A comparison of the use of an ATP-based bioluminescent assay and image analysis for the assessment of bacterial adhesion to standard HEMA and biomimetic soft contact lenses

Microbial Adherence to Contact Lenses and Pseudomonas aeruginosa as a Model Organism for Microbial Keratitis

Microbial keratitis (MK), the infection of the cornea, is a devastating disease and the fifth leading cause of blindness and visual impairment around the world. The overwhelming majority of MK cases are linked to contact lens wear combined with factors which promote infection such as corneal abrasion, an immunocompromised state, improper contact lens use, or failing to routinely disinfect lenses after wear. Contact lens-related MK involves the adherence of microorganisms to the contact lens. Therefore, this review discusses the information currently available regarding the disease pathophysiology, the common types of microorganisms causing MK, physical and organic mechanisms of adhesion, material properties which are involved in adhesion, and current antimicrobial strategies. This review also concludes that Pseudomonas aeruginosa is a model organism for the investigation of contact lens microbial adherence due to its prevalence in MK cases, its extremely robust adhesion, antimicrobial-resistant properties, and the severity of the disease it causes.

Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models

Catheter-associated urinary tract infections (CAUTIs) are one of the most common nosocomial infections and can lead to numerous medical complications from the mild catheter encrustation and bladder stones to the severe septicaemia, endotoxic shock, and pyelonephritis. Catheters are one of the most commonly used medical devices in the world and can be characterised as either indwelling (ID) or intermittent catheters (IC). The primary challenges in the use of IDs are biofilm formation and encrustation. ICs are increasingly seen as a solution to the complications caused by IDs as ICs pose no risk of biofilm formation due to their short time in the body and a lower risk of bladder stone formation. Research on IDs has focused on the use of antimicrobial and antibiofilm compounds, while research on ICs has focused on preventing bacteria entering the urinary tract or coming into contact with the catheter. There is an urgent need for in vitro urinary tract models to facilitate faster research and development for CAUTI prevention. There are currently three urinary tract models that test IDs; however, there is only a single very limited model for testing ICs. There is currently no standardised urinary tract model to test the efficacies of ICs.

Comparative Analysis of Adverse Events From a Series of Proof-of-Principle Extended Wear Studies

AIM

A series of proof-of-principle extended wear (EW) contact lens studies were conducted to assess what effect different interventions had on adverse events (AEs). Comparative analysis of AEs across studies was conducted to determine whether some interventions were more effective at reducing inflammatory AEs.

METHOD

Multiple logistic regression analysis of AEs from 30-day EW studies each with a different intervention including (1) nightly replacement (NR) of lenses, (2) morning replacement (MR) of lenses, (3) instillation of prophylactic antibiotic drops (AB) each morning/evening, (4) daily lens cleaning (LC) each morning. All studies conducted at the same site using same lens type (lotrafilcon A) and EW schedule.

RESULTS

Comparison of the different interventions to the individual control groups showed no difference in significant corneal infiltrative event (CIE) or mechanical events. Replacing lenses nightly, during an EW schedule, had the highest incidence of significant CIEs (4.9% [NR] vs. 2.5% [MR] vs. 1.8% [AB] vs. 0% [LC]); however, adjusted logistic regression analysis of the combined control data compared with the individual interventions showed no difference in significant CIEs (P=0.086) or mechanical AEs (P=0.140).

CONCLUSIONS

Replacing lenses each night seemed to be inferior compared with the other interventions of replacing lenses each morning, daily lens cleaning, and daily antibiotic drop instillation during EW. The results of the collective studies and additional analysis suggest that overnight wear of contact lenses seems to create an adverse environment that remains, despite the various interventions intended to improve this adverse environment.

Impact of wall shear stress on initial bacterial adhesion in rotating annular reactor

