Production of extracellular slime by coryneforms colonizing hydrocephalus shunts

Biofilm formation byPropionibacterium acnes on biomaterialsin vitro andin vivo: Impact on diagnosis and treatment

Propionibacterium acnes is found increasingly as a cause of delayed infection, usually involving implanted biomaterials. Despite susceptibility to common antibiotics, such infections are very difficult to treat and usually require surgical removal of the device. Three clinical isolates of P. acnes were assessed for ability to adhere to titanium, surgical steel and silicone, with and without a plasma conditioning film. After adherence, the biomaterials were then incubated for a further 6 days and examined for biofilm development. All three isolates adhered to all three biomaterials similarly. Importantly, we were able to demonstrate biofilm formation, including production of exopolymer similar in appearance to the polysaccharide intercellular adhesin of Staphylococcus epidermidis. A case summary also demonstrated failure to eradicate P. acnes infection in a hydrocephalus shunt after prolonged treatment. The removed shunt showed obvious biofilm formation, initially obscured by exopolymer when viewed by environmental scanning electron microscopy. Biofilm development by P. acnes explains the difficulties encountered in clinical management of such infections.

Effect of cast molded rifampicin/silicone onstaphylococcus epidermidis biofilm formation

Infection is one of the most common catheter-related complications, especially in shunt systems used to treat hydrocephalus. Staphylococcus epidermidis is directly related to biomaterial infections owing to its ability to form a biofilm on implanted materials. In this study, scanning electron microscopy (SEM) and atomic force microscopy (AFM) were employed to investigate the effect of the antibiotic rifampicin on the colonization and growth of S. epidermidis 35984 on the surface of silicone. A cast molding method was used to load rifampicin into the silicone precursor before it was cured. Bacteria with a diameter of 800-1000 nm and height of 200-500 nm were found to be embedded in the biofilm. Compact multilayer biofilm structures were found on silicone surfaces upon incubation for 4 and 24 h. On the other hand, sparser biofilm structures were observed on rifampicin-loaded surfaces after incubation for the same duration. Deformation of bacteria was observed by AFM. Moreover, different bacterial colony structures on the surfaces of silicone and rifampicin-loaded silicone were observed by AFM and SEM.

An investigation of structural degradation of cerebrospinal fluid shunt valves performed using scanning electron microscopy and energy-dispersive x-ray microanalysis

OBJECT

Surveys of cerebrospinal fluid (CSF) shunts that have been removed from patients have shown that even when the ventricular catheter is the cause of the obstruction, the valve may be obstructed or underperforming. The aim of this pilot study was to investigate the degradation of shunt valve structure over time due to the deposition of debris. The findings were compared with findings in unused valves.

METHODS

Scanning electron microscopy was used to visualize the structures of the valves. The items that were examined included two unused and nine explanted cylindrical medium pressure valves, one unused and six explanted Delta 1.5 valves (PS Medical, Goleta, CA), and one explanted Medos Programmable valve (Codman Johnson & Johnson, LeLocle, Switzerland). The valves were cut open, disassembled, and coated in gold. The areas that were analyzed included the main valve chamber, the diaphragm unit, and the antisiphon device. For areas with abnormal deposits, energy-dispersive x-ray microanalysis was performed to establish the chemical composition of the deposits. The reference unused valves had smooth surfaces with no deposits in any areas. All explanted valves had extensive deposits in all surveyed areas. The deposits varied from small clusters of crystals to large areas that displayed a cobblestone appearance. In diaphragm valves the deposits extensively affected the surface of the diaphragm and the gap between the diaphragm and the surrounding case, where normally CSF flows; in the Medos valve the deposits affected in the spring and "staircase" unit. Deposits were present as early as 2 weeks after implantation. On some valves there was a complete film covering the entire outlet of the valve, which formed a cast inside the valve stretching from wall to wall. The deposits consisted mostly of sodium and chloride, but occasionally contained calcium. In all infected and some noninfected valves there was a significant peak of carbon, indicating the presence of protein deposits.

CONCLUSIONS

It appears that the continuous flow of CSF through shunt valves causes surface deposits of sodium chloride and other crystals on all aspects of the valve, including the outlet pathways. The formation of deposits may be encouraged by the adhesive properties of the materials that constitute the valve parts.

Corynebacterium jeikeium bacteremia in bone marrow transplant patients with Hickman catheters

Prior studies suggest that Corynebacterium jeikeium bacteremia in immunocompromised patients results in frequent morbidity that may be decreased by prompt removal of the indwelling catheter. To summarize recent experience, charts of 53 bone marrow transplant recipients with Hickman catheters and C. jeikeium bacteremia were reviewed. Forty-one patients were treated with vancomycin without catheter removal and 10 patients underwent catheter removal with subsequent vancomycin therapy. No patient in either group died with C. jeikeium bacteremia as the proximate cause. Salvage of the intravascular catheter was successful in 38 of 41 (93%) attempts. Three patients (7%) in the catheter-salvage group and one patient (10%) in the catheter-removal group experienced recurrent bacteremia. In both catheter-salvage and catheter-removal groups, median time to negative blood culture was 2 days. Thus, time to clearance of bacteremia and patient clinical outcome did not differ between treatment groups. In many patients with Hickman catheters, C. jeikeium bacteremia may be treated successfully with vancomycin and without removal of the catheter.

