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Dadkhahfar S, Ohadi L, Biglari F, Jafari Kafiabadi M. Surgical site infection following orthopedic surgery in a patient with acne: A challenging case. Clin Case Rep 2022; 10:e6700. [PMID: 36514471 PMCID: PMC9731166 DOI: 10.1002/ccr3.6700] [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: 05/13/2022] [Revised: 07/09/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
Propionibacterium acnes is a typical component of the human body's flora and has been implicated as the causative infectious agent following a variety of operations, including device installation. We present a case of a 21-year-old male patient with severe global acneiform eruption with a non-healing limb lesion near the orthopedic surgery incisions.
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Affiliation(s)
- Sahar Dadkhahfar
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Laya Ohadi
- Shahid Beheshti University of medical sciencesTehranIran
| | - Farsad Biglari
- Department of Orthopedic SurgeryClinical Research Development Unit of Shohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Meisam Jafari Kafiabadi
- Department of Orthopedic SurgeryClinical Research Development Unit of Shohada‐e Tajrish HospitalShahid Beheshti University of Medical SciencesTehranIran
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2
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Sultan AR, Tavakol M, Lemmens-den Toom NA, Croughs PD, Verkaik NJ, Verbon A, van Wamel WJB. Real time monitoring of Staphylococcus aureus biofilm sensitivity towards antibiotics with isothermal microcalorimetry. PLoS One 2022; 17:e0260272. [PMID: 35171906 PMCID: PMC8849495 DOI: 10.1371/journal.pone.0260272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022] Open
Abstract
Biofilm-associated infections with Staphylococcus aureus are difficult to treat even after administration of antibiotics that according to the standard susceptibility assays are effective. Currently, the assays used in the clinical laboratories to determine the sensitivity of S. aureus towards antibiotics are not representing the behaviour of biofilm-associated S. aureus, since these assays are performed on planktonic bacteria. In research settings, microcalorimetry has been used for antibiotic susceptibility studies. Therefore, in this study we investigated if we can use isothermal microcalorimetry to monitor the response of biofilm towards antibiotic treatment in real-time. We developed a reproducible method to generate biofilm in an isothermal microcalorimeter setup. Using this system, the sensitivity of 5 methicillin-sensitive S. aureus (MSSA) and 5 methicillin-resistant S. aureus (MRSA) strains from different genetic lineages were determined towards: flucloxacillin, cefuroxime, cefotaxime, gentamicin, rifampicin, vancomycin, levofloxacin, clindamycin, erythromycin, linezolid, fusidic acid, co-trimoxazole, and doxycycline. In contrast to conventional assays, our calorimetry-based biofilm susceptibility assay showed that S. aureus biofilms, regardless MSSA or MRSA, can survive the exposure to the maximum serum concentration of all tested antibiotics. The only treatment with a single antibiotic showing a significant reduction in biofilm survival was rifampicin, yet in 20% of the strains, emerging antibiotic resistance was observed. Furthermore, the combination of rifampicin with flucloxacillin, vancomycin or levofloxacin was able to prevent S. aureus biofilm from becoming resistant to rifampicin. Isothermal microcalorimetry allows real-time monitoring of the sensitivity of S. aureus biofilms towards antibiotics in a fast and reliable way.
