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Rajangam SL, Narasimhan MK. Current treatment strategies for targeting virulence factors and biofilm formation in Acinetobacter baumannii. Future Microbiol 2024; 19:941-961. [PMID: 38683166 PMCID: PMC11290764 DOI: 10.2217/fmb-2023-0263] [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: 11/24/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
A higher prevalence of Acinetobacter baumannii infections and mortality rate has been reported recently in hospital-acquired infections (HAI). The biofilm-forming capability of A. baumannii makes it an extremely dangerous pathogen, especially in device-associated hospital-acquired infections (DA-HAI), thereby it resists the penetration of antibiotics. Further, the transmission of the SARS-CoV-2 virus was exacerbated in DA-HAI during the epidemic. This review specifically examines the complex interconnections between several components and genes that play a role in the biofilm formation and the development of infections. The current review provides insights into innovative treatments and therapeutic approaches to combat A. baumannii biofilm-related infections, thereby ultimately improving patient outcomes and reducing the burden of HAI.
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Affiliation(s)
- Seetha Lakshmi Rajangam
- Department of Genetic Engineering, School of Bioengineering, College of Engineering & Technology, SRM Institute of Science & Technology, Kattankulathur, Chennai, Tamil Nadu, 603203, India
| | - Manoj Kumar Narasimhan
- Department of Genetic Engineering, School of Bioengineering, College of Engineering & Technology, SRM Institute of Science & Technology, Kattankulathur, Chennai, Tamil Nadu, 603203, India
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Jordan A, Smojver I, Budimir A, Gabrić D, Vuletić M. Evaluation of Different Procedures for Titanium Dental Implant Surface Decontamination-In Vitro Study. Bioengineering (Basel) 2024; 11:326. [PMID: 38671748 PMCID: PMC11048723 DOI: 10.3390/bioengineering11040326] [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: 01/28/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Polymicrobial biofilm removal and decontamination of the implant surface is the most important goal in the treatment of periimplantitis. The aim of this study is to evaluate the efficacy of four different decontamination methods for removing Acinetobacter baumannii and Staphylococcus aureus biofilms in vitro. Seventy-five dental implants were contaminated with a bacterial suspension and randomly divided into five groups (n = 15): the negative control group, which received no treatment; the positive control group, treated with 0.2% chlorhexidine; group 1, treated with a chitosan brush (Labrida BioCleanTM, Labrida AS, Oslo, Norway); group 2, treated with a chitosan brush and 0.2% chlorhexidine; and group 3, treated with a device based on the electrolytic cleaning method (GalvoSurge, GalvoSurge Dental AG, Widnau, Switzerland). The colony-forming unit (CFU) count was used to assess the number of viable bacteria in each sample, and statistical analyses were performed. When compared to the negative control group, all the decontamination methods reduced the CFU count. The electrolytic cleaning method decontaminated the implant surface more effectively than the other three procedures, while the chitosan brush was the least effective. Further research in more realistic settings is required to assess the efficacy of the decontamination procedures described in this study.
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Affiliation(s)
- Ante Jordan
- Department of Oral Surgery, Dental Polyclinic Zagreb, 10000 Zagreb, Croatia
| | - Igor Smojver
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia;
| | - Ana Budimir
- Department of Clinical Microbiology, Infection Prevention and Control, University Hospital Centre Zagreb, University of Zagreb, 10000 Zagreb, Croatia;
| | - Dragana Gabrić
- Department of Oral Surgery, School of Dental Medicine, University Hospital Centre Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (D.G.); (M.V.)
| | - Marko Vuletić
- Department of Oral Surgery, School of Dental Medicine, University Hospital Centre Zagreb, University of Zagreb, 10000 Zagreb, Croatia; (D.G.); (M.V.)