The objective of this study was to investigate the bacterial adhesion under different wall shear stresses in turbulent flow and using a diverse bacterial consortium. A better understanding of the mechanisms governing microbial adhesion can be useful in diverse domains such as industrial processes, medical fields or environmental biotechnologies. The impact of wall shear stress—four values ranging from 0.09 to 7.3 Pa on polypropylene (PP) and polyvinyl chloride (PVC)—was carried out in rotating annular reactors to evaluate the adhesion in terms of morphological and microbiological structures. A diverse inoculum consisting of activated sludge was used. Epifluorescence microscopy was used to quantitatively and qualitatively characterize the adhesion. Attached bacterial communities were assessed by molecular fingerprinting profiles (CE-SSCP). It has been demonstrated that wall shear stress had a strong impact on both quantitative and qualitative aspects of the bacterial adhesion. ANOVA tests also demonstrated the significant impact of wall shear stress on all three tested morphological parameters (surface coverage, number of objects and size of objects) (p-values < 2.10⁻¹⁶). High wall shear stresses increased the quantity of attached bacteria but also altered their spatial distribution on the substratum surface. As the shear increased, aggregates or clusters appeared and their size grew when increasing the shears. Concerning the microbiological composition, the adhered bacterial communities changed gradually with the applied shear.

Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done

This review is largely based on a previous paper published in the journal Spinal Cord. The care of many patients undergoing long-term bladder catheterization is complicated by encrustation and blockage of their Foley catheters. This problem stems from infection by urease-producing bacteria, particularly Proteus mirabilis. These organisms colonize the catheter forming an extensive biofilm; they also generate ammonia from urea, thus elevating the pH of urine. As the pH rises, crystals of calcium and magnesium phosphates precipitate in the urine and in the catheter biofilm. The continued development of this crystalline biofilm blocks the flow of urine through the catheter. Urine then either leaks along the outside of the catheter and the patient becomes incontinent or is retained causing painful distension of the bladder and reflux of urine to the kidneys. The process of crystal deposition can also initiate stone formation. Most patients suffering from recurrent catheter encrustation develop bladder stones. P. mirabilis establishes stable residence in these stones and is extremely difficult to eliminate from the catheterized urinary tract by antibiotic therapy. If blocked catheters are not identified and changed, serious symptomatic episodes of pyelonephritis, septicaemia and endotoxic shock can result. All types of Foley catheters including silver- or nitrofurazone-coated devices are vulnerable to this problem. In this review, the ways in which biofilm formation on Foley catheters is initiated by P. mirabilis will be described. The implications of understanding these mechanisms for the development of an encrustation-resistant catheter will be discussed. Finally, the way forward for the prevention and control of this problem will be considered.

A laboratory assessment of factors that affect bacterial adhesion to contact lenses

Adhesion of pathogenic microbes, particularly bacteria, to contact lenses is implicated in contact lens related microbial adverse events. Various in vitro conditions such as type of bacteria, the size of initial inoculum, contact lens material, nutritional content of media, and incubation period can influence bacterial adhesion to contact lenses and the current study investigated the effect of these conditions on bacterial adhesion to contact lenses. There was no significant difference in numbers of bacteria that adhered to hydrogel etafilcon A or silicone hydrogel senofilcon A contact lenses. Pseudomonas aeruginosa adhered in higher numbers compared to Staphylococcus aureus. Within a genera/species, adhesion of different bacterial strains did not differ appreciably. The size of initial inoculum, nutritional content of media, and incubation period played significant roles in bacterial adhesion to lenses. A set of in vitro assay conditions to help standardize adhesion between studies have been recommended.

Quantification of initial adhesion of Enterococcus faecalis to medical grade polymers using a DNA-based fluorescence assay

This paper reports on the use of a DNA-based fluorescence assay to study and quantify the initial interactions of the uropathogen Enterococcus faecalis with different polymers commonly used for the fabrication of medical devices and implants, including polyurethane (PU), silicone (SI), high-density polyethylene (HDPE), polyamide (PA), poly(methyl methacrylate) (PMMA) and polytetrafluoroethylene (PTFE). To follow the kinetics of E. faecalis adhesion, polymer samples were incubated in bacterial solution for various times and the relative concentration of adhered bacteria was obtained using two methods: commonly used CFU plate counting and a DNA quantification assay. Results obtained from DNA-based fluorescence assays showed that E. faecalis adhesion on PU is 3-times higher than that on PTFE following exposure to bacteria for 180 min. Neither surface wettability nor surface roughness of the studied polymers was found to correlate with E. faecalis adhesion, suggesting the involvement of much more complex adhesion mechanisms of bacteria onto surfaces. SEM micrographs of adhered bacteria illustrated that adhesion was different depending on the type of polymeric substrate: adhesion on PU samples was characterized by the aggregation of bacterial cells in dense clusters, as well as by the presence of fimbriae between cells and the substrate, which could explain the high adhesion to PU compared to the other polymers. This work demonstrated that the bacterial adhesion to polymers occurs at an early stage of the contact and suggests that the initial adhesion stage should be controlled, in order to prevent subsequent biofilm formation and, thus, reduce the risk of implant-associated infections.