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Affiliation(s)
- Andi Rofian Sultan
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Microbiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Mehri Tavakol
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nicole A. Lemmens-den Toom
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter D. Croughs
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annelies Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Willem J. B. van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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3
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Wang L, Tkhilaishvili T, Trampuz A, Gonzalez Moreno M. Evaluation of Staphylococcal Bacteriophage Sb-1 as an Adjunctive Agent to Antibiotics Against Rifampin-Resistant Staphylococcus aureus Biofilms. Front Microbiol 2020; 11:602057. [PMID: 33262752 PMCID: PMC7686474 DOI: 10.3389/fmicb.2020.602057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022] Open
Abstract
Rifampin plays a crucial role in the treatment of staphylococcal implant-associated infection, as it is the only antibiotic capable of eradicating Staphylococcus aureus biofilms. However, the emergence of rifampin resistance strongly limits its use. Combinatorial therapy of antibiotics and bacteriophages may represent a strategy to overcome the resistance. Here, we evaluated the activity of staphylococcal bacteriophage Sb-1 in combination with different antibiotics against the biofilms of 10 rifampin-resistant S. aureus clinical strains, including MRSA and MSSA. S. aureus biofilms formed on porous glass beads were exposed to antibiotics alone or combined with Sb-1 simultaneously or staggered (first Sb-1 for 24 h followed by antibiotic). Recovered bacteria were detected by measuring growth-related heat production at 37°C (isothermal microcalorimetry) and the biofilm eradication was assessed by sonication of beads and plating of the resulting sonication fluid. Minimum biofilm eradication concentration (MBEC) was defined as the lowest concentration of antibiotic required to kill all adherent bacteria, resulting in absence of growth after plating the sonication fluid. Tested antibiotics presented high MBEC values when administered alone (64 to > 1,024 μg/ml). The simultaneous or staggered combination of Sb-1 with daptomycin showed the highest activity against all MRSA biofilms, whereas the exposure to Sb-1 with vancomycin showed no improved anti-biofilm activity. Staggered administration of Sb-1 and flucloxacillin, cefazolin, or fosfomycin improved the antibiofilm activity in four out of six MSSA, whereas simultaneous exposure exhibited similar or lesser synergy. In conclusion, the combinatorial effect of Sb-1 and antibiotics enabled to eradicate rifampin-resistant S. aureus biofilms in vitro.
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Affiliation(s)
- Lei Wang
- Center for Musculoskeletal Surgery, Humboldt-Universität zu Berlin and Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tamta Tkhilaishvili
- Center for Musculoskeletal Surgery, Humboldt-Universität zu Berlin and Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Humboldt-Universität zu Berlin and Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mercedes Gonzalez Moreno
- Center for Musculoskeletal Surgery, Humboldt-Universität zu Berlin and Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
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4
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Choudhury I, Han H, Manthani K, Gandhi S, Dabhi R. COVID-19 as a Possible Cause of Functional Exhaustion of CD4 and CD8 T-cells and Persistent Cause of Methicillin-Sensitive Staphylococcus aureus Bacteremia. Cureus 2020; 12:e9000. [PMID: 32775080 PMCID: PMC7402531 DOI: 10.7759/cureus.9000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
We report a case of a 73-year-old male with a history of diabetes mellitus, osteomyelitis, methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia who recently completed an extended intravenous course of cefazolin eight days back, and presented with MSSA bacteremia complicated by epidural abscess, endocarditis, and aortic root abscess. Meanwhile, the patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Even with aggressive antibiotic treatment, the patient remained bacteremic and developed endocarditis with a worsening aortic root abscess. We suspect coronavirus disease 2019 (COVID-19) as a cause for the infectious paradox and will discuss the possible mechanisms in this case report.
