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Ghezzi D, Graziani G, Cappelletti M, Fadeeva IV, Montesissa M, Sassoni E, Borciani G, Barbaro K, Boi M, Baldini N, Rau JV. New strontium-based coatings show activity against pathogenic bacteria in spine infection. Front Bioeng Biotechnol 2024; 12:1347811. [PMID: 38665815 PMCID: PMC11044685 DOI: 10.3389/fbioe.2024.1347811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Infections of implants and prostheses represent relevant complications associated with the implantation of biomedical devices in spine surgery. Indeed, due to the length of the surgical procedures and the need to implant invasive devices, infections have high incidence, interfere with osseointegration, and are becoming increasingly difficult to threat with common therapies due to the acquisition of antibiotic resistance genes by pathogenic bacteria. The application of metal-substituted tricalcium phosphate coatings onto the biomedical devices is a promising strategy to simultaneously prevent bacterial infections and promote osseointegration/osseoinduction. Strontium-substituted tricalcium phosphate (Sr-TCP) is known to be an encouraging formulation with osseoinductive properties, but its antimicrobial potential is still unexplored. To this end, novel Sr-TCP coatings were manufactured by Ionized Jet Deposition technology and characterized for their physiochemical and morphological properties, cytotoxicity, and bioactivity against Escherichia coli ATCC 8739 and Staphylococcus aureus ATCC 6538P human pathogenic strains. The coatings are nanostructured, as they are composed by aggregates with diameters from 90 nm up to 1 μm, and their morphology depends significantly on the deposition time. The Sr-TCP coatings did not exhibit any cytotoxic effects on human cell lines and provided an inhibitory effect on the planktonic growth of E. coli and S. aureus strains after 8 h of incubation. Furthermore, bacterial adhesion (after 4 h of exposure) and biofilm formation (after 24 h of cell growth) were significantly reduced when the strains were cultured on Sr-TCP compared to tricalcium phosphate only coatings. On Sr-TCP coatings, E. coli and S. aureus cells lost their organization in a biofilm-like structure and showed morphological alterations due to the toxic effect of the metal. These results demonstrate the stability and anti-adhesion/antibiofilm properties of IJD-manufactured Sr-TCP coatings, which represent potential candidates for future applications to prevent prostheses infections and to promote osteointegration/osteoinduction.
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Affiliation(s)
- Daniele Ghezzi
- University of Bologna, Department of Pharmacy and Biotechnology, Bologna, Italy
| | - Gabriela Graziani
- IRCCS Istituto Ortopedico Rizzoli, Biomedical Science and Technologies and Nanobiotechnology Lab, Bologna, Italy
| | - Martina Cappelletti
- University of Bologna, Department of Pharmacy and Biotechnology, Bologna, Italy
| | - Inna V. Fadeeva
- AA Baikov Institute of Metallurgy and Materials Science, Russian Academy of Sciences, Moscow, Russia
| | - Matteo Montesissa
- University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy
| | - Enrico Sassoni
- University of Bologna, Department of Civil, Chemical, Environmental and Materials Engineering, Bologna, Italy
| | - Giorgia Borciani
- IRCCS Istituto Ortopedico Rizzoli, Biomedical Science and Technologies and Nanobiotechnology Lab, Bologna, Italy
| | | | - Marco Boi
- IRCCS Istituto Ortopedico Rizzoli, Biomedical Science and Technologies and Nanobiotechnology Lab, Bologna, Italy
| | - Nicola Baldini
- IRCCS Istituto Ortopedico Rizzoli, Biomedical Science and Technologies and Nanobiotechnology Lab, Bologna, Italy
- University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy
| | - Julietta V. Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Rome, Italy
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Rammos A, Bechlioulis A, Kekiopoulou A, Kekiopoulos P, Katsouras CS, Sioka C. Myocardial Perfusion Imaging and C-Reactive Protein in Myocardial Ischemia: A Retrospective Single-Center Study. Life (Basel) 2024; 14:261. [PMID: 38398769 PMCID: PMC10890337 DOI: 10.3390/life14020261] [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: 01/05/2024] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Inflammation is an important mechanism in atherosclerosis and plaque formation. C-reactive protein (CRP) is a common inflammatory biomarker associated with the risk of coronary heart disease. We investigated the relationship of CRP with findings from myocardial perfusion imaging (MPI). METHODS In this retrospective study, 102 consecutive patients (mean age 71 years, 68% males) who underwent MPI (for diagnostic reasons or quantification of myocardial ischemia) and CRP determination (upper limit: 6 mg/L) within 1 month from MPI were included. The patients had no infection or recent acute coronary syndrome. RESULTS The median CRP level was 4 mg/L (2, 10) among the study population. Patients with raised CRP had higher summed stress score (SSS) (p = 0.006) and summed rest score (SRS) (p = 0.001) and higher risk for SSS > 3 (OR 9.25, 95% CI 2.03-42.13, p = 0.001) compared to those with low CRP. The association of SSS and SRS with CRP levels was more evident in patients over 70 years (p = 0.027 and p = 0.005, respectively). No significant difference in summed difference score was shown. The two groups had no difference in other risk factors (p > 0.05 for all comparisons). CONCLUSION a high level of CRP was associated with the presence and extent of stress-induced myocardial ischemia in MPI.