Detection of virulence factors in Serratia strains isolated from contact lens-associated corneal ulcers

PURPOSE

This paper reports on the microbiological findings pertaining to three Serratia isolates from soft contact lens-related corneal ulcers, which represent a complication of contact lens wear reported with increasing frequency.

METHODS

Bacterial identification and antibiotic susceptibility testing were performed using the Vitek system. Serratia's ability to form biofilm, produce gelatinase, elastase and alkaline protease, and invade human corneal epithelial (HCE) cells was investigated. The isolates' susceptibility to the following disinfectants was tested: (a) ReNu MultiPlus(®) , containing polyaminopropyl biguanide 0.0001%; (b) Opti-Free Express(®) , containing polyquaternium-1 0.001% and myristamidopropyldimethylamine 0.0005%; (c) Opti-Free Replenish(®) , containing polyquaternium-1 0.001% and myristamidopropyldimethylamine 0.0005%, and (d) Oxysept Comfort(®) , a one-step 3% hydrogen peroxide-catalase system.

RESULTS

Two Serratia marcescens and one Serratia liquefaciens were identified. All the strains were susceptible to aminoglycosides and fluoroquinolones. No isolate formed biofilm or significantly invaded HCE cells; all produced alkaline protease and gelatinase, but not elastase. Opti-Free Express(®) and Opti-Free Replenish(®) were active against S. liquefaciens, but failed to kill the S. marcescens isolates within the minimum recommended time (6 hours). ReNu MultiPlus(®) needed 6 hours to kill one strain of S. marcescens, which is 2 hours more than recommended. Conversely, Oxysept Comfort(®) was always effective within the minimum recommended time (6 hours).

CONCLUSIONS

The ability to produce alkaline protease and gelatinase may play a major role in the pathogenesis of contact lens-related Serratia keratitis. Several types of contact lens solutions may be ineffective in eradicating Serratia from contaminated contact lens cases within the minimum recommended time. Only exposure to Oxysept Comfort(®) was always effective against Serratia in this study.

A three-phase in-vitro system for studying Pseudomonas aeruginosa adhesion and biofilm formation upon hydrogel contact lenses

Background

Pseudomonas aeruginosa is commonly associated with contact lens (CL) -related eye infections, for which bacterial adhesion and biofilm formation upon hydrogel CLs is a specific risk factor. Whilst P. aeruginosa has been widely used as a model organism for initial biofilm formation on CLs, in-vitro models that closely reproduce in-vivo conditions have rarely been presented.

Results

In the current investigation, a novel in-vitro biofilm model for studying the adherence of P. aeruginosa to hydrogel CLs was established. Nutritional and interfacial conditions similar to those in the eye of a CL wearer were created through the involvement of a solid:liquid and a solid:air interface, shear forces and a complex artificial tear fluid. Bioburdens varied depending on the CL material and biofilm maturation occurred after 72 h incubation. Whilst a range of biofilm morphologies were visualised including dispersed and adherent bacterial cells, aggregates and colonies embedded in extracellular polymer substances (EPS), EPS fibres, mushroom-like formations, and crystalline structures, a compact and heterogeneous biofilm morphology predominated on all CL materials.

Conclusions

In order to better understand the process of biofilm formation on CLs and to test the efficacy of CL care solutions, representative in-vitro biofilm models are required. Here, we present a three-phase biofilm model that simulates the environment in the eye of a CL wearer and thus generates biofilms which resemble those commonly observed in-situ.

Increased resistance of contact lens-related bacterial biofilms to antimicrobial activity of soft contact lens care solutions

PURPOSE

To determine if clinical and reference strains of Pseudomonas aeruginosa, Serratia marcescens, and Staphylococcus aureus form biofilms on silicone hydrogel contact lenses and ascertain antimicrobial activities of contact lens care solutions.

METHODS

Clinical and American Type Culture Collection reference strains of P. aeruginosa, S. marcescens, and S. aureus were incubated with lotrafilcon A lenses under conditions that facilitate biofilm formation. Biofilms were quantified by quantitative culturing (colony-forming units, CFUs), and gross morphology and architecture were evaluated using scanning electron microscopy and confocal microscopy. Susceptibilities of the planktonic and biofilm growth phases of the bacteria to 5 common multipurpose contact lens care solutions and 1 hydrogen peroxide care solution were assessed.