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Affiliation(s)
- Ivana Choudhury
- Family Medicine, Kaweah Delta Health Care District, Visalia, USA.,Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Haowei Han
- Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Kaushik Manthani
- Family Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
| | - Sandeep Gandhi
- Medicine, Peconic Bay Medical Center-Northwell Health, Riverhead, USA
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5
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Kong Q, Cao Z, Lv N, Zhang H, Liu Y, Hu L, Li J. Minocycline and Fluconazole Have a Synergistic Effect Against Cryptococcus neoformans Both in vitro and in vivo. Front Microbiol 2020; 11:836. [PMID: 32431685 PMCID: PMC7214679 DOI: 10.3389/fmicb.2020.00836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022] Open
Abstract
In recent decades, the incidence of Cryptococcus neoformans infection, which causes cryptococcosis, has consistently increased. Fluconazole (FLU) is frequently used in the treatment of this disease, mainly in the immunocompromised population, and long-term therapy usually produces drug resistance. Research on antifungal sensitizers has gained attention as a possible means of overcoming this drug resistance. Minocycline (MINO) has an inhibitory effect in vitro on FLU-resistant Candida albicans, and the combination of MINO and FLU has a synergistic effect on FLU-resistant C. albicans. A synergistic effect of MINO/FLU has been reported against C. neoformans, but this effect has not been evaluated on FLU-resistant isolates. This study aimed to investigate the interaction of MINO and FLU against FLU-resistant C. neoformans both in vitro and in vivo. We found that the combination of MINO and FLU had a synergistic effect on FLU-resistant C. neoformans in vitro. For all FLU-resistant strains, the minimum inhibitory concentration (MIC) of FLU decreased significantly when used in combination with MINO, dropping from >128 μg/ml down to 4–8 μg/ml. Additionally, MINO and FLU had a synergistic effect on both susceptible and resistant C. neoformans biofilms, in which the MIC of FLU decreased from >256 μg/ml down to 4–16 μg/ml. Compared with FLU alone, the combination of MINO with FLU prolonged the survival rate of Galleria mellonella larvae infected with FLU-resistant C. neoformans, and also significantly decreased the fungal burden of infected larvae and reduced the tissue damage and destruction caused by FLU-resistant C. neoformans. These findings will contribute to the discovery of antifungal agents and may yield a new approach for the treatment of cryptococcosis caused by FLU-resistant C. neoformans.
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Affiliation(s)
- Qinxiang Kong
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Infectious Diseases, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Zubai Cao
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Na Lv
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hui Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yanyan Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, China.,Institute of Bacterium Resistance, Anhui Medical University, Hefei, China
| | - Lifen Hu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, China.,Institute of Bacterium Resistance, Anhui Medical University, Hefei, China
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Infectious Diseases, Chaohu Hospital of Anhui Medical University, Hefei, China.,Anhui Center for Surveillance of Bacterial Resistance, Hefei, China.,Institute of Bacterium Resistance, Anhui Medical University, Hefei, China
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Phenotypic Characterization of Rhodococcus equi Biofilm Grown In Vitro and Inhibiting and Dissolving Activity of Azithromycin/Rifampicin Treatment. Pathogens 2019; 8:pathogens8040284. [PMID: 31817114 PMCID: PMC6963269 DOI: 10.3390/pathogens8040284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 01/11/2023] Open
Abstract
Microbial biofilm has been implicated in a wide range of chronic infections. In spite of the fact that Rhodococcus equi is a recognized cause of chronic disease in animals and humans, few studies have focused on the sessile phenotype of R.equi. The aim of this research was to phenotypically characterize the biofilm development of R. equi and its answerability for hypo-responsiveness to macrolides and rifampicin. Biofilm formation is initiated by bacterial adhesion to the surface. In this work, the ability of R. equi to adhere to the surface of human lung epithelial cells was detected by a fluorometric adhesion test performed on 40 clinical isolates. Subsequently, the capability of R. equi to produce biofilm was investigated by colorimetric, fluorescence and scanning electron microscopy analysis, revealing a general slow growth of rhodococcal biofilm and different sessile phenotypes among field isolates, some also including filamented bacteria. Azithromycin treatment produced a higher long-term inhibition and dissolution of R. equi biofilms than rifampicin, while the two antibiotics combined boosted the anti-biofilm effect in a statistically significant manner, although this was not equally effective for all R. equi isolates. Increasing the MIC concentrations of drugs tenfold alone and in combination did not completely eradicate pre-formed R. equi biofilms, while a rifampicin-resistant isolate produced an exceptionally abundant extracellular matrix. These results have strengthened the hypothesis that biofilm production may occur as an antibiotic tolerance system in R. equi, potentially determining persistence and, eventually, chronic infection.
