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Verma A, Kumar S, Venkatesh V, Jain P, Kalyan R, Reddy H. Staphylococcus hemolyticus: The Most Common and Resistant Coagulase-Negative Staphylococcus Species Causing Bacteremia in North India. Cureus 2024; 16:e51680. [PMID: 38313906 PMCID: PMC10838378 DOI: 10.7759/cureus.51680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Coagulase-negative Staphylococcus (CoNS) species are normal skin commensals but may also cause bacteremia. Therefore, isolating a CoNS species on blood culture often leads to a diagnostic dilemma about whether to consider the isolate as a true pathogen or not. This study was done to understand the distribution of various CoNS species in bloodstream infections, determine their antibiotic resistance patterns, and identify possible risk factors and patient outcomes in hospital settings. MATERIALS AND METHODS Inpatients with confirmed bacteremia defined as isolation of the same CoNS species with similar antibiograms from paired blood culture bottles, which were obtained from patients with at least clinical evidence of infection, were included. The isolates obtained were studied for CoNS species distribution and antibiotic resistance patterns, and the corresponding patients were assessed for possible risk factors and outcomes. RESULTS A total of 170 CoNS isolates obtained from 85 patients were analyzed. Staphylococcus haemolyticus (S. haemolyticus)(90, 52.9%) was the most common species isolated, and it was also the most resistant of all, followed by S. hominis (50, 29.4%), S. epidermidis (26, 15.3%), S. lentus (2,1.2%), and S. succinus (2,1.2%). S. haemolyticus and S. hominis were significantly more isolated from patients aged 18-60 years and >60 years, respectively. Methicillin-resistant (MR)-CoNS (68.8%) were significantly more resistant than methicillin-sensitive (MS)-CoNS (31.2%) to certain antibiotics, and none were resistant to vancomycin, linezolid, or teicoplanin. Mortality occurred in 17.6% of patients, which was most commonly associated with S. haemolyticus infection. CONCLUSION Age-specific predisposition of CoNS species, high rates of methicillin resistance, and mortality in CoNS bacteremia are highlights of this study. To our knowledge, we are the first to study the age-related association of CoNS species.
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Affiliation(s)
- Anuragani Verma
- Microbiology, King George's Medical University, Lucknow, IND
| | - Sanjay Kumar
- Microbiology, King George's Medical University, Lucknow, IND
| | | | - Parul Jain
- Microbiology, King George's Medical University, Lucknow, IND
| | - RajKumar Kalyan
- Microbiology, King George's Medical University, Lucknow, IND
| | - Himanshu Reddy
- Internal Medicine, King George's Medical University, Lucknow, IND
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Wu X, Li L, Tao W, Hong H, Zhang L, Zheng S, Yang R, Li Q, Li X, Qiu H, Chen J. Built-up sodium alginate/chlorhexidine multilayer coating on dental implants with initiating anti-infection and cyto-compatibility sequentially for soft-tissue sealing. BIOMATERIALS ADVANCES 2023; 151:213491. [PMID: 37295195 DOI: 10.1016/j.bioadv.2023.213491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
Soft-tissue sealing at transmucosal sites is very important for preventing the invasion of pathogens and maintaining the long-term stability and function of dental implants. However, the colonization of oral pathogens on the implant surface and surrounding soft tissues can disturb the early establishment of soft-tissue sealing and even induce peri-implant infection. The purpose of this study was to construct two antibacterial coatings with 5 or 10 sodium alginate/chlorhexidine bilayers on titanium surfaces using layer-by-layer self-assembly technology to promote soft-tissue sealing. The corresponding chemical composition, surface topography, wettability and release behaviour were investigated to prove that the resultant coating of sodium alginate and chlorhexidine was coated on the porous titanium surface. In-vitro and in-vivo antibacterial results showed that both prepared coatings inhibited or killed the bacteria on their surfaces and the surrounding areas to prevent plaque biofilm formation, especially the coating with 10 bilayers. Although both coatings inhibited the initial adhesion of fibroblasts, the cytocompatibility gradually improved with coating degradation. More importantly, both coatings achieved cell adhesion and proliferation in an in-vitro bacterial environment and effectively alleviated bacteria-induced subcutaneous inflammation in-vivo. Therefore, this study demonstrated that the multilayered coating could prevent implant-related infections in the initial stage of implant surgery and then improve soft-tissue integration with implant devices.
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Affiliation(s)
- Xiaoqin Wu
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Liqi Li
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Wei Tao
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Huilei Hong
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Lijie Zhang
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Shunli Zheng
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Runhuai Yang
- Department of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
| | - Quanli Li
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China
| | - Xiangyang Li
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China.
| | - Hua Qiu
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China.
| | - Jialong Chen
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei 230032, China.
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Gupta A, Agarwal J, Singh V, Das A, Sen M. Matrix-Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF) as an Indispensable Tool in Diagnostic Bacteriology: A Comparative Analysis With Conventional Technique. Cureus 2023; 15:e36984. [PMID: 37139282 PMCID: PMC10149887 DOI: 10.7759/cureus.36984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION Owing to its accurate diagnosis, rapid turnaround time, cost effectivity, and less rates of error, Matrix-assisted Laser Desorption Ionization Time of Flight (MALDI-TOF) has replaced most of the phenotypic methods of identification. Thus, the objective of this study was to compare and evaluate MALDI-TOF MS to conventional biochemical-to identify bacterial microorganisms. METHODS Different bacterial species isolated from 2010 to 2018 (pre-MALDI-TOF era), using routine bio-chemicals were compared to bacterial species isolated from 2019 to August 2021 (post MALDI-TOF), using MALDI-TOF, in the microbiology laboratory of a tertiary care hospital in North India. Chi-Square test (χ2) was used for the evaluation of bacterial identification between biochemical tests and MALDI-TOF MS association with a 95% confidence interval, considering wrong identification in genera or at a species level. RESULTS Many different and new genera and species of bacteria could be identified using MALDI-TOF, which was not possible using only routine manual bio-chemicals like Kocuria rhizophilus, Rothia mucilaginosa, Enterococcus casseliflavus, Enterococcus gallinarum, Leuconostoc, Leclercia adecarboxylata, Raoultella ornithological, Cryseobacterium indologenes. Conclusion: Each of the newly identified bacteria played an important role in deciding treatment. Wide use of the MALDI-TOF system will not only strengthen diagnostic stewardship but also encourage antimicrobial stewardship programs.