The shampoo clue: two cases of infection of a ventriculoatrial shunt

Despite the use of sophisticated tools, infections of implanted devices may be difficult to diagnose. Two cases of infections of ventriculoatrial shunts, which demonstrate the eminent importance of meticulously taking history, are reported and discussed.

Cell surface components and adhesion in Corynebacterium diphtheriae

Main primary approaches and new developments in the study of the molecular basis of the adhesive process of Corynebacterium diphtheriae are reviewed along with a discussion of the potential importance of hemagglutinins, exposed sugar residues, hydrophobins and trans-sialidase enzymes as adhesins of strains of the sucrose fermenting and non-fermenting biotypes.

Characterization of surface saccharides in two Corynebacterium diphtheriae strains

Two Corynebacterium diphtheriae strains were analyzed by assays employing a battery of highly purified fluorescent lectins. From 22 lectins tested only seven with affinity to receptor molecules containing N-acetylglucosamine (D-GlcNAc), N-acetylgalactosamine (D-GalNAc), galactose (D-Gal), mannose-like (D-Man-like) and sialic acid residues showed positive fluorescent labeling. A higher reactivity of Triticum vulgaris (WGA), which binds to sialic acid and/or beta-D-GlcNAc-containing residues, and Bandeiraea simplicifolia II (BS-II), which recognizes alpha and beta-D-GlcNAc units, was shown by the sucrose-fermenting strain. Ricinus communis (RCA-I), which recognizes D-Gal units in addition to both Glycine max (SBA) and Artocarpus integrifolia (Jacaline) agglutinins that bind to D-GalNAc-containing residues, reacted preferentially with the sucrose-negative strain. Canavalia ensiformis (Con A), which recognizes D-Man-like receptors, reacted with both sucrose-fermenting and non-sucrose-fermenting C. diphtheriae biotypes. However, higher interaction was observed with the non-sucrose-fermenting strain. Fluorescence of WGA binding was significantly decreased by neuraminidase treatment suggesting the presence of an exposed sialic acid moiety on C. diphtheriae surfaces. Binding assay using radiolabeled [125I]WGA essentially confirmed the lectin fluorescence studies. N-Acetylneuraminic acid moieties were detected in whole cell hydrolysates as assessed by thin-layer and gas-liquid chromatography. The data indicate differences on the cell surface saccharide ligands between the sucrose-fermenting and the non-sucrose-fermenting C. diphtheriae strains.

Clinical microbiology of coryneform bacteria

Coryneform bacteria are aerobically growing, asporogenous, non-partially-acid-fast, gram-positive rods of irregular morphology. Within the last few years, there has been a massive increase in the number of publications related to all aspects of their clinical microbiology. Clinical microbiologists are often confronted with making identifications within this heterogeneous group as well as with considerations of the clinical significance of such isolates. This review provides comprehensive information on the identification of coryneform bacteria and outlines recent changes in taxonomy. The following genera are covered: Corynebacterium, Turicella, Arthrobacter, Brevibacterium, Dermabacter. Propionibacterium, Rothia, Exiguobacterium, Oerskovia, Cellulomonas, Sanguibacter, Microbacterium, Aureobacterium, "Corynebacterium aquaticum," Arcanobacterium, and Actinomyces. Case reports claiming disease associations of coryneform bacteria are critically reviewed. Minimal microbiological requirements for publications on disease associations of coryneform bacteria are proposed.

Variations in DNA subtype, antifungal susceptibility, and slime production among clinical isolates of Candida parapsilosis

Candida parapsilosis is an important nosocomial pathogen that can proliferate in high concentrations of glucose and form biofilms on prosthetic materials. We investigated the genotypic diversity, slime production, and antifungal susceptibility among 60 isolates of C. parapsilosis from 44 patients and 10 patient care providers from five different medical centers. Molecular typing was performed using macrorestriction digest profiles with BssHII followed by pulsed-field gel electrophoresis (REAG) and by electrophoretic karyotyping (EK). Slime production was evaluated by growing the organisms in Sabouraud broth with 8% glucose and examining the walls of the tubes for the presence of an adherent slime layer. Antifungal susceptibility to amphotericin B, 5-fluorocytosine, fluconazole, and itraconazole was determined using National Committee for Clinical Laboratory Standards proposed standard methods. Overall 28 different DNA types were identified by REAG and EK methods. MIC90 values ranged from 0.12 microgram/ml for itraconazole to 1.0 microgram/ml for fluconazole and amphotericin B. Sixty-five percent of the isolates produced slime: 37% were moderately to strongly positive, 28% were weakly positive, and 35% were negative. Overall, 83% of blood and catheter isolates were slime positive versus 53% of isolates from all other sites (P < 0.05). These data underscore the genetic diversity and susceptibility of C. parapsilosis to antifungal agents. Slime production may be important in enabling C. parapsilosis to cause catheter-related bloodstream infections.