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7
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Beganovic M, Luther MK, Daffinee KE, LaPlante KL. Biofilm prevention concentrations (BPC) of minocycline compared to polymyxin B, meropenem, and amikacin against Acinetobacter baumannii. Diagn Microbiol Infect Dis 2019; 94:223-226. [PMID: 30827805 DOI: 10.1016/j.diagmicrobio.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 12/03/2018] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
Infections caused by Acinetobacter baumannii are difficult to treat as they are often multidrug resistant (MDR) and frequently form biofilms. We investigated the activities of minocycline, polymyxin B, meropenem, and amikacin against diverse Acinetobacter baumannii strains with biofilm formation classified as weak versus moderate/strong. At clinically achievable concentrations, minocycline prevented biofilm formation for 96% of isolates versus 54% for polymyxin B, 29% for meropenem and 29% for amikacin. Minocycline and polymyxin B demonstrated highest in vitro activity against A. baumannii and prevented biofilm formation for a majority of isolates.
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Affiliation(s)
- Maya Beganovic
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States; College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - Megan K Luther
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States; College of Pharmacy, University of Rhode Island, Kingston, RI, United States; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Kathryn E Daffinee
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, United States; College of Pharmacy, University of Rhode Island, Kingston, RI, United States; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, United States; Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI.
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8
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Abstract
Staphylococci, with the leading species Staphylococcus aureus and Staphylococcus epidermidis, are the most frequent causes of infections on indwelling medical devices. The biofilm phenotype that those bacteria adopt during device-associated infection facilitates increased resistance to antibiotics and host immune defenses. This review presents and discusses the molecular mechanisms contributing to staphylococcal biofilm development and their in-vivo importance. Furthermore, it summarizes current strategies for the development of therapeutics against staphylococcal biofilm-associated infection.
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Watt JP, Dunn RN. The Use of Vacuum Dressings for Dead Space Management in Deep Surgical Site Infections Allows Implant and Bone Graft Retention. Global Spine J 2017; 7:756-761. [PMID: 29238639 PMCID: PMC5721991 DOI: 10.1177/2192568217696694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
STUDY DESIGN Retrospective, descriptive study. OBJECTIVES Managing early surgical site infection following elective lumbar spine surgery remains a challenge with controversy regarding retention of instrumentation and bone graft. Wound closure may also pose considerable challenges. We aim to report on our method of managing deep surgical site infections complicating elective spine surgery with surgeon assembled deep vacuum dressings. Identification of causative organisms with their sensitivities was a secondary objective. METHODS Patients were identified from a prospectively maintained, single-surgeon database from 2003-2015. Patients who had an infective or trauma related diagnosis, cervical procedures, and were younger than 18 years were excluded. Records were reviewed to identify bacteriology, laboratory tests performed, antibiotics administered, and type and frequency of surgical management. One thousand two hundred twenty patients qualified for inclusion, with 19 identified as having developed acute wound sepsis. RESULTS All patients had surgical debridement on the day of presentation and the majority of wounds were managed with a vacuum dressing. In all but 1 patient was instrumentation retained. Specimens for culture were taken at each debridement and antibiotics changed accordingly. Patients received a minimum 6 weeks of antibiotics. CONCLUSIONS The management of deep surgical site infection is labor intensive and frustrating for both surgeon and patient due to the unexpected prolonged admission. Management goals are identification and eradication of the causative organism with subsequent healing of the surgical wound. This process is enhanced with the use of negative-suction dressings made from theatre stock replaced at regular intervals and allows retention of bone graft and instrumentation in the majority of cases.