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Antimicrobial resistance and genomic analysis of staphylococci isolated from livestock and farm attendants in Northern Ghana. BMC Microbiol 2022; 22:180. [PMID: 35864456 PMCID: PMC9306040 DOI: 10.1186/s12866-022-02589-9] [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: 08/02/2021] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The emergence of antimicrobial resistant bacteria in food producing animals is of growing concern to food safety and health. Staphylococci are common inhabitants of skin and mucous membranes in humans and animals. Infections involving antibiotic resistant staphylococci are associated with increased morbidity and mortality, with notable economic consequences. Livestock farms may enable cross-species transfer of antibiotic resistant staphylococci. The aim of the study was to investigate antimicrobial resistance patterns of staphylococci isolated from livestock and farm attendants in Northern Ghana using phenotypic and genotypic methods. Antimicrobial susceptibility testing was performed on staphylococci recovered from livestock and farm attendants and isolates resistant to cefoxitin were investigated using whole genome sequencing. Results One hundred and fifty-two staphylococci comprising S. sciuri (80%; n = 121), S. simulans (5%; n = 8), S. epidermidis (4%; n = 6), S. chromogens (3%; n = 4), S. aureus (2%; n = 3), S. haemolyticus (1%; n = 2), S. xylosus (1%; n = 2), S. cohnii (1%; n = 2), S. condimenti (1%; n = 2), S. hominis (1%; n = 1) and S. arlettae (1%; n = 1) were identified. The isolates showed resistance to penicillin (89%; n = 135), clindamycin (67%; n = 102), cefoxitin (19%; n = 29), tetracycline (15%; n = 22) and erythromycin (11%; n = 16) but showed high susceptibility to gentamicin (96%; n = 146), sulphamethoxazole/trimethoprim (98%; n = 149) and rifampicin (99%; n = 151). All staphylococci were susceptible to linezolid and amikacin. Carriage of multiple resistance genes was common among the staphylococcal isolates. Genome sequencing of methicillin (cefoxitin) resistant staphylococci (MRS) isolates revealed majority of S. sciuri (93%, n = 27) carrying mecA1 (which encodes for beta-lactam resistance) and the sal(A) gene, responsible for resistance to lincosamide and streptogramin. Most of the MRS isolates were recovered from livestock. Conclusion The study provides insights into the genomic content of MRS from farm attendants and livestock in Ghana and highlights the importance of using whole-genome sequencing to investigate such opportunistic pathogens. The finding of multi-drug resistant staphylococci such as S. sciuri carrying multiple resistant genes is of public health concern as they could pose a challenge for treatment of life-threatening infections that they may cause.
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Rey J, Gil M, de Mendoza JH, García A, Gaitskell-Phillips G, Bastidas-Caldes C, Zalama L. Clonality and Persistence of Multiresistant Methicillin-Resistant Coagulase-Negative Staphylococci Isolated from the Staff of a University Veterinary Hospital. Antibiotics (Basel) 2022; 11:antibiotics11060811. [PMID: 35740217 PMCID: PMC9220325 DOI: 10.3390/antibiotics11060811] [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: 05/28/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to characterize methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolates from the healthy staff of a university veterinary hospital in order to assess their importance as a reservoir of antimicrobial resistance and to determine their population structure and evolution. The study duration was over two years (2020–2021), 94 individuals were analyzed in duplicate, and 78 strains were obtained. The overall prevalence of methicillin-resistant strains detected throughout the study was 61.7%, with point prevalence values of 53.2% in 2020 and 31.5% in 2021. A total of 19.1% of the individuals analyzed were carriers throughout the study. The most frequently identified MRCoNs were Staphylococcus epidermidis (92.3%) and S. warneri (3.8%). A total of 75.6% of the isolates obtained showed the development of multi-resistance, preferentially against erythromycin, gentamicin, and tetracycline, and to a lesser extent against fusidic acid, norfloxacin, and clindamycin; these antimicrobials are frequently used in the veterinary field. Although most of the S. epidermidis isolates obtained showed wide genetic variability and low dispersion, which are characteristic of community-associated isolates, a small number of strains spread between individuals in close physical proximity and were maintained over time, forming stable clones. These clones generally maintained the same type of staphylococcal cassette chromosome mec (SCCmec) and had a similar antimicrobial resistance pattern.
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Affiliation(s)
- Joaquín Rey
- Unidad de Patología Infecciosa y Epidemiología, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain; (M.G.); (J.H.d.M.); (L.Z.)
- Correspondence:
| | - María Gil
- Unidad de Patología Infecciosa y Epidemiología, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain; (M.G.); (J.H.d.M.); (L.Z.)
| | - Javier Hermoso de Mendoza
- Unidad de Patología Infecciosa y Epidemiología, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain; (M.G.); (J.H.d.M.); (L.Z.)
| | - Alfredo García
- Área de Producción Animal, CICYTEX-La Orden, 06187 Badajoz, Spain;
| | - Gemma Gaitskell-Phillips
- Unidad de Reproducción y Obstetricia, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain;
| | - Carlos Bastidas-Caldes
- One Health Group, Facultad de Ingeniería y Ciencias Aplicadas (FICA), Biotecnología, Universidad de las Américas (UDLA), Quito 170125, Ecuador;
| | - Laura Zalama
- Unidad de Patología Infecciosa y Epidemiología, Facultad de Veterinaria, Universidad de Extremadura, 10003 Cáceres, Spain; (M.G.); (J.H.d.M.); (L.Z.)