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Higashihira S, Simpson SJ, Morita A, Suryavanshi JR, Arnold CJ, Natoli RM, Greenfield EM. Halicin remains active against Staphylococcus aureus in biofilms grown on orthopaedically relevant substrates. Bone Joint Res 2024; 13:101-109. [PMID: 38432258 PMCID: PMC10909403 DOI: 10.1302/2046-3758.133.bjr-2023-0038.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Aims Biofilm infections are among the most challenging complications in orthopaedics, as bacteria within the biofilms are protected from the host immune system and many antibiotics. Halicin exhibits broad-spectrum activity against many planktonic bacteria, and previous studies have demonstrated that halicin is also effective against Staphylococcus aureus biofilms grown on polystyrene or polypropylene substrates. However, the effectiveness of many antibiotics can be substantially altered depending on which orthopaedically relevant substrates the biofilms grow. This study, therefore, evaluated the activity of halicin against less mature and more mature S. aureus biofilms grown on titanium alloy, cobalt-chrome, ultra-high molecular weight polyethylene (UHMWPE), devitalized muscle, or devitalized bone. Methods S. aureus-Xen36 biofilms were grown on the various substrates for 24 hours or seven days. Biofilms were incubated with various concentrations of halicin or vancomycin and then allowed to recover without antibiotics. Minimal biofilm eradication concentrations (MBECs) were defined by CFU counting and resazurin reduction assays, and were compared with the planktonic minimal inhibitory concentrations (MICs). Results Halicin continued to exert significantly (p < 0.01) more antibacterial activity against biofilms grown on all tested orthopaedically relevant substrates than vancomycin, an antibiotic known to be affected by biofilm maturity. For example, halicin MBECs against both less mature and more mature biofilms were ten-fold to 40-fold higher than its MIC. In contrast, vancomycin MBECs against the less mature biofilms were 50-fold to 200-fold higher than its MIC, and 100-fold to 400-fold higher against the more mature biofilms. Conclusion Halicin is a promising antibiotic that should be tested in animal models of orthopaedic infection.
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Affiliation(s)
- Shota Higashihira
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Stefanie J. Simpson
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Akira Morita
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Joash R. Suryavanshi
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher J. Arnold
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Roman M. Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edward M. Greenfield
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Wang X, Huang S, Peng Q. Metal Ion-Doped Hydroxyapatite-Based Materials for Bone Defect Restoration. Bioengineering (Basel) 2023; 10:1367. [PMID: 38135958 PMCID: PMC10741145 DOI: 10.3390/bioengineering10121367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
Hydroxyapatite (HA)-based materials are widely used in the bone defect restoration field due to their stable physical properties, good biocompatibility, and bone induction potential. To further improve their performance with extra functions such as antibacterial activity, various kinds of metal ion-doped HA-based materials have been proposed and synthesized. This paper offered a comprehensive review of metal ion-doped HA-based materials for bone defect restoration based on the introduction of the physicochemical characteristics of HA followed by the synthesis methods, properties, and applications of different kinds of metal ion (Ag+, Zn2+, Mg2+, Sr2+, Sm3+, and Ce3+)-doped HA-based materials. In addition, the underlying challenges for bone defect restoration using these materials and potential solutions were discussed.
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Affiliation(s)
- Xuan Wang
- Xiangya Stomatological Hospital, Central South University, Changsha 410008, China;
- Xiangya School of Stomatology, Central South University, Changsha 410008, China
| | - Shan Huang
- Changsha Health Vocational College, Changsha 410100, China;
| | - Qian Peng
- Xiangya Stomatological Hospital, Central South University, Changsha 410008, China;
- Xiangya School of Stomatology, Central South University, Changsha 410008, China
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Ivankovic T, Turk H, Hrenovic J, Schauperl Z, Ivankovic M, Ressler A. Antibacterial activity of silver doped hydroxyapatite toward multidrug-resistant clinical isolates of Acinetobacter baumannii. JOURNAL OF HAZARDOUS MATERIALS 2023; 458:131867. [PMID: 37331061 DOI: 10.1016/j.jhazmat.2023.131867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/31/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
Bacteria Acinetobacter baumannii is a persistent issue in hospital-acquired infections due to its fast and potent development of multi-drug resistance. To address this urgent challenge, a novel biomaterial using silver (Ag+) ions within the hydroxyapatite (HAp) lattice has been developed to prevent infections in orthopedic surgery and bone regeneration applications without relying on antibiotics. The aim of the study was to examine the antibacterial activity of mono-substituted HAp with Ag+ ions and a mixture of mono-substituted HAps with Sr2+, Zn2+, Mg2+, SeO32- and Ag+ ions against the A. baumannii. The samples were prepared in the form of powder and disc and analyzed by disc diffusion, broth microdilution method, and scanning electron microscopy. The results from the disc-diffusion method have shown a strong antibacterial efficacy of the Ag-substituted and mixture of mono-substituted HAps (Sr, Zn, Se, Mg, Ag) toward several clinical isolates. The Minimal Inhibitory Concentrations for the powdered HAp samples ranged from 32 to 42 mg/L (Ag+ substituted) and 83-167 mg/L (mixture of mono-substituted), while the Minimal Bactericidal Concentrations after 24 h of contact ranged from 62.5 (Ag+) to 187.5-292 mg/L (ion mixture). The lower substitution level of Ag+ ions in a mixture of mono-substituted HAps was the cause of lower antibacterial effects measured in suspension. However, the inhibition zones and bacterial adhesion on the biomaterial surface were comparable. Overall, the clinical isolates of A. baumannii were effectively inhibited by substituted HAp samples, probably in the same amount as by other commercially available silver-doped materials, and such materials may provide a promising alternative or supplementation to antibiotic treatment in the prevention of infections associated with bone regeneration. The antibacterial activity of prepared samples toward A. baumannii was time-dependent and should be considered in potential applications.