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Affiliation(s)
- James P. Watt
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Robert N. Dunn
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Hu Y, Hegde V, Johansen D, Loftin AH, Dworsky E, Zoller SD, Park HY, Hamad CD, Nelson GE, Francis KP, Scaduto A, Bernthal NM. Combinatory antibiotic therapy increases rate of bacterial kill but not final outcome in a novel mouse model of Staphylococcus aureus spinal implant infection. PLoS One 2017; 12:e0173019. [PMID: 28245229 PMCID: PMC5330510 DOI: 10.1371/journal.pone.0173019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/12/2017] [Indexed: 12/04/2022] Open
Abstract
Background Management of spine implant infections (SII) are challenging. Explantation of infected spinal hardware can destabilize the spine, but retention can lead to cord compromise and biofilm formation, complicating management. While vancomycin monotherapy is commonly used, in vitro studies have shown reduced efficacy against biofilm compared to combination therapy with rifampin. Using an established in vivo mouse model of SII, we aim to evaluate whether combination therapy has increased efficacy compared to both vancomycin alone and infected controls. Methods An L-shaped, Kirschner-wire was transfixed into the L4 spinous process of 12-week-old C57BL/6 mice, and inoculated with bioluminescent Staphylococcus aureus. Mice were randomized into a vancomycin group, a combination group with vancomycin plus rifampin, or a control group receiving saline. Treatment began on post-operative day (POD) 7 and continued through POD 14. In vivo imaging was performed to monitor bioluminescence for 35 days. Colony-forming units (CFUs) were cultured on POD 35. Results Bioluminescence peaked around POD 7 for all groups. The combination group had a 10-fold decrease in signal by POD 10. The vancomycin and control groups reached similar levels on POD 17 and 21, respectively. On POD 25 the combination group dropped below baseline, but rebounded to the same level as the other groups, demonstrating a biofilm-associated infection by POD 35. Quantification of CFUs on POD 35 confirmed an ongoing infection in all three groups. Conclusions Although both therapies were initially effective, they were not able to eliminate implant biofilm bacteria, resulting in a rebound infection after antibiotic cessation. This model shows, for the first time, why histologic-based, static assessments of antimicrobials can be misleading, and the importance of longitudinal tracking of infection. Future studies can use this model to test combinations of antibiotic therapies to see if they are more effective in eliminating biofilm prior to human trials.
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Affiliation(s)
- Yan Hu
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Vishal Hegde
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Daniel Johansen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Amanda H. Loftin
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Erik Dworsky
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Stephen D. Zoller
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Howard Y. Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Christopher D. Hamad
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - George E. Nelson
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kevin P. Francis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Anthony Scaduto
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
| | - Nicholas M. Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California, United States of America
- * E-mail:
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Malone M, Goeres DM, Gosbell I, Vickery K, Jensen S, Stoodley P. Approaches to biofilm-associated infections: the need for standardized and relevant biofilm methods for clinical applications. Expert Rev Anti Infect Ther 2016; 15:147-156. [PMID: 27858472 DOI: 10.1080/14787210.2017.1262257] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION The concept of biofilms in human health and disease is now widely accepted as cause of chronic infection. Typically, biofilms show remarkable tolerance to many forms of treatments and the host immune response. This has led to vast increase in research to identify new (and sometimes old) anti-biofilm strategies that demonstrate effectiveness against these tolerant phenotypes. Areas covered: Unfortunately, a standardized methodological approach of biofilm models has not been adopted leading to a large disparity between testing conditions. This has made it almost impossible to compare data across multiple laboratories, leaving large gaps in the evidence. Furthermore, many biofilm models testing anti-biofilm strategies aimed at the medical arena have not considered the matter of relevance to an intended application. This may explain why some in vitro models based on methodological designs that do not consider relevance to an intended application fail when applied in vivo at the clinical level. Expert commentary: This review will explore the issues that need to be considered in developing performance standards for anti-biofilm therapeutics and provide a rationale for the need to standardize models/methods that are clinically relevant. We also provide some rational as to why no standards currently exist.