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Affiliation(s)
- Aidonis Rammos
- 2nd Department of Cardiology, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - Aris Bechlioulis
- 2nd Department of Cardiology, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - Areti Kekiopoulou
- Department of Nuclear Medicine, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - Pavlos Kekiopoulos
- Department of Nuclear Medicine, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - Christos S. Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, 45110 Ioannina, Greece
| | - Chrissa Sioka
- Department of Nuclear Medicine, University Hospital of Ioannina, 45110 Ioannina, Greece
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Pisani AR, Rubini D, Altini C, Ruta R, Gazzilli M, Sardaro A, Iuele F, Maggialetti N, Rubini G. The Role of the 18F-FDG PET/CT in the Management of Patients Suspected of Cardiac Implantable Electronic Devices' Infection. J Pers Med 2024; 14:65. [PMID: 38248766 PMCID: PMC10820973 DOI: 10.3390/jpm14010065] [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: 11/23/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Infection of Cardiac Implantable Electronic Devices (CIEDI) is a real public health problem. The main aim of this study was to determine the diagnostic performance of 18F-FDG PET/CT in the diagnosis of CIEDI. Methods: A total of 48 patients, who performed 18F-FDG PET/CT for the clinical suspicion of CIEDI were retrospectively analyzed; all patients were provided with a model with procedural recommendations before the exam. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 18F-FDG PET/CT were calculated; the reproducibility of qualitative analysis was assessed with Cohen's κ test. The semi-quantitative parameters (SUVmax, SQR and TBR) were evaluated in CIEDI+ and CIEDI- patients using the Student' t-test; ROC curves were elaborated to detect cut-off values. The trend of image quality with regards to procedural recommendation adherence was evaluated. Results: Se, Sp, PPV, NPV and DA were respectively 96.2%, 81.8%, 86.2%, 94.7% and 89.6%. The reproducibility of qualitative analysis was excellent (K = 0.89). Semiquantitative parameters resulted statistically different in CIEDI+ and CIEDI- patients. Cut-off values were SUVmax = 2.625, SQR = 3.766 and TBR = 1.29. Trend curves showed increasing image quality due to adherence to procedural recommendations. Conclusions:18F-FDG-PET/CT is a valid tool in the management of patients suspected of CIEDI and adherence to procedural recommendations improves its image quality.