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Affiliation(s)
- Tomislav Ivankovic
- Faculty of Science, Department of Biology, University of Zagreb, 10000 Zagreb, Croatia.
| | - Helena Turk
- Faculty of Science, Department of Biology, University of Zagreb, 10000 Zagreb, Croatia.
| | - Jasna Hrenovic
- Faculty of Science, Department of Biology, University of Zagreb, 10000 Zagreb, Croatia.
| | - Zdravko Schauperl
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ivana Lučića 5, 10000 Zagreb, Croatia.
| | - Marica Ivankovic
- Faculty of Chemical Engineering and Technology, University of Zagreb, Trg Marka Marulića 19, 10000 Zagreb, Croatia.
| | - Antonia Ressler
- Faculty of Chemical Engineering and Technology, University of Zagreb, Trg Marka Marulića 19, 10000 Zagreb, Croatia; Faculty of Engineering and Natural Sciences, Tampere University, Korkeakoulunkatu 6, 33014 Tampere, Finland.
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Li Z, Maimaiti Z, Fu J, Li ZY, Hao LB, Xu C, Chen JY. The superiority of immune-inflammation summary index for diagnosing periprosthetic joint infection. Int Immunopharmacol 2023; 118:110073. [PMID: 36989888 DOI: 10.1016/j.intimp.2023.110073] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Accurate and rapid diagnosis of periprosthetic joint infections (PJI) is particularly challenging. This study aimed to evaluate the diagnostic value of a newly developed immune-inflammation summary index (IISI) for PJI. METHODS Our study enrolled 171 aseptic loosening (AL) and 172 PJI cases. Based on a biological-driven approach, the IISI was formulated as C-reaction protein (CRP) × globulin × neutrophil / [lymphocyte × albumin]. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic performance of IISI with other known serum markers. Subgroup analysis was also performed to explore the robustness of IISI. Restricted cubic splines were used to evaluate the dose-response association. Additionally, changes in IISI levels prior to reimplantation were investigated. RESULTS The levels of all tested biomarkers were significantly different between the PJI and AL groups (all P < 0.05). ROC analysis revealed that IISI outperformed any other marker in diagnosing PJI with an area under the curve (AUC) value of 0.890. The diagnostic performance of IISI was also optimal in the hip (0.898), knee (0.903), low-grade infection (0.841), and culture-negative (0.919) subgroups. The optimal cut-off value is stabilized at around 1.6. The nonlinear association between IISI scores and PJI was also confirmed (P < 0.001). The levels of IISI before reimplantation demonstrated a significant decrease (P < 0.001) and were comparable to those of the AL group (P = 0.143). CONCLUSION IISI can improve the utilization of serum indicators and is superior to other well-known biomarkers in diagnosing PJI. Further studies should evaluate its specific role in different infectious and inflammatory diseases.
