1
|
Cometta S, Hutmacher DW, Chai L. In vitro models for studying implant-associated biofilms - A review from the perspective of bioengineering 3D microenvironments. Biomaterials 2024; 309:122578. [PMID: 38692146 DOI: 10.1016/j.biomaterials.2024.122578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
Biofilm research has grown exponentially over the last decades, arguably due to their contribution to hospital acquired infections when they form on foreign body surfaces such as catheters and implants. Yet, translation of the knowledge acquired in the laboratory to the clinic has been slow and/or often it is not attempted by research teams to walk the talk of what is defined as 'bench to bedside'. We therefore reviewed the biofilm literature to better understand this gap. Our search revealed substantial development with respect to adapting surfaces and media used in models to mimic the clinical settings, however many of the in vitro models were too simplistic, often discounting the composition and properties of the host microenvironment and overlooking the biofilm-implant-host interactions. Failure to capture the physiological growth conditions of biofilms in vivo results in major differences between lab-grown- and clinically-relevant biofilms, particularly with respect to phenotypic profiles, virulence, and antimicrobial resistance, and they essentially impede bench-to-bedside translatability. In this review, we describe the complexity of the biological processes at the biofilm-implant-host interfaces, discuss the prerequisite for the development and characterization of biofilm models that better mimic the clinical scenario, and propose an interdisciplinary outlook of how to bioengineer biofilms in vitro by converging tissue engineering concepts and tools.
Collapse
Affiliation(s)
- Silvia Cometta
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Engineering, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Dietmar W Hutmacher
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Engineering, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology, Brisbane, QLD 4059, Australia.
| | - Liraz Chai
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; The Hebrew University of Jerusalem, Institute of Chemistry, Jerusalem, 91904, Israel; The Harvey M. Krueger Family Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 9190401, Israel.
| |
Collapse
|
2
|
Ward SA, Habibi AA, Ashkenazi I, Arshi A, Meftah M, Schwarzkopf R. Innovations in the Isolation and Treatment of Biofilms in Periprosthetic Joint Infection: A Comprehensive Review of Current and Emerging Therapies in Bone and Joint Infection Management. Orthop Clin North Am 2024; 55:171-180. [PMID: 38403364 DOI: 10.1016/j.ocl.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Periprosthetic joint infections (PJIs) are a devastating complication of joint arthroplasty surgeries that are often complicated by biofilm formation. The development of biofilms makes PJI treatment challenging as they create a barrier against antibiotics and host immune responses. This review article provides an overview of the current understanding of biofilm formation, factors that contribute to their production, and the most common organisms involved in this process. This article focuses on the identification of biofilms, as well as current methodologies and emerging therapies in the management of biofilms in PJI.
Collapse
Affiliation(s)
- Spencer A Ward
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Akram A Habibi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Itay Ashkenazi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Armin Arshi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Morteza Meftah
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA.
| |
Collapse
|
3
|
Bhagowati P, Sahariah MB. Structure, stability and electronic properties of zirconium nitride nanoclusters. NANOTECHNOLOGY 2023; 35:025701. [PMID: 37802047 DOI: 10.1088/1361-6528/ad00c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/06/2023] [Indexed: 10/08/2023]
Abstract
Zirconium nitride (ZrN) is an industrial material having very high melting point, hardness and chemical stability. Compared to the bulk ZrN, its nanoclusters (NCs) are rarely explored. In this report, we generate a few ZrN NCs usingab initiomolecular dynamics simulation. We investigate their electronic properties in terms of Bader charge, electron localization function and density of states. The obtained results are compared with their bulk counterpart. We also study the static and dynamical stability of the NCs with the help of binding energy, density of states and phonon dispersion spectra. The electron localization function of bulk ZrN is reported here for the first time to better understand its often confusing bonding behaviour.