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Campoccia D, Montanaro L, Arciola CR. Tracing the origins of extracellular DNA in bacterial biofilms: story of death and predation to community benefit. BIOFOULING 2021; 37:1022-1039. [PMID: 34823431 DOI: 10.1080/08927014.2021.2002987] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
Extracellular DNA (eDNA) is a macromolecule copiously found in various natural microenvironments, but its origin and significance still remain partly mysterious phenomena. Here, the multifaceted origins of eDNA in bacterial biofilms are explored. The release of eDNA can follow a suicidal programmed bacterial apoptosis or a fratricide-induced death, under the control of quorum sensing systems or triggered by specific stressors. eDNA can be released into the extracellular space or as a free macromolecule or enclosed within membrane vesicles or even through an explosion of bubbles. eDNA can also be derived from host tissue cells through bacterial cytolytic/proapoptotic toxins or stolen from neutrophil extracellular traps (NETs). eDNA can alternatively be produced by lysis-independent mechanisms. Sub-inhibitory doses of antibiotics, by killing a fraction of bacteria, result in stimulating the release of eDNA. Even phages appear to play a role in favoring eDNA release. Unveiling the origins of eDNA is critical to correctly address biofilm-associated infections.
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Affiliation(s)
- Davide Campoccia
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lucio Montanaro
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carla Renata Arciola
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Smith JT, Andam CP. Extensive Horizontal Gene Transfer within and between Species of Coagulase-Negative Staphylococcus. Genome Biol Evol 2021; 13:evab206. [PMID: 34498042 PMCID: PMC8462280 DOI: 10.1093/gbe/evab206] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 01/10/2023] Open
Abstract
Members of the gram-positive bacterial genus Staphylococcus have historically been classified into coagulase-positive Staphylococcus (CoPS) and coagulase-negative Staphylococcus (CoNS) based on the diagnostic presentation of the coagulase protein. Previous studies have noted the importance of horizontal gene transfer (HGT) and recombination in the more well-known CoPS species Staphylococcus aureus, yet little is known of the contributions of these processes in CoNS evolution. In this study, we aimed to elucidate the phylogenetic relationships, genomic characteristics, and frequencies of HGT in CoNS, which are now being recognized as major opportunistic pathogens of humans. We compiled a data set of 1,876 publicly available named CoNS genomes. These can be delineated into 55 species based on allele differences in 462 core genes and variation in accessory gene content. CoNS species are a reservoir of transferrable genes associated with resistance to diverse classes of antimicrobials. We also identified nine types of the mobile genetic element SCCmec, which carries the methicillin resistance determinant mecA. Other frequently transferred genes included those associated with resistance to heavy metals, surface-associated proteins related to virulence and biofilm formation, type VII secretion system, iron capture, recombination, and metabolic enzymes. The highest frequencies of receipt and donation of recombined DNA fragments were observed in Staphylococcus capitis, Staphylococcus caprae, Staphylococcus hominis, Staphylococcus haemolyticus, and members of the Saprophyticus species group. The variable rates of recombination and biases in transfer partners imply that certain CoNS species function as hubs of gene flow and major reservoir of genetic diversity for the entire genus.
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Affiliation(s)
- Joshua T Smith
- Department of Molecular, Cellular and Biomedical Sciences, University of New Hampshire, Durham, New Hampshire, USA
| | - Cheryl P Andam
- Department of Biological Sciences, University at Albany, State University of New York, New York, USA
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Bohara S, Rohner N, Budziszewski E, Suthakorn J, von Recum HA, Exner AA. Ultrasound Triggered Drug Release from Affinity-Based β-Cyclodextrin Polymers for Infection Control. Ann Biomed Eng 2021; 49:2513-2521. [PMID: 34173088 DOI: 10.1007/s10439-021-02814-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/13/2021] [Indexed: 12/21/2022]
Abstract
This work demonstrates a slow, sustained drug delivery system that provides on-demand delivery bursts through the application of pulsed therapeutic ultrasound (TUS). Insoluble β-cyclodextrin-polymer (pCD) disks were loaded with a saturated antibiotic solution of rifampicin (RIF) and used for drug delivery studies. To obtain on-demand release from the implants, TUS was applied at an intensity of 1.8 W/cm2. The therapeutic efficacy of the combination treatment was assessed in bacterial culture via an in vitro Staphylococcus aureus bioluminescence assay. The results demonstrated that the application of pulsed TUS at 3 MHz and 1.8 W/cm2 to pCD implants leads to a significantly higher short-term burst in the drug release rate compared to samples not treated with TUS. The addition of TUS increased the drug release by 100% within 4 days. The pCD disk + RIF stimulated with TUS showed a comparatively higher bacterial eradication with CFU/mL of 4.277E+09, and 8.00E+08 at 1 and 24 h compared with control treated bacteria at 1.48E+10. Overall, these results suggest that the addition of pulsed TUS could be an effective technology to noninvasively expedite antibiotic release on demand at desired intervals.
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Affiliation(s)
- Smriti Bohara
- Department of Biomedical Engineering, Mahidol University, Salaya, Thailand.,Department of Radiology, Case Western Reserve University (CWRU), 10900 Euclid Avenue, Cleveland, OH, 44106-5056, USA
| | - Nathan Rohner
- Department of Biomedical Engineering, Case Western Reserve University (CWRU), 10900 Euclid Avenue, Cleveland, OH, 44106-7207, USA
| | - Emily Budziszewski
- Department of Radiology, Case Western Reserve University (CWRU), 10900 Euclid Avenue, Cleveland, OH, 44106-5056, USA
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Mahidol University, Salaya, Thailand
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University (CWRU), 10900 Euclid Avenue, Cleveland, OH, 44106-7207, USA.
| | - Agata A Exner
- Department of Radiology, Case Western Reserve University (CWRU), 10900 Euclid Avenue, Cleveland, OH, 44106-5056, USA. .,Department of Biomedical Engineering, Case Western Reserve University (CWRU), 10900 Euclid Avenue, Cleveland, OH, 44106-7207, USA.