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Affiliation(s)
- Antonio Rosario Pisani
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Dino Rubini
- Radiotherapy, Precision Medicine Department, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Corinna Altini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Rossella Ruta
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesca Iuele
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Maggialetti
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Rubini
- Interdisciplinary Department of Medicine, Section of Nuclear Medicine, University of Bari "Aldo Moro", Policlinic of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Pretet V, Blondet C, Ruch Y, Martinez M, El Ghannudi S, Morel O, Hansmann Y, Schindler TH, Imperiale A. Advantages of 18F-FDG PET/CT Imaging over Modified Duke Criteria and Clinical Presumption in Patients with Challenging Suspicion of Infective Endocarditis. Diagnostics (Basel) 2021; 11:diagnostics11040720. [PMID: 33919643 PMCID: PMC8073326 DOI: 10.3390/diagnostics11040720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
According to European Society of Cardiology guidelines (ESC2015) for infective endocarditis (IE) management, modified Duke criteria (mDC) are implemented with a degree of clinical suspicion degree, leading to grades such as "possible" or "rejected" IE despite a persisting high level of clinical suspicion. Herein, we evaluate the 18F-FDG PET/CT diagnostic and therapeutic impact in IE suspicion, with emphasis on possible/rejected IE with a high clinical suspicion. Excluding cases of definite IE diagnosis, 53 patients who underwent 18F-FDG PET/CT for IE suspicion were selected and afterwards classified according to both mDC (possible IE/Duke 1, rejected IE/Duke 0) and clinical suspicion degree (high and low IE suspicion). The final status regarding IE diagnosis (gold standard) was based on the multidisciplinary decision of the Endocarditis Team, including the 'imaging specialist'. PET/CT images of the cardiac area were qualitatively interpreted and the intensity of each focus of extra-physiologic 18F-FDG uptake was evaluated by a maximum standardized uptake value (SUVmax) measurement. Extra-cardiac 18F-FDG PET/CT pathological findings were considered to be a possible embolic event, a possible source of IE, or even a concomitant infection. Based on the Endocarditis Team consensus, final diagnosis of IE was retained in 19 (36%) patients and excluded in 34 (64%). With a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and global accuracy of 79%, 100%, 100%, 89%, and 92%, respectively, PET/CT performed significantly better than mDC (p = 0.003), clinical suspicion degree (p = 0.001), and a combination of both (p = 0.001) for IE diagnosis. In 41 patients with possible/rejected IE but high clinical suspicion, sensitivity, specificity, PPV, NPV, and global accuracies were 78%, 100%, 100%, 85%, and 90%, respectively. Moreover, PET/CT contributed to patient management in 24 out of 53 (45%) cases. 18F-FDG PET/CT represents a valuable diagnostic tool that could be proposed for challenging IE cases with significant differences between mDC and clinical suspicion degree. 18F-FDG PET/CT allows a binary diagnosis (definite or rejected IE) by removing uncertain diagnostic situations, thus improving patient therapeutic management.
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Affiliation(s)
- Valentin Pretet
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
| | - Cyrille Blondet
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
| | - Yvon Ruch
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
- Infectious Diseases, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Matias Martinez
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Nuclear Medicine and Molecular Imaging, Oulton Institute, 5000 Cordoba, Argentina
- Nuclear Medicine, Hospital Privado Universitario, 5000 Cordoba, Argentina
| | - Soraya El Ghannudi
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Radiology, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Olivier Morel
- Cardiology, University Hospitals of Strasbourg, 67000 Strasbourg, France;
| | - Yves Hansmann
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
- Infectious Diseases, University Hospitals of Strasbourg, 67000 Strasbourg, France
| | - Thomas H. Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Washington University, St Louis, MO 63110, USA;
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, ICANS, University Hospitals of Strasbourg, rue Albert Calmette, 67093 Strasbourg, France; (V.P.); (C.B.); (M.M.); (S.E.G.)
- Faculty of Medicine, FMTS, University of Strasbourg, 67000 Strasbourg, France; (Y.R.); (Y.H.)
- Molecular Imaging–DRHIM, IPHC, UMR 7178, CNRS, 67037 Strasbourg, France
- Correspondence: ; Tel.: +33-368-767-448; Fax: +33-368-767-256
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Rodríguez Esteban M, Ode Febles J, Miranda Montero SI, Ramos López M, Farrais Villalba M, Álvarez Acosta L, Quijada Fumero A, Hernández Afonso J, Cabrera León A. [Evolution of antimicrobial resistance and mortality in Staphylococcus aureus endocarditis during 15 years in a university hospital]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:100-106. [PMID: 33491408 PMCID: PMC8019456 DOI: 10.37201/req/103.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. METHODS Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. RESULTS Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04). CONCLUSIONS We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.
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Affiliation(s)
- M Rodríguez Esteban
- Marcos Rodríguez Esteban. Servicio de Cardiología. Hospital Universitario Nuestra Señora de Candelaria. Ctra del Rosario, 135. 38010. Santa Cruz de Tenerife. Spain.
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