Collapse
Affiliation(s)
- Purbajyoti Bhagowati
- Institute of Advanced Study in Science and Technology, Guwahati, Assam-781035, India
| | - Munima B Sahariah
- Institute of Advanced Study in Science and Technology, Guwahati, Assam-781035, India
| |
Collapse
|
4
|
Kang SU, Kim CH, You S, Lee DY, Kim YK, Kim SJ, Kim CK, Kim HK. Plasma Surface Modification of 3Y-TZP at Low and Atmospheric Pressures with Different Treatment Times. Int J Mol Sci 2023; 24:7663. [PMID: 37108832 PMCID: PMC10144831 DOI: 10.3390/ijms24087663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
The efficiency of plasma surface modifications depends on the operating conditions. This study investigated the effect of chamber pressure and plasma exposure time on the surface properties of 3Y-TZP with N2/Ar gas. Plate-shaped zirconia specimens were randomly divided into two categories: vacuum plasma and atmospheric plasma. Each group was subdivided into five subgroups according to the treatment time: 1, 5, 10, 15, and 20 min. Following the plasma treatments, we characterized the surface properties, including wettability, chemical composition, crystal structure, surface morphology, and zeta potential. These were analyzed through various techniques, such as contact angle measurement, XPS, XRD, SEM, FIB, CLSM, and electrokinetic measurements. The atmospheric plasma treatments increased zirconia's electron donation (γ-) capacity, while the vacuum plasma treatments decreased γ- parameter with increasing times. The highest concentration of the basic hydroxyl OH(b) groups was identified after a 5 min exposure to atmospheric plasmas. With longer exposure times, the vacuum plasmas induce electrical damage. Both plasma systems increased the zeta potential of 3Y-TZP, showing positive values in a vacuum. In the atmosphere, the zeta potential rapidly increased after 1 min. Atmospheric plasma treatments would be beneficial for the adsorption of oxygen and nitrogen from ambient air and the generation of various active species on the zirconia surface.
Collapse
Affiliation(s)
- Sung Un Kang
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon 16499, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon 16499, Republic of Korea
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Republic of Korea
| | - Sanghyun You
- Department of Chemical Engineering, Department of Energy Systems Research, Ajou University, Suwon 16499, Republic of Korea
| | - Da-Young Lee
- Department of Chemistry, Department of Energy Systems Research, Ajou University, Suwon 16499, Republic of Korea
| | - Yu-Kwon Kim
- Department of Chemistry, Department of Energy Systems Research, Ajou University, Suwon 16499, Republic of Korea
| | - Seung-Joo Kim
- Department of Chemistry, Department of Energy Systems Research, Ajou University, Suwon 16499, Republic of Korea
| | - Chang-Koo Kim
- Department of Chemical Engineering, Department of Energy Systems Research, Ajou University, Suwon 16499, Republic of Korea
| | - Hee-Kyung Kim
- Department of Prosthodontics, Institute of Oral Health Science, School of Medicine, Ajou University, Suwon 16499, Republic of Korea
| |
Collapse
|
5
|
Biological Characteristics of Polyurethane-Based Bone-Replacement Materials. Polymers (Basel) 2023; 15:polym15040831. [PMID: 36850115 PMCID: PMC9966979 DOI: 10.3390/polym15040831] [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: 12/15/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
A study is presented on four polymers of the polyurethane family, obtained using a two-stage process. The first composition is the basic polymer; the others differ from it by the presence of a variety of fillers, introduced to provide radiopacity. The fillers used were 15% bismuth oxide (Composition 2), 15% tantalum pentoxide (Composition 3), or 15% zirconium oxide (Composition 4). Using a test culture of human fibroblasts enabled the level of cytotoxicity of the compositions to be determined by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay, along with variations in the characteristics of the cells resulting from their culture directly on the specimens. The condition of cells on the surfaces of the specimens was assessed using fluorescence microscopy. It was shown that introducing 15% bismuth, tantalum, or zinc compounds as fillers produced a range of effects on the biological characteristics of the compositions. With the different fillers, the levels of toxicity differed and the cells' proliferative activity or adhesion was affected. However, in general, all the studied compositions may be considered cytocompatible in respect of their biological characteristics and are promising for further development as bases for bone-substituting materials. The results obtained also open up prospects for further investigations of polyurethane compounds.