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Affiliation(s)
- Matthew Malone
- a Molecular Microbiology Research Group, Faculty of Medicine , Western Sydney University , Sydney , Australia.,b Liverpool Diabetes Collaborative Research Group , Ingham Institute of Applied Medical Research , Liverpool , Australia
| | - Darla M Goeres
- c Center for Biofilm Engineering , Montana State University , Bozeman , MT , USA
| | - Iain Gosbell
- a Molecular Microbiology Research Group, Faculty of Medicine , Western Sydney University , Sydney , Australia
| | - Karen Vickery
- d Surgical Infection Research Group, Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Slade Jensen
- a Molecular Microbiology Research Group, Faculty of Medicine , Western Sydney University , Sydney , Australia
| | - Paul Stoodley
- e Departments of Microbial Infection and Immunity, Orthopedics, Center for Microbial Interface Biology , The Ohio State University , Columbus , OH , USA.,f National Centre for Advanced Tribology (nCATS), Engineering Sciences , University of Southampton , Southampton , UK
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12
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Kluin OS, Busscher HJ, Neut D, van der Mei HC. Poly(trimethylene carbonate) as a carrier for rifampicin and vancomycin to target therapy-recalcitrant staphylococcal biofilms. J Orthop Res 2016; 34:1828-1837. [PMID: 26876651 DOI: 10.1002/jor.23194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 02/08/2016] [Indexed: 02/04/2023]
Abstract
Standard antibiotic therapy in osteomyelitis patients is of limited value when methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis (MRSE), or small-colony variants (SCV) are present. Far better results are obtained by local drug delivery of antibiotic combinations including rifampicin, using a suitable carrier. We therefore investigated release kinetics of antibiotics from biodegradable poly(trimethylene carbonate) (PTMC) and in vitro biofilm inhibition of MRSA, MRSE, and S. aureus SCV strains in the course of 24, 72, and 168 h treatment by PTMC, either unloaded, gentamicin-loaded, loaded with rifampicin and fosfomycin, or rifampicin and vancomycin. PTMC appeared to be a suitable carrier for rifampicin alone or in combination with other antibiotics. Biofilm colony forming units and metabolic activity measurement (MTT assay) demonstrated significant (p < 0.05) inhibition for all strains when PTMC loaded with rifampicin and vancomycin was employed, especially after 168 h treatment. Confocal laser scanning microscopy images showed similar qualitative results. PTMC loaded with only gentamicin did not show any inhibition. This exemplifies that PTMC loaded with rifampicin and vancomycin holds promise for the treatment of recalcitrant osteomyelitis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1828-1837, 2016.
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Affiliation(s)
- Otto S Kluin
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713, AV Groningen, The Netherlands
| | - Henk J Busscher
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713, AV Groningen, The Netherlands
| | - Daniëlle Neut
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713, AV Groningen, The Netherlands.
| | - Henny C van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713, AV Groningen, The Netherlands
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Bactericidal activity of ACH-702 against nondividing and biofilm Staphylococci. Antimicrob Agents Chemother 2012; 56:3812-8. [PMID: 22547614 DOI: 10.1128/aac.00092-12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Many bacterial infections involve slow or nondividing bacterial growth states and localized high cell densities. Antibiotics with demonstrated bactericidal activity rarely remain bactericidal at therapeutic concentrations under these conditions. The isothiazoloquinolone (ITQ) ACH-702 is a potent, bactericidal compound with activity against many antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). We evaluated its bactericidal activity under conditions where bacterial cells were not dividing and/or had slowed their growth. Against S. aureus cultures in stationary phase, ACH-702 showed concentration-dependent bactericidal activity and achieved a 3-log-unit reduction in viable cell counts within 6 h of treatment at ≥ 16× MIC values; in comparison, the bactericidal quinolone moxifloxacin and the additional comparator compounds vancomycin, linezolid, and rifampin at 16× to 32× MICs showed little or no bactericidal activity against stationary-phase cells. ACH-702 at 32× MIC retained bactericidal activity against stationary-phase S. aureus across a range of inoculum densities. ACH-702 did not kill cold-arrested cells yet remained bactericidal against cells arrested by protein synthesis inhibitors, suggesting that its bactericidal activity against nondividing cells requires active metabolism but not de novo protein synthesis. ACH-702 also showed a degree of bactericidal activity at 16× MIC against S. epidermidis biofilm cells that was superior to that of moxifloxacin, rifampin, and vancomycin. The bactericidal activity of ACH-702 against stationary-phase staphylococci and biofilms suggests potential clinical utility in infections containing cells in these physiological states.
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