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Caldwell M, Hughes M, Wei F, Ngo C, Pascua R, Pugazhendhi AS, Coathup MJ. Promising applications of D-amino acids in periprosthetic joint infection. Bone Res 2023; 11:14. [PMID: 36894568 PMCID: PMC9998894 DOI: 10.1038/s41413-023-00254-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023] Open
Abstract
Due to the rise in our aging population, a disproportionate demand for total joint arthroplasty (TJA) in the elderly is forecast. Periprosthetic joint infection (PJI) represents one of the most challenging complications that can occur following TJA, and as the number of primary and revision TJAs continues to rise, an increasing PJI burden is projected. Despite advances in operating room sterility, antiseptic protocols, and surgical techniques, approaches to prevent and treat PJI remain difficult, primarily due to the formation of microbial biofilms. This difficulty motivates researchers to continue searching for an effective antimicrobial strategy. The dextrorotatory-isoforms of amino acids (D-AAs) are essential components of peptidoglycan within the bacterial cell wall, providing strength and structural integrity in a diverse range of species. Among many tasks, D-AAs regulate cell morphology, spore germination, and bacterial survival, evasion, subversion, and adhesion in the host immune system. When administered exogenously, accumulating data have demonstrated that D-AAs play a pivotal role against bacterial adhesion to abiotic surfaces and subsequent biofilm formation; furthermore, D-AAs have substantial efficacy in promoting biofilm disassembly. This presents D-AAs as promising and novel targets for future therapeutic approaches. Despite their emerging antibacterial efficacy, their role in disrupting PJI biofilm formation, the disassembly of established TJA biofilm, and the host bone tissue response remains largely unexplored. This review aims to examine the role of D-AAs in the context of TJAs. Data to date suggest that D-AA bioengineering may serve as a promising future strategy in the prevention and treatment of PJI.
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Affiliation(s)
- Matthew Caldwell
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Megan Hughes
- School of Biosciences, Cardiff University, CF10 3AT, Wales, UK
| | - Fei Wei
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Christopher Ngo
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Raven Pascua
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Abinaya Sindu Pugazhendhi
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Melanie J Coathup
- Biionix Cluster & College of Medicine, University of Central Florida, 6900 Lake Nona Blvd, Orlando, FL, 32827, USA.
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Evaluation of Serum Albumin and Globulin in Combination With C-Reactive Protein Improves Serum Diagnostic Accuracy for Low-Grade Periprosthetic Joint Infection. J Arthroplasty 2023; 38:555-561. [PMID: 36115535 DOI: 10.1016/j.arth.2022.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Serum immune markers can be useful in the diagnosis of periprosthetic joint infection (PJI) by detecting long-lasting abnormal immunological conditions. The purpose of this study was to examine whether serum immune markers can improve the diagnostic accuracy of PJI. METHODS We enrolled 51 PJI, 45 aseptic loosening, and 334 osteoarthritis patients for assessment of the discriminatory accuracy of serum markers including white blood cell count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer, total protein, albumin (Alb), globulin (Glb), neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, albumin-globulin ratio (AGR), CRP-albumin ratio (CAR), and CRP-AGR ratio (CAGR). These diagnostic accuracies for low-grade PJI were also calculated in patients who had serum CRP levels < 10 mg/L. RESULTS Among serum markers, Alb, Glb, AGR, CRP, ESR, CAR, and CAGR had highly accurate diagnostic accuracy for PJI, with area under the curve of 0.92, 0.90, 0.96, 0.97, 0.92, 0.97, and 0.98, respectively. In low-grade PJI patients, area under the curve of CRP, ESR, CAR, and CAGR (0.69, 0.80, 0.65, and 0.82, respectively) was decreased but that of Alb, Glb, and AGR (0.90, 0.88, and 0.95, respectively) remained high, indicating the diagnostic utility of these immune markers. The sensitivity and specificity of AGR with cutoff value of 1.1 were demonstrated as 0.92 and 0.89, respectively, and with cutoff value of 1.2, 1.00, and 0.79, respectively, in the diagnosis of low-grade infection. CONCLUSION Our results demonstrate the potential value of Alb, Glb, AGR, and combination indices of these immune makers with CRP in improving preoperative serum diagnosis for PJI, especially in low-grade PJI. LEVEL OF EVIDENCE Diagnostic- Level II.
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