Collapse
|
6
|
Chowdhury MA, Hossain N, Mostofa MG, Mia MR, Tushar M, Rana MM, Hossain MH. Green synthesis and characterization of zirconium nanoparticlefor dental implant applications. Heliyon 2022; 9:e12711. [PMID: 36685390 PMCID: PMC9850058 DOI: 10.1016/j.heliyon.2022.e12711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/26/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
Green synthesis is a promising and cost-effective technique to synthesize nanoparticles from plant extract. The present study shows the green synthesis of zirconium nanoparticles using the extract of ginger, garlic, and zirconium nitride. The obtained nanoparticles were studied for potential dental implant applications. The synthesized nanoparticles were characterized by Fourier Transform Infrared Spectroscopy (FTIR), Field Emission Scanning Electron Microscopy (FESEM), Energy Dispersive X-Ray Spectroscopy (EDX), X-Ray diffraction analysis (XRD), and antibacterial analysis. FTIR analysis confirmed the presence of various organic compounds in the synthesized nanoparticles. The synthesized nanoparticles were spherical, triangular, and irregular, with varying sizes confirmed by FESEM analysis. The nanoparticles synthesized from the combination of garlic and ginger, and zirconium exhibited potent antibacterial activity against S. aureus. Anti-biofilm, anti-microbial activity, biointegration formation, and cell mechanism survival are also mentioned. Thus, the synthesized nanoparticles can be a good candidate for a dental implant because of their excellent antimicrobial properties.
Collapse
Affiliation(s)
- Mohammad Asaduzzaman Chowdhury
- Department of Mechanical Engineering, Dhaka University of Engineering and Technology (DUET), Gazipur, Gazipur, 1707, Bangladesh
| | - Nayem Hossain
- Department of Mechanical Engineering, IUBAT-International University of Business Agriculture and Technology, Bangladesh,Corresponding author.
| | - Md. Golam Mostofa
- Department of Mechanical Engineering, Dhaka University of Engineering and Technology (DUET), Gazipur, Gazipur, 1707, Bangladesh
| | - Md. Riyad Mia
- Department of Mechanical Engineering, Dhaka University of Engineering and Technology (DUET), Gazipur, Gazipur, 1707, Bangladesh
| | - Md. Tushar
- Department of Mechanical Engineering, Dhaka University of Engineering and Technology (DUET), Gazipur, Gazipur, 1707, Bangladesh
| | - Md. Masud Rana
- Department of Mechanical Engineering, Dhaka University of Engineering and Technology, Gazipur, Bangladesh
| | - Md. Helal Hossain
- Department of Mechanical Engineering, Dhaka University of Engineering and Technology, Gazipur, Bangladesh
| |
Collapse
|
7
|
Stogov MV, Emanov AA, Goodovykh NV, Ovchinnikov EN, Tushina NV, Kuznetsov VP. Microbiological Profile of the Implantation Zone under Different Mechanical Compression of Percutaneous Implants: Experimental Study. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022; 28:38-47. [DOI: 10.17816/2311-2905-1725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Background. Infection of percutaneous implants in patients with limb amputation is the most common complication.
Aim of the study evaluation of the microflora in the implantation zone depending on the mechanical compression of the implant in conditions of its additional external fixation.
Methods. The study was performed on 36 male rabbits. The tibia of all the rabbits was sawn at the border of the upper and middle parts. The medullary canal was reamed and a percutaneous implant was placed in the tibial stump. The segment and the implant were fixed with an Ilizarov apparatus. An additional compression device was installed in 30 animals. We used 5 compression modes, accordingly, 6 experimental groups were formed, 6 animals in each: group 1 without compression, group 2 compression on the implant with force of 0.053 N/mm2, group 3 compression on the implant with force of 0.105 N/mm2, group 4 compression on the implant with force of 0.158 N/mm2, group 5 compression on the implant with force of 0.211 N/mm2, group 6 compression on the implant with force of 0.263 N/mm2. The restraint was removed 6 weeks after implantation for a total follow-up of 26 weeks. The microflora of the place where the implant enters the skin (the implant / skin interface) was investigated, the level of blood leukocytes and the level of C-reactive protein in blood serum were determined.
Results. On days 9-10 after implantation, significant differences in the microbial landscape were found at the site of the exit of the metal implant in animals of different groups. The largest number of strains was found in animals of groups 1, 5 and 6, the smallest in groups 2 and 3. The most frequently detected strains: S. saprophyticus and Enterococcus spp. It was found that the greatest statistically significant increase in the level of CRP in the blood serum was observed in animals of group 6. The level of leukocytes in animals of all groups did not change statistically significantly relative to preoperative values. Animals with better osseointegration (groups 2 and 3 no cases of implant loss) showed a minimal number of growing strains.