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Al-Bakri AG, Bulatova NR, Younes NA, Othman G, Jaber D, Schleimer N, Kriegeskorte A, Becker K. Characterization of staphylococci sampled from diabetic foot ulcer of Jordanian patients. J Appl Microbiol 2021; 131:2552-2566. [PMID: 33813786 DOI: 10.1111/jam.15096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to isolate and characterize staphylococcal isolates from diabetic foot ulcers (DFU) in Jordanian patients. METHODS AND RESULTS Selected aerobic pathogens recovered from DFU specimens and patients' nares with a focus on staphylococci were investigated. Antimicrobial susceptibilities and the prevalence of methicillin-resistant staphylococci (MRS) were determined. SCCmec types and toxigenic characteristics were analysed and spa typing was performed for methicillin-resistant Staphylococcus aureus (MRSA) isolates. The relationship between toxigenic characteristics of MRSA and the Wagner ulcer grading system was statistically analysed. A total number of 87 DFU patients were recruited for the study. The DFU cultures were polymicrobial. Members of the genus Staphylococcus were the most common among DFU-associated isolates found in 48·3% (n = 42) of all patients enrolled. Coagulase-negative staphylococci (CoNS) comprised 63·3% of staphylococci isolated from DFUs predominated by Staphylococcus epidermidis in both DFU (7·6%) and nares (39·2%). Staphylococcus aureus was isolated from DFUs and nares in 14·2 and 9·8%, respectively, while 93 and 70% of these isolates were MRSA. Most of MRSA carried SCCmec type IV (76·2%) while SCCmec elements were non-typeable in most methicillin resistant coagulase negative staphylococci (MR-CoNS) (61·9%). The most frequent MRSA spa type was t386 (23·8%). Most MRSA and MR-CoNS exhibited resistance towards aminoglycosides, fluoroquinolones and macrolides and susceptibility towards vancomycin, mupirocin and linezolid. No association was found between the possession of pvl, tst, sea and hlg toxins and Wagner ulcer grading system (P value >0·05). CONCLUSIONS This analysis of Jordanian DFU culture demonstrated its polymicrobial nature with predominance of Staphylococcus sp. SIGNIFICANCE AND IMPACT OF THE STUDY This study is the first of its type to assess the microbiology of DFU among Jordanian patients. The results will help in the appropriate application of antimicrobial chemotherapy in the management of DFU.
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Affiliation(s)
- A G Al-Bakri
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - N R Bulatova
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - N A Younes
- General Surgery Department, School of Medicine, The University of Jordan, Amman, Jordan
| | - G Othman
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - D Jaber
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - N Schleimer
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - A Kriegeskorte
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - K Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.,Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
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Alsharif SM, El-Sayed WS, Hanafy AM. Geographic distribution and prevalence of potential asymptomatic Staphylococcus spp. in the nasopharyngeal cavity of elementary school boys at Al-Madinah, KSA. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2021. [DOI: 10.1080/16583655.2021.1892991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sultan M. Alsharif
- Department of Biology, College of Science, Taibah University, Al-Madinah, Kingdom of Saudi Arabia
| | - Wael S. El-Sayed
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Ahmed M. Hanafy
- Department of Biology, College of Science, Taibah University, Al-Madinah, Kingdom of Saudi Arabia
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, Egypt
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Wang Z, Han L, Liu J, Yao M. Refrigeration temperature enhanced synergistic interaction of curcumin and 460 nm light-emitting diode against Staphylococcus saprophyticus at neutral pH. FOOD QUALITY AND SAFETY 2021. [DOI: 10.1093/fqsafe/fyaa029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
As considered highly resistant to antibiotics like mecillinam, the rise of Staphylococcus saprophyticus (S. saprophyticus) contamination of fresh foods and food processing environments necessitates the development of a new antimicrobial approach for food safety control. This study aimed to investigate the synergistic effect of food-grade curcumin (CUR) and blue light-emitting diode (LED) on S. saprophyticus.
Materials and Methods
S. saprophyticus was subjected to the synergistic treatment at 4 and 25 °C. The influence of parameters, including CUR concentration, light dose, and pH incubation time on the inactivation of S. saprophyticus was characterized through plate counting method.
Results:
The combined treatment of CUR and blue light irradiation significantly (P < 0.05) reduced bacterial counts and the antimicrobial effect was in a CUR concentration and light dose-dependent manner. Moreover, refrigeration temperature (4 °C) significantly (P < 0.05) enhanced the antibacterial effect at neutral pH condition (6.2–7.2), resulting in approximately 6.0 log reductions. Under acidic condition (pH 2.2–5.2), there was no significant difference in bacterial population reduction between treatments at both temperatures.
Conclusions
These findings proposed that synergistic interaction of CUR and 460 nm LED under refrigerated temperature could enhance the inactivation of S. saprophyticus at neutral pH condition.
