E49. [PMID: 32858838 PMCID: PMC7554993 DOI: 10.3390/medicines7090049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/22/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022]
Abstract
Catheter related blood stream infection is an ever present hazard for those patients requiring venous access and particularly for those requiring long term medication. The implementation of more rigorous care bundles and greater adherence to aseptic techniques have yielded substantial reductions in infection rates but the latter is still far from acceptable and continues to place a heavy burden on patients and healthcare providers. While advances in engineering design and the arrival of functional materials hold considerable promise for the development of a new generation of catheters, many challenges remain. The aim of this review is to identify the issues that presently impact catheter performance and provide a critical evaluation of the design considerations that are emerging in the pursuit of these new catheter systems.
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Affiliation(s)
| | | | | | | | | | - James Davis
- School of Engineering, Ulster University, Jordanstown BT37 0QB, Northern Ireland, UK; (C.C.); (T.R.); (C.H.); (R.B.); (A.D.)
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Khalil GM, Azqul MM. Risk factors and microbial profile of central venous catheter related blood stream infection in medical cardiac care units, National Heart Institute, Egypt. Egypt Heart J 2018; 70:361-364. [PMID: 30591755 PMCID: PMC6303371 DOI: 10.1016/j.ehj.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/14/2018] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Catheter related blood stream infection (CRBSI) is the main complication of central venous catheter (CVC) use. The aim of the study is to improve the safety of patients with central venous catheter in National Heart Institute (NHI) medical cardiac care units. METHODS A Prospective cohort study was conducted on one hundred and eleven cardiac patients in (NHI) cardiac care units from August 2017 to February 2018. All patients subjected to central venous catheter (CVC) in cardiac care units, NHI, were included except: 1. Patients with obvious source of infection, 2. Immunocompromised patients, 3. patients having infective endocarditis, 4. patients whose catheter was put outside NHI. RESULTS Noncompliance of health care providers to care bundle elements of CVC of Centers for Disease Control and Prevention (CDC) represents a risk factor for CRBSI occurrence. Coagulase negative staphylococci was the most common isolated organism. CONCLUSION Health care providers should adhere care bundle elements recommended by CDC during insertion and handling of CVC. This will in turn decrease CRBSI.
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Affiliation(s)
- Ghada Mahmoud Khalil
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Egypt
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