Conclusions. The microbiological profile of the implantation zone of percutaneous implants changes depending on the amount of mechanical compression. The optimal mode is 0.053-0.105 N/mm2.
Collapse
|
8
|
Cyphert EL, Zhang N, Learn GD, Hernandez CJ, von Recum HA. Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo. ACS Infect Dis 2021; 7:3125-3160. [PMID: 34761915 DOI: 10.1021/acsinfecdis.1c00465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While orthopedic implant-associated infections are rare, revision surgeries resulting from infections incur considerable healthcare costs and represent a substantial research area clinically, in academia, and in industry. In recent years, there have been numerous advances in the development of antimicrobial strategies for the prevention and treatment of orthopedic implant-associated infections which offer promise to improve the limitations of existing delivery systems through local and controlled release of antimicrobial agents. Prior to translation to in vivo orthopedic implant-associated infection models, the properties (e.g., degradation, antimicrobial activity, biocompatibility) of the antimicrobial materials can be evaluated in subcutaneous implant in vivo models. The antimicrobial materials are then incorporated into in vivo implant models to evaluate the efficacy of using the material to prevent or treat implant-associated infections. Recent technological advances such as 3D-printing, bacterial genomic sequencing, and real-time in vivo imaging of infection and inflammation have contributed to the development of preclinical implant-associated infection models that more effectively recapitulate the clinical presentation of infections and improve the evaluation of antimicrobial materials. This Review highlights the advantages and limitations of antimicrobial materials used in conjunction with orthopedic implants for the prevention and treatment of orthopedic implant-associated infections and discusses how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers in the selection of an appropriate orthopedic implant-associated infection preclinical model to evaluate novel antimicrobial materials.
Collapse
Affiliation(s)
- Erika L. Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Greg D. Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Christopher J. Hernandez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
- Hospital for Special Surgery, New York, New York 10021, United States
| | - Horst A. von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| |
Collapse
|
9
|
Guo J, Cao G, Wang X, Tang W, Diwu W, Yan M, Yang M, Bi L, Han Y. Coating CoCrMo Alloy with Graphene Oxide and ε-Poly-L-Lysine Enhances Its Antibacterial and Antibiofilm Properties. Int J Nanomedicine 2021; 16:7249-7268. [PMID: 34737563 PMCID: PMC8560011 DOI: 10.2147/ijn.s321800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION With increases in implant infections, the search for antibacterial and biofilm coatings has become a new interest for orthopaedists and dentists. In recent years, graphene oxide (GO) has been extensively studied for its superior antibacterial properties. However, most of these studies have focused on solutions and there are few antibacterial studies on metal surfaces, especially the surfaces of cobalt-chromium-molybdenum (CoCrMo) alloys. ε-Poly-L-lysine (ε-PLL), as a novel food preservative, has a spectrum of antimicrobial activity; however, its antimicrobial activity after coating an implant surface is not clear. METHODS In this study, for the first time, a two-step electrodeposition method was used to coat GO and ε-PLL on the surface of a CoCrMo alloy. Its antibacterial and antibiofilm properties against S. aureus and E. coli were then studied. RESULTS The results show that the formation of bacteria and biofilms on the coating surface was significantly inhibited, GO and ε-PLL composite coatings had the best antibacterial and antibiofilm effects, followed by ε-PLL and GO coatings. In terms of classification, the coatings are anti-adhesive and contact-killing/inhibitory surfaces. In addition to oxidative stress, physical damage to GO and electrostatic osmosis of ε-PLL are the main antibacterial and antibiofilm mechanisms. DISCUSSION This is the first study that GO and ε-PLL coatings were successfully prepared on the surface of CoCrMo alloy by electrodeposition. It provides a promising new approach to the problem of implant infection in orthopedics and stomatology.