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Ceresa C, Rinaldi M, Tessarolo F, Maniglio D, Fedeli E, Tambone E, Caciagli P, Banat IM, Diaz De Rienzo MA, Fracchia L. Inhibitory Effects of Lipopeptides and Glycolipids on C. albicans-Staphylococcus spp. Dual-Species Biofilms. Front Microbiol 2021; 11:545654. [PMID: 33519721 PMCID: PMC7838448 DOI: 10.3389/fmicb.2020.545654] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022] Open
Abstract
Microbial biofilms strongly resist host immune responses and antimicrobial treatments and are frequently responsible for chronic infections in peri-implant tissues. Biosurfactants (BSs) have recently gained prominence as a new generation of anti-adhesive and antimicrobial agents with great biocompatibility and were recently suggested for coating implantable materials in order to improve their anti-biofilm properties. In this study, the anti-biofilm activity of lipopeptide AC7BS, rhamnolipid R89BS, and sophorolipid SL18 was evaluated against clinically relevant fungal/bacterial dual-species biofilms (Candida albicans, Staphylococcus aureus, Staphylococcus epidermidis) through quantitative and qualitative in vitro tests. C. albicans-S. aureus and C. albicans-S. epidermidis cultures were able to produce a dense biofilm on the surface of the polystyrene plates and on medical-grade silicone discs. All tested BSs demonstrated an effective inhibitory activity against dual-species biofilms formation in terms of total biomass, cell metabolic activity, microstructural architecture, and cell viability, up to 72 h on both these surfaces. In co-incubation conditions, in which BSs were tested in soluble form, rhamnolipid R89BS (0.05 mg/ml) was the most effective among the tested BSs against the formation of both dual-species biofilms, reducing on average 94 and 95% of biofilm biomass and metabolic activity at 72 h of incubation, respectively. Similarly, rhamnolipid R89BS silicone surface coating proved to be the most effective in inhibiting the formation of both dual-species biofilms, with average reductions of 93 and 90%, respectively. Scanning electron microscopy observations showed areas of treated surfaces that were free of microbial cells or in which thinner and less structured biofilms were present, compared to controls. The obtained results endorse the idea that coating of implant surfaces with BSs may be a promising strategy for the prevention of C. albicans-Staphylococcus spp. colonization on medical devices, and can potentially contribute to the reduction of the high economic efforts undertaken by healthcare systems for the treatment of these complex fungal-bacterial infections.
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Affiliation(s)
- Chiara Ceresa
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Maurizio Rinaldi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Francesco Tessarolo
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, Università di Trento, Trento, Italy.,Healthcare Research and Innovation Program (IRCS-FBK-PAT), Bruno Kessler Foundation, Trento, Italy
| | - Devid Maniglio
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, Università di Trento, Trento, Italy
| | - Emanuele Fedeli
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Erica Tambone
- BIOtech Center for Biomedical Technologies, Department of Industrial Engineering, Università di Trento, Trento, Italy
| | - Patrizio Caciagli
- Section of Electron Microscopy, Department of Medicine Laboratory, Azienda Provinciale per i Servizi Sanitari di Trento, Trento, Italy
| | - Ibrahim M Banat
- School of Biomedical Sciences, Faculty of Life and Health Sciences, Ulster University, Coleraine, United Kingdom
| | - Mayri Alessandra Diaz De Rienzo
- School of Pharmacy and Biomolecular Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Letizia Fracchia
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
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13
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Adhesin genes and biofilm formation among pediatric Staphylococcus aureus isolates from implant-associated infections. PLoS One 2020. [PMID: 32569268 DOI: 10.1371/journalpone0235115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Microbial surface component recognizing adhesive matrix molecules (MSCRAMMs) facilitate Staphylococcus aureus adherence to host tissue. We hypothesized that S. aureus isolates from implant-associated infections (IAIs) would differ in MSCRAMM profile and biofilm formation in vitro compared to skin and soft tissue infection (SSTI) isolates. METHODS Pediatric patients and their isolates were identified retrospectively. IAI and SSTI isolates were matched (1:4). Pulsed field gel electrophoresis was performed to group isolates as USA300 vs. non-USA300. Whole genome sequencing was performed and raw sequence data were interrogated for presence of MSCRAMMs (clfA, clfB, cna, ebh, efb, fnbpA, fnbpB, isdA, isdB, sdrC, sdrD, sdrE), biofilm-associated (icaA,D,B,C), and Panton-Valentine leukocidin (lukSF-PV) genes, accessory gene regulator group, and multilocus sequence types. In vitro biofilm formation was assessed for 47 IAI and 47 SSTI isolates using a microtiter plate assay. Conditional logistic regression was performed for analysis of matched data (STATA11, College Station, TX). RESULTS Forty-seven IAI and 188 SSTI isolates were studied. IAI isolates were more often methicillin susceptible S. aureus and non-USA300 vs. SSTI isolates [34 (72%) vs. 79 (42%), p = 0.001 and 38 (81%) vs. 57 (30%) p <0.001, respectively]. Greater than 98% of isolates carried clfA, clfB, efb, isdA, isdB, and icaA,D,B,C while cna was more frequently found among IAI vs. SSTI isolates (p = 0.003). Most isolates were strong biofilm producers. CONCLUSIONS S. aureus IAI isolates were significantly more likely to be MSSA and non-USA300 than SSTI isolates. Carriage of MSCRAMMs and biofilm formation did not differ significantly between isolates. Evaluation of genetic polymorphisms and gene expression profiles are needed to further delineate the role of adhesins in the pathogenesis of IAIs.
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14
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Foster CE, Kok M, Flores AR, Minard CG, Luna RA, Lamberth LB, Kaplan SL, Hulten KG. Adhesin genes and biofilm formation among pediatric Staphylococcus aureus isolates from implant-associated infections. PLoS One 2020; 15:e0235115. [PMID: 32569268 PMCID: PMC7307771 DOI: 10.1371/journal.pone.0235115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/09/2020] [Indexed: 02/01/2023] Open
Abstract
Background Microbial surface component recognizing adhesive matrix molecules (MSCRAMMs) facilitate Staphylococcus aureus adherence to host tissue. We hypothesized that S. aureus isolates from implant-associated infections (IAIs) would differ in MSCRAMM profile and biofilm formation in vitro compared to skin and soft tissue infection (SSTI) isolates. Methods Pediatric patients and their isolates were identified retrospectively. IAI and SSTI isolates were matched (1:4). Pulsed field gel electrophoresis was performed to group isolates as USA300 vs. non-USA300. Whole genome sequencing was performed and raw sequence data were interrogated for presence of MSCRAMMs (clfA, clfB, cna, ebh, efb, fnbpA, fnbpB, isdA, isdB, sdrC, sdrD, sdrE), biofilm-associated (icaA,D,B,C), and Panton-Valentine leukocidin (lukSF-PV) genes, accessory gene regulator group, and multilocus sequence types. In vitro biofilm formation was assessed for 47 IAI and 47 SSTI isolates using a microtiter plate assay. Conditional logistic regression was performed for analysis of matched data (STATA11, College Station, TX). Results Forty-seven IAI and 188 SSTI isolates were studied. IAI isolates were more often methicillin susceptible S. aureus and non-USA300 vs. SSTI isolates [34 (72%) vs. 79 (42%), p = 0.001 and 38 (81%) vs. 57 (30%) p <0.001, respectively]. Greater than 98% of isolates carried clfA, clfB, efb, isdA, isdB, and icaA,D,B,C while cna was more frequently found among IAI vs. SSTI isolates (p = 0.003). Most isolates were strong biofilm producers. Conclusions S. aureus IAI isolates were significantly more likely to be MSSA and non-USA300 than SSTI isolates. Carriage of MSCRAMMs and biofilm formation did not differ significantly between isolates. Evaluation of genetic polymorphisms and gene expression profiles are needed to further delineate the role of adhesins in the pathogenesis of IAIs.