RESULTS

Pseudomonas aeruginosa, S. marcescens, and S. aureus reference and clinical strains formed biofilms on lotrafilcon A silicone hydrogel contact lenses, as dense networks of cells arranged in multiple layers with visible extracellular matrix. The biofilms were resistant to commonly used biguanide-preserved multipurpose care solutions. Pseudomonas aeruginosa and S. aureus biofilms were susceptible to a hydrogen peroxide and a polyquaternium-preserved care solution, whereas S. marcescens biofilm was resistant to a polyquaternium-preserved care solution but susceptible to hydrogen peroxide disinfection. In contrast, the planktonic forms were always susceptible.

CONCLUSION

Pseudomonas aeruginosa, S. marcescens, and S. aureus form biofilms on lotrafilcon A contact lenses, which in contrast to planktonic cells are resistant to the antimicrobial activity of several soft contact lens care products.

Synthesis of biocompatible sterically-stabilized poly(2-(methacryloyloxy)ethyl phosphorylcholine) latexes via dispersion polymerization in alcohol/water mixtures

Poly(2-(methacryloyloxy)ethyl phosphorylcholine) (PMPC) is soluble in either 2-propanol or water but becomes insoluble in certain alcohol-rich 2-propanol/water mixtures. We have exploited this unusual cononsolvency behavior in order to prepare new biocompatible sterically stabilized PMPC latexes via nonaqueous dispersion polymerization in 2-propanol/water mixtures. All polymerizations were conducted in the presence of monomethoxy-capped poly(ethylene glycol) methacrylate (PEGMA) as a reactive stabilizer, with some formulations including ethylene glycol dimethacrylate (EGDMA) as a cross-linker. Under optimized conditions, unimodal size distributions could be obtained with a mean latex diameter of approximately 1 microm, as judged by laser diffraction and DLS. The mean latex diameter depended on both the PEGMA and initiator concentration but was almost independent of the cross-linking density. Smaller PMPC latexes were obtained by increasing the alcohol content of the dispersion medium. On dilution with water, these latexes acquired microgel character. The microgel solution viscosity was insensitive to added salt due to the so-called "antipolyelectrolyte" effect, which is characteristic of polyzwitterions. Finally, copolymerization of MPC with a fluorescein-based methacrylic comonomer produced fluorescently labeled PMPC latexes, which may have potential biomedical applications.

Influence of Surface Properties on the Adhesion of Staphylococcus epidermidis to Acrylic and Silicone

The aim of the present study was to compare the ability of eight Staphylococcus epidermidis strains to adhere to acrylic and silicone, two polymers normally used in medical devices manufacture. Furthermore, it was tried to correlate that with the surface properties of substrata and cells. Therefore, hydrophobicity and surface tension components were calculated through contact angle measurements. Surface roughness of substrata was also assessed by atomic force microscopy (AFM). No relationship was found between microbial surface hydrophobicity and adhesion capability. Nevertheless, Staphylococcus epidermidis IE214 showed very unique adhesion behaviour, with cells highly aggregated between them, which is a consequence of their specific surface features. All strains, determined as being hydrophilic, adhered at a higher extent to silicone than to acrylic, most likely due to its more hydrophobic character and higher roughness. This demonstrates the importance of biomaterial surface characteristics for bacterial adhesion.

Surface modification of poly(oligoethylene oxide methacrylate) for resisting protein adsorption

We prepare poly(2-methoxyethyl-, 2-(2-methoxyethoxy)ethyl-, 2-[2-(2-methoxyethoxy)ethoxy]ethyl methacrylate) (p(nEOMA), n=1, 2, and 3) brushed surfaces with varying the polymer density by surface initiated polymerization. The amount of bovine serum albumin (BSA) adsorbed on the surfaces is investigated. The mobility of the polymer chain in the polymer/water interfaces and the structure of adsorbed water on the surfaces are characterized by Electron Spin Resonance (ESR) and transmission-Fourier transform infrared (FT-IR) spectroscopy, respectively. This work reports the relationship between these surface properties and albumin adsorption. As a result, the surface having both a high molecular mobility and bulk-like water found to be very effective in preventing albumin adsorption.