Collapse
Affiliation(s)
- Jianbin Guo
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
- Department of Joint Surgery, Hong-Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, People’s Republic of China
| | - Guihua Cao
- Department of Geriatrics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Xing Wang
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Wenhao Tang
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Weilong Diwu
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Ming Yan
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Min Yang
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Long Bi
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| | - Yisheng Han
- Department of Orthopedics, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, People’s Republic of China
| |
Collapse
|
10
|
Redanz S, Enz A, Podbielski A, Warnke P. Targeted Swabbing of Implant-Associated Biofilm Formation-A Staining-Guided Sampling Approach for Optimizing Routine Microbiological Diagnostics. Diagnostics (Basel) 2021; 11:diagnostics11061038. [PMID: 34200008 PMCID: PMC8228097 DOI: 10.3390/diagnostics11061038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Swabbing of implants removed from potentially infected sites represents a time saving and ubiquitously applicable alternative to sonication approaches. The latter bears an elevated risk of processing related contaminations due to the high number of handling steps. Since biofilms are usually invisible to the naked eye, adequate swabbing relies on the chance of hitting the colonized area on the implant. A targeted directed swabbing approach could overcome this detriment. Method: Three dyes were tested at different concentrations for their toxicity on biofilm-associated cells of S. epidermidis, the species most frequently identified as a causative agent of implant-associated infections. Results: Malachite green (0.2%) delivered the highest bacterial recovery rates combined with the best results in biofilm visualization. Its suitability for diagnostic approaches was demonstrated for smooth and rough implant surfaces. Biofilm-covered areas were successfully visualized. Conclusion: Subsequent targeted swab-sampling resulted in a significantly increased bacterial recovery rate compared to a dye-free “random swabbing” diagnostic approach.
Collapse
Affiliation(s)
- Sylvio Redanz
- Institute of Medical Microbiology, Virology, and Hygiene, University Medicine Rostock, Schillingallee 70, 18057 Rostock, Germany; (S.R.); (A.P.); (P.W.)
- Department of Translational Rheumatology and Immunology, Institute for Musculoskeletal Medicine, Medical Faculty Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Andreas Enz
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberaner Str. 142, 18057 Rostock, Germany
- Correspondence: ; Tel.: +49-(0)381-494-9301
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology, and Hygiene, University Medicine Rostock, Schillingallee 70, 18057 Rostock, Germany; (S.R.); (A.P.); (P.W.)
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology, and Hygiene, University Medicine Rostock, Schillingallee 70, 18057 Rostock, Germany; (S.R.); (A.P.); (P.W.)
| |
Collapse
|
11
|
Grimberg AW, Grupp TM, Elliott J, Melsheimer O, Jansson V, Steinbrück A. Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection. J Arthroplasty 2021; 36:991-997. [PMID: 33012599 DOI: 10.1016/j.arth.2020.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA. METHODS In total, 117,660 cemented primary TKAs in patients with primary osteoarthritis recorded in the German arthroplasty registry since 2012 were followed up for a maximum of 3 years. The primary endpoint was risk of revision for PJI on ceramic coated and uncoated cobalt-chromium-molybdenum femoral components. Propensity score matching for age, gender, obesity, diabetes mellitus, depression and Elixhauser comorbidity index, and substratification on common design twins with and without coating was performed. RESULTS In total, 4637 TKAs (85.1% female) with a ceramic-coated femoral component were identified, 42 had been revised for PJI and 122 for other reasons at 3 years. No survival advantage due to the risk of revision for PJI could be determined for ceramic-coated components. Revision for all other reasons demonstrated a significant higher rate for TKAs with ceramic-coated components. However, the results of this were confounded by a strong prevalence (20.7% vs 0.3%) of metal sensitivity in the ceramic-coated group. CONCLUSION No evidence of reduced risk for PJI due to ceramic-coated implants in cemented primary TKA was found. Further analysis for revision reasons other than PJI is required.