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Affiliation(s)
- Catherine E. Foster
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
- * E-mail:
| | - Melissa Kok
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
| | - Anthony R. Flores
- Division of Infectious Diseases, Department of Pediatrics, Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
| | - Ruth A. Luna
- Department of Pediatrics, Section of Pathology and Immunology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
| | - Linda B. Lamberth
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
| | - Sheldon L. Kaplan
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
| | - Kristina G. Hulten
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States of America
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15
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Szemraj M, Grazul M, Balcerczak E, Szewczyk EM. Staphylococcal species less frequently isolated from human clinical specimens - are they a threat for hospital patients? BMC Infect Dis 2020; 20:128. [PMID: 32046678 PMCID: PMC7014773 DOI: 10.1186/s12879-020-4841-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background Coagulase-negative staphylococci belonging to S. haemolyticus, S. hominis subsp. hominis, S. simulans, and S. warneri are often described as etiological factors of infections. Staphylococci are a phylogenetically coherent group; nevertheless, there are differences among the species which may be important to clinicians. Methods We investigated selected virulence factors and antibiotic resistance that were phenotypically demonstrated, the presence and expression of genes encoding the virulence factors, and the type of the SCCmec cassette. Results The differences between the tested species were revealed. A great number of isolates produced a biofilm and many of them contained single icaADBC operon genes. Clear differences between species in the lipolytic activity spectrum could be related to their ability to cause various types of infections. Our studies also revealed the presence of genes encoding virulence factors homologous to S. aureus in the analysed species such as enterotoxin and pvl genes, which were also expressed in single isolates of S. simulans and S. warneri. S. haemolyticus and S. hominis subsp. hominis isolates were resistant to all clinically important antibiotics including ß-lactams. The identified SCCmec cassettes belonged to IV, V, VII, and IX type but most of the detected cassettes were non-typeable. Among the investigated species, S. hominis subsp. hominis isolates accumulated virulence genes typical for S. aureus in the most efficient way and were widely resistant to antibiotics. Conclusions Our results clearly indicated significant differences between the tested species, which might be a result of the horizontal gene transfer (HGT) and can lead to the formation and selection of multi-drug resistant strains as well as strains with new virulence features. Such strains can have a new clinical relevance.
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Affiliation(s)
- Magdalena Szemraj
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Pomorska 137, 90-235, Łódź, Poland.
| | - Magdalena Grazul
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Pomorska 137, 90-235, Łódź, Poland
| | - Ewa Balcerczak
- Department of Pharmaceutical Biochemistry and Molecular Diagnostic, Laboratory of Molecular Diagnostic and Pharmacogenomics, Medical University of Lodz, Łódź, Poland
| | - Eligia M Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Medical University of Lodz, Pomorska 137, 90-235, Łódź, Poland
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16
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Rodrigues ME, Gomes F, Rodrigues CF. Candida spp./Bacteria Mixed Biofilms. J Fungi (Basel) 2019; 6:jof6010005. [PMID: 31861858 PMCID: PMC7151131 DOI: 10.3390/jof6010005] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 12/21/2022] Open
Abstract
The ability to form biofilms is a common feature of microorganisms, such as bacteria or fungi. These consortiums can colonize a variety of surfaces, such as host tissues, dentures, and catheters, resulting in infections highly resistant to drugs, when compared with their planktonic counterparts. This refractory effect is particularly critical in polymicrobial biofilms involving both fungi and bacteria. This review emphasizes Candida spp.-bacteria biofilms, the epidemiology of this community, the challenges in the eradication of such biofilms, and the most relevant treatments.
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Affiliation(s)
- Maria Elisa Rodrigues
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Fernanda Gomes
- CEB, Centre of Biological Engineering, LIBRO–Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, 4710-057 Braga, Portugal; (M.E.R.); (F.G.)
| | - Célia F. Rodrigues
- LEPABE–Dep. of Chemical Engineering, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Correspondence:
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17
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Arciola CR, Campoccia D, Montanaro L. Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol 2019; 16:397-409. [PMID: 29720707 DOI: 10.1038/s41579-018-0019-y] [Citation(s) in RCA: 1037] [Impact Index Per Article: 207.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Medical device-associated infections account for a large proportion of hospital-acquired infections. A variety of opportunistic pathogens can cause implant infections, depending on the type of the implant and on the anatomical site of implantation. The success of these versatile pathogens depends on rapid adhesion to virtually all biomaterial surfaces and survival in the hostile host environment. Biofilm formation on implant surfaces shelters the bacteria and encourages persistence of infection. Furthermore, implant-infecting bacteria can elude innate and adaptive host defences as well as biocides and antibiotic chemotherapies. In this Review, we explore the fundamental pathogenic mechanisms underlying implant infections, highlighting orthopaedic implants and Staphylococcus aureus as a prime example, and discuss innovative targets for preventive and therapeutic strategies.