Bacterial adhesion to phosphorylcholine-based polymers with varying cationic charge and the effect of heparin pre-adsorption

The steady increase in the use of medical implants and the associated rise of medical device infections has fuelled the need for the production of biomaterials with improved biocompatibility. 2-(methacryloyloxyethyl phosphorylcholine) (MPC) based coatings have been used to improve the biocompatibility of a number of different medical devices. Recent studies have investigated the use of a phosphorylcholine modified with cationic charge to encourage specific bio-interaction. Until now the affect of cationic charge incorporation in MPC copolymers on bacterial adhesion has not been investigated. This study attempts to address this by investigating the affect of charge on four different strains of bacteria commonly associated with medical device infections. In addition, the affect of pre-incubating these MPC-copolymers in heparin is also evaluated as this has previously been shown to improve biocompatibility and reduce bacterial adhesion. Bacterial adhesion was assessed by ATP bioluminescence and Scanning Electron Microscopy (SEM). Results suggest that bacterial adhesion generally increased with increasing cationic charge. When samples were however, pre-incubated with heparin a significant reduction in bacterial adhesion to the MPC-based samples was observed. The heparin remained bound and effective at reducing bacterial adhesion to the cationic MPC-based samples even after three weeks incubation in PBS. To conclude, the MPC-based cationic polymer coatings complexed with heparin may provide a promising solution to reduce medical device related infections.

Probing surface adhesion forces of Enterococcus faecalis to medical-grade polymers using atomic force microscopy

The aim of this study was to compare the initial adhesion forces of the uropathogen Enterococcus faecalis with the medical-grade polymers polyurethane (PU), polyamide (PA), and poly(tetrafluoroethylene) (PTFE). To quantify the cell-substrate adhesion forces, a method was developed using atomic force microscopy (AFM) in liquid that allows for the detachment of individual live cells from a polymeric surface through the application of increasing force using unmodified cantilever tips. Results show that the lateral force required to detach E. faecalis cells from a substrate differed depending on the nature of the polymeric surface: a force of 19 +/- 4 nN was required to detach cells from PU, 6 +/- 4 nN from PA, and 0.7 +/- 0.3 nN from PTFE. Among the unfluorinated polymers (PU and PA), surface wettability was inversely proportional to the strength of adhesion. AFM images also demonstrated qualitative differences in bacterial adhesion; PU was covered by clusters of cells with few cell singlets present, whereas PA was predominantly covered by individual cells. Moreover, extracellular material could be observed on some clusters of PU-adhered cells as well as in the adjacent region surrounding cells adhered on PA. E. faecalis adhesion to the fluorinated polymer (PTFE) showed different characteristics; only a few individual cells were found, and bacteria were easily damaged, and thus detached, by the tip. This work demonstrates the utility of AFM for measurement of cell-substrate lateral adhesion forces and the contribution these forces make toward understanding the initial stages of bacterial adhesion. Further, it suggests that initial adhesion can be controlled, through appropriate biomaterial design, to prevent subsequent formation of aggregates and biofilms.

Relative primary adhesion of Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus to HEMA-type contact lenses and an extended wear silicone hydrogel contact lens of high oxygen permeability

PURPOSE

To compare multiple strains of Pseudomonas aeruginosa and representative isolates of Staphylococcus aureus and Serratia marcescens for their relative primary adhesion to a high Dk silicone hydrogel lens (36% H2O) with that of a HEMA-type lens (58% H2O).

METHODS

A radiolabeled cell procedure with a 2-h cell exposure was employed for enumerating bacteria on unworn and worn silicone hydrogel (balafilcon A) and HEMA-type (etafilcon A) hydrogel lenses.

RESULTS

The degree of primary adhesion of P. aeruginosa to 7-day worn balafilcon A lens was similar to the degree of adhesion to unworn balafilcon A lenses. The degree of primary adhesion by clinical strains to unworn balafilcon A lenses and etafilcon lenses was strain variable, but did not differ markedly for the two lenses with a given strain of P. aeruginosa. Relative to most of the pseudomonad strains, adhesion to the hydrogel lenses by S. aureus and S. marcescens was non-significant.

CONCLUSION

Adhesion of strains of P. aeruginosa to a hydrogel contact lens does not appear to differ appreciably between the HEMA-type etafilcon A and the high Dk silicone hydrogel balafilcon A lens.