Collapse
Affiliation(s)
- Alexander W Grimberg
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Johanna Elliott
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Department of Orthopaedic Surgery and Traumatology, St Vinzenz Hospital, Dinslaken, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany
| | - Arnd Steinbrück
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany; German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; Orthopaedic Surgical Competence Center Augsburg (OCKA), Augsburg, Germany
| |
Collapse
|
12
|
Antibacterial and antibiofilm properties of graphene and its derivatives. Colloids Surf B Biointerfaces 2021; 200:111588. [PMID: 33529928 DOI: 10.1016/j.colsurfb.2021.111588] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 12/22/2022]
Abstract
Infections resulting from bacteria and biofilms have become a huge problem threatening human health. In recent years, the antibacterial and antibiofilm effects of graphene and its derivatives have been extensively studied. However, there continues to be some controversy over whether graphene and its derivatives can resist infection and biofilms. Moreover, the antibacterial mechanism and cytotoxicity of graphene and its derivatives are unclear. In the present review, antibacterial and antibiofilm abilities of graphene and its derivatives in solution, on the surface are reviewed, and their toxicity and possible mechanisms are also reviewed. Furthermore, we propose possible future development directions for graphene and its derivatives in antibacterial and antibiofilm applications.
Collapse
|
13
|
Abstract
Rates of peri-prosthetic joint infection (PJI) in primary total hip and total knee arthroplasty range between 0.3% and 1.9%, and up to 10% in revision cases. Significant morbidity is associated with this devastating complication, the economic burden on our healthcare system is considerable, and the personal cost to the affected patient is immeasurable. The risk of surgical site infection (SSI) and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. Reducing the risk of SSI in primary hip and knee arthroplasty requires a multi-faceted strategy including pre-operative patient bacterial decolonization, screening and avoidance of anaemia, peri-operative patient warming, skin antisepsis, povidone-iodine wound lavage, and anti-bacterial coated sutures. This article also considers newer concepts such as the influence of bearing surfaces on infection risk, as well as current controversies such as the potential effects of blood transfusion, laminar flow, and protective hoods and suits, on infection risk.
Cite this article: EFORT Open Rev 2020;5:604-613. DOI: 10.1302/2058-5241.5.200004
Collapse
Affiliation(s)
- Philip F Dobson
- Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK
| | - Michael R Reed
- Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK
| |
Collapse
|
14
|
Kunrath MF, Monteiro MS, Gupta S, Hubler R, de Oliveira SD. Influence of titanium and zirconia modified surfaces for rapid healing on adhesion and biofilm formation of Staphylococcus epidermidis. Arch Oral Biol 2020; 117:104824. [DOI: 10.1016/j.archoralbio.2020.104824] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
|
15
|
Fabritius M, Al-Munajjed AA, Freytag C, Jülke H, Zehe M, Lemarchand T, Arts JJ, Schumann D, Alt V, Sternberg K. Antimicrobial Silver Multilayer Coating for Prevention of Bacterial Colonization of Orthopedic Implants. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E1415. [PMID: 32245004 PMCID: PMC7143109 DOI: 10.3390/ma13061415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
Due to increasing rates of periprosthetic joint infections (PJI), new approaches are needed to minimize the infection risk. The first goal of this study was to modify a well-established infection model to test surface-active antimicrobial systems. The second goal was to evaluate the antimicrobial activity of a silver multilayer (SML) coating. In vitro tests with SML items showed a >4 Log reduction in a proliferation assay and a 2.2 Log reduction in an agar immersion test (7 d). In the in vivo model blank and SML coated K-wires were seeded with ~2 × 104 CFU of a methicillin-sensitive Staphylococcus epidermidis (MSSE) and inserted into the intramedullary tibial canal of rabbits. After 7 days, the animals were sacrificed and a clinical, microbiological and histological analysis was performed. Microbiology showed a 1.6 Log pathogen reduction on the surface of SML items (p = 0.022) and in loosely attached tissue (p = 0.012). In the SML group 7 of 12 SML items were completely free of pathogens (cure rate = 58%, p = 0.002), while only 1 of 12 blank items were free of pathogens (cure rate = 8%, p = 0.110). No silver was detected in the blood or urine of the SML treated animals and only scarcely in the liver or adjacent lymph nodes. In summary, an in vivo infection model to test implants with bacterial pre-incubation was established and the antimicrobial activity of the SML coating was successfully proven.