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Affiliation(s)
- Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy. .,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
| | - Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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18
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Vision for medicine: Staphylococcus aureus biofilm war and unlocking key's for anti-biofilm drug development. Microb Pathog 2018; 123:339-347. [DOI: 10.1016/j.micpath.2018.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 01/28/2023]
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19
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Meneghetti KL, do Canto Canabarro M, Otton LM, Dos Santos Hain T, Geimba MP, Corção G. Bacterial contamination of human skin allografts and antimicrobial resistance: a skin bank problem. BMC Microbiol 2018; 18:121. [PMID: 30249183 PMCID: PMC6154792 DOI: 10.1186/s12866-018-1261-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 09/17/2018] [Indexed: 01/15/2023] Open
Abstract
Background Bacterial contamination remains the major problem in skin banks, even after antimicrobial treatment, and results in high rates of tissue discarding. This study aimed to analyze bacterial contamination in 32 human skin allografts from the skin bank of Dr. Roberto Corrêa Chem from the Hospital Complex Santa Casa de Misericórdia de Porto Alegre. These samples were already discarded due to microbial contamination. The identification of the bacteria isolated from skin allografts was performed by matrix assisted laser desorption ionization–time of flight. The antimicrobial susceptibility of the isolates to six different classes of antimicrobials was determined using the disk-diffusion agar method, and the evaluation of the inhibitory potential was determined by the minimal inhibitory concentration (50/90) of antimicrobials already used in the skin bank and those that most isolates were susceptible to. Results A total of 21 (65.6%) skin samples were contaminated with Gram-positive bacteria: 1 (4.7%) with Paenibacillus sp., 12 (61.9%) with Bacillus sp., 6 (28.5%) with Staphylococcus sp., and 2 (9.5%) with Bacillus sp. and Staphylococcus sp. Several resistance profiles, including multiresistance, were found among the isolates. Most of the isolates were susceptible to at least one of the antimicrobials used in the skin bank. All isolates were susceptible to amikacin, gentamicin, and tetracycline, which demonstrated the best inhibitory activities against the isolates and were considered as potential candidates for new antimicrobial treatments. Conclusions Bacillus, Paenibacillus, and Staphylococcus were isolated from the skin allografts, thus demonstrating the predominance of Gram-positive bacteria contamination. Other factors not related to the resistance phenotype may also be involved in the persistence of bacterial isolates in the skin allografts after antibiotic treatment. Gentamicin, amikacin, and tetracycline can be considered as an option for a more effective treatment cocktail. Electronic supplementary material The online version of this article (10.1186/s12866-018-1261-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karine Lena Meneghetti
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Micaela do Canto Canabarro
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Letícia Muner Otton
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Thaís Dos Santos Hain
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Mercedes Passos Geimba
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil
| | - Gertrudes Corção
- Department of Microbiology, Immunology and Parasitology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Sarmento Leite 500, Porto Alegre, 90050-170, Brazil.
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20
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Frickmann H, Hahn A, Skusa R, Mund N, Viehweger V, Köller T, Köller K, Schwarz NG, Becker K, Warnke P, Podbielski A. Comparison of the etiological relevance of Staphylococcus haemolyticus and Staphylococcus hominis. Eur J Clin Microbiol Infect Dis 2018; 37:1539-1545. [PMID: 29777490 DOI: 10.1007/s10096-018-3282-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/10/2018] [Indexed: 01/19/2023]
Abstract
The study was performed to assess potential differences in the etiological relevance of two coagulase-negative staphylococci (CoNS), Staphylococcus haemolyticus and Staphylococcus hominis, in an observational single-center study. Over a 5-year interval, patients in whom there was detected S. haemolyticus or S. hominis of presumed etiological relevance were assessed for the primary endpoint death during hospital stay and the secondary endpoint transfer to an intensive care unit (ICU) after the detection of S. haemolyticus or S. hominis. Patients with S. haemolyticus or S. hominis died in 11.3% (50 out of 444) and 9.5% (60 out of 631) of cases, respectively, and were transferred to ICU after S. haemolyticus and S. hominis detection in 8.7% (19 out of 219) and 11.7% (44 out of 377) of cases, respectively. There was no significance for species-related influence on the primary outcome parameter (P > 0.1), while ICU transfers were more likely for patients with S. hominis detections (P = 0.016). Delayed diagnosis of both CoNS species was associated with an increased probability of death (P = 0.009). The study revealed comparable morbidity caused by S. haemolyticus and S. hominis identified in a clinically relevant context.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Bernhard Nocht Str. 74, 20359, Hamburg, Germany. .,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany.
| | - Andreas Hahn
- Institute for Microbiology, Charité - University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Romy Skusa
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Nils Mund
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Vivian Viehweger
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Thomas Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Kerstin Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Norbert Georg Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard Nocht Str. 74, 20359, Hamburg, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Domagkstraße 10, 48149, Münster, Germany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Schillingallee 70, 18057, Rostock, Germany
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21
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Romanò CL, Morelli I, Romanò D, Meani E, Drago L. ICS classification system of infected osteosynthesis: Long-term results. Injury 2018; 49:564-569. [PMID: 29361293 DOI: 10.1016/j.injury.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/05/2018] [Indexed: 02/02/2023]
Abstract
The best treatment strategy for infected osteosyntheses is still debated. While hardware removal or eventually early device exchange may be necessary in most of the cases, temporary hardware retention until fracture healing can be a valid alternative option in others. Aim of the present study is to report the long-term results of 215 patients with infected osteosyntheses, treated according to the ICS (Infection, Callus, Stability) classification in two Italian hospitals. Patients classified as ICS Type 1 (N = 83) feature callus progression and hardware stability, in spite of the presence of infection; these patients were treated with suppressive antibiotic therapy coupled with local debridement in 18.1% of the cases, and no hardware removal until bone healing. Type 2 patients (N = 75) are characterized by the presence of infection and hardware stability, but no callus progression; these patients were treated as Type 1 patients, but with additional callus stimulation therapies. Type 3 patients (N = 57), showing infection, no callus progression and loss of hardware stability, underwent removal and exchange of the fixation device. Considering only the initial treatment, performed according to the ICS classification, at a minimum 5 years follow up, 89.3% achieved bone healing and 93.5% did not show infection recurrence. The ICS classification appears as a useful and reliable tool to help standardizing the decision-making process in treating infected osteosynthesis with the most conservative approach.