Collapse
Affiliation(s)
- Martin Fabritius
- Aesculap AG, Research and Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (D.S.); (K.S.)
| | | | | | | | - Markus Zehe
- QualityLabs, Neumeyerstr. 46a, 90411 Nuremberg, Germany;
| | | | - Jacobus J. Arts
- Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, 6202 Maastricht, The Netherlands;
| | - Detlef Schumann
- Aesculap AG, Research and Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (D.S.); (K.S.)
| | - Volker Alt
- Department of Trauma Surgery, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Katrin Sternberg
- Aesculap AG, Research and Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany; (D.S.); (K.S.)
| |
Collapse
|
16
|
Pedroza-Dávila U, Uribe-Alvarez C, Morales-García L, Espinoza-Simón E, Méndez-Romero O, Muhlia-Almazán A, Chiquete-Félix N, Uribe-Carvajal S. Metabolism, ATP production and biofilm generation by Staphylococcus epidermidis in either respiratory or fermentative conditions. AMB Express 2020; 10:31. [PMID: 32048056 PMCID: PMC7013028 DOI: 10.1186/s13568-020-00966-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023] Open
Abstract
Staphylococcus epidermidis is a Gram-positive saprophytic bacterium found in the microaerobic/anaerobic layers of the skin that becomes a health hazard when it is carried across the skin through punctures or wounds. Pathogenicity is enhanced by the ability of S. epidermidis to associate into biofilms, where it avoids attacks by the host and antibiotics. To test the effect of oxygen on metabolism and biofilm generation, cells were cultured at different oxygen concentrations ([O2]). As [O2] decreased, S. epidermidis metabolism went from respiratory to fermentative. Remarkably, the rate of growth decreased at low [O2] while a high concentration of ATP ([ATP]) was kept. Under hypoxic conditions bacteria associated into biofilms. Aerobic activity sensitized the cell to hydrogen peroxide-mediated damage. In the presence of metabolic inhibitors, biofilm formation decreased. It is suggested that at low [O2] S. epidermidis limits its growth and develops the ability to form biofilms.
Collapse
|
17
|
Wang X, Wang S, Fu J, Sun D, Shen J, Xie Z. Risk factors associated with recurrence of extremity osteomyelitis treated with the induced membrane technique. Injury 2020; 51:307-311. [PMID: 31771787 DOI: 10.1016/j.injury.2019.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/10/2019] [Accepted: 11/20/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Our aim was to observe the efficacy of the induced membrane technique in the treatment of extremity osteomyelitis and to analyse the causes of infection recurrence and its risk factors. METHODS We retrospectively analysed 424 cases of extremity osteomyelitis treated with the induced membrane technique in our department between May 2013 and June 2017. Infection recurrence time, recurrence sites and other relevant information were collected, summarized, and analysed. RESULTS A total of 424 patients were considered as "cured" of osteomyelitis after the first stage and the induced membrane technique was performed to rebuild the bone defects. After a mean follow-up of 31.6 (16-63) months, 52 patients had recurrence of infection, including 42 tibias and 10 femurs. The recurrence rate was 12.26%. Symptoms were relieved in 16 patients after intravenous antibiotic treatment. In the remaining 36 cases (8.49%), the infection was uncontrolled by intravenous antibiotics and surgical debridement was performed. The recurrence rate of infection of the tibia (16.22%) was higher than that of the femur (8.70%). The recurrence rate of post-traumatic osteomyelitis (14.66%) was significantly higher than that of hematogenous osteomyelitis (2.41%). Patients in whom Pseudomonas aeruginosa was isolated at the first stage had a recurrence rate of 28% (7/25), which was higher than that with the other isolated bacteria. Logistic regression analysis showed that repeated operations (≥3), post-traumatic osteomyelitis, and internal fixation at the first stage were risk factors for recurrence of infection, with odds ratios (ORs) of 2.30, 5.53 and 5.28 respectively. CONCLUSIONS The induced membrane technique is an effective method in the treatment of extremity osteomyelitis, although infection recurs in some cases. Repeated operations, post-traumatic osteomyelitis, and internal fixation at the first stage were risk factors for recurrence of infection. P. aeruginosa isolated at the first stage, tibia osteomyelitis, the presence of sinus, or flaps may also be associated with recurrence of infection.
Collapse
Affiliation(s)
- Xiaohua Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Shulin Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Jingshu Fu
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Dong Sun
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Jie Shen
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China
| | - Zhao Xie
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.
| |
Collapse
|
18
|
Dhar Y, Han Y. Current developments in biofilm treatments: Wound and implant infections. ENGINEERED REGENERATION 2020. [DOI: 10.1016/j.engreg.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|