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Affiliation(s)
- Carlo L Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections, C.R.I.O Unit I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy
| | - Ilaria Morelli
- Department of Reconstructive Surgery of Osteo-articular Infections, C.R.I.O Unit I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy; Residency Program in Orthopaedics and Trauma, University of Milan, Italy.
| | - Delia Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections, C.R.I.O Unit I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy
| | | | - Lorenzo Drago
- Clinical-Chemistry and Microbiology Lab, I.R.C.C.S. Galeazzi Orthopedic Institute, Milan - Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Italy
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22
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Campoccia D, Montanaro L, Visai L, Corazzari T, Poggio C, Pegreffi F, Maso A, Pirini V, Ravaioli S, Cangini I, Speziale P, Arciola CR. Characterization of 26 Staphylococcus warneri isolates from orthopedic infections. Int J Artif Organs 2018; 33:575-81. [DOI: 10.1177/039139881003300903] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 11/16/2022]
Abstract
Staphylococcus warneri is a coagulase negative Staphylococcus (CNS) commonly present in the flora of human epithelia and mucosal membranes. Over the last two decades, similarly to other CNS species, S. warneri has been reported as a new emerging pathogen, capable of causing serious infections usually in association with the presence of implant materials, but, at times, even in the absence of a foreign body and in patients considered immunocompetent. At present, there is still a lack of scientific data on the pathogenesis and epidemiology of this species. The present study investigated a collection of 26 clinical isolates derived from orthopedic infections, some associated with implant materials and others not. Automated ribotyping showed the existence of 5 distinct ribogroups. Except for the least numerous ribogroup consisting of a single isolate, all other ribogroups included at least one strain obtained from an infection not associated with implant materials, suggesting that putative virulence factors necessary for infections even in the absence of a foreign body could be transversal to most ribogroup categories. Orthopedic infections were found to involve S. warneri strains with low antibiotic resistance potential, differing in this respect from the strains isolated at neonatal intensive care units, where this species has been described to figure among the principal causative agents and exhibit an alarming profile of antibiotic resistance.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Livia Visai
- Department of Biochemistry Pavia, Pavia - Italy
- Center for Tissue Engineering, University of Pavia, Pavia - Italy
| | - Tolmino Corazzari
- Laboratory of Medical Physics, University of Modena and Reggio Emilia, Modena - Italy
| | - Claudio Poggio
- Department of Endodontics, University of Pavia, Pavia - Italy
| | - Francesco Pegreffi
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Alessandra Maso
- Microbiological Analysis Section of the Musculoskeletal Tissue Bank, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Valter Pirini
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Stefano Ravaioli
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - Ilaria Cangini
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
| | | | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Experimental Pathology Department, University of Bologna, Bologna - Italy
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23
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Poggio C, Arciola CR, Dagna A, Colombo M, Bianchi S, Visai L. Solubility of Root Canal Sealers: A Comparative Study. Int J Artif Organs 2018; 33:676-81. [DOI: 10.1177/039139881003300914] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 11/17/2022]
Abstract
Introduction Root canal sealers used in odontological applications are capable of providing an apical seal, thus inhibiting potential bacterial penetration into the periradicular tissues. Since insolubility is the ideal characteristic for a root canal sealer material, in dentistry the sealability of the material depends on its solubility. Purpose This study tested the solubility of six different root canal sealers: two ZnOE-based sealers (Endomethasone C and Argoseal), two calcium hydroxide-containing sealers (Bioseal Normal and Acroseal), and two resin-based sealers (AH Plus and MM Seal). Methods Ten specimens of each material were prepared using stainless steel ring molds with the same internal diameter and the same height in order to obtain similar samples, and immersed in water. Solubility was determined by using sample weight loss (%) after 24 hours and after 2 months. The test was performed according to the International Standards Organization 6876 standard and the American Dental Association specifications No. 30 and No. 57. Data were statistically analyzed with a one-way analysis of variance test (ANOVA). Results The ANOVA test showed significant differences between the various groups. The post-hoc test showed that resin-based root canal sealers had significantly lower solubility percentages than other groups (p<0.05), and showed no difference between them (p>0.05). Conclusions All the materials fulfilled the requirements of International Standard 6876 and ANSI/ADA specifications demonstrating a weight loss of less than 3%. Under the conditions of the present study, all root canal sealers were of low solubility, but the lowest solubility percentages were recorded in resin-based root canal sealers, which can be considered virtually insoluble, and thanks to this physical property, ideal for use as endodontic sealer.
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Affiliation(s)
- Claudio Poggio
- Department of Operative Dentistry, University of Pavia, Pavia - Italy
| | - Carla Renata Arciola
- Research Unit on Implant Infections of the Rizzoli Orthopedic Institute of Bologna and Experimental Pathology Department of the University of Bologna, Bologna - Italy
| | - Alberto Dagna
- Department of Operative Dentistry, University of Pavia, Pavia - Italy
| | - Marco Colombo
- Department of Operative Dentistry, University of Pavia, Pavia - Italy
| | - Stefano Bianchi
- Department of Operative Dentistry, University of Pavia, Pavia - Italy
| | - Livia Visai
- Department of Biochemistry and Center for Tissue Engineering (CIT), University of Pavia, Pavia - Italy
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24
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Del Pozo J, Alonso M, Arciola C, Gonzalez R, Leiva J, Lasa I, Penades J. Biotechnological War against Biofilms. Could Phages Mean the End of Device-Related Infections? Int J Artif Organs 2018; 30:805-12. [DOI: 10.1177/039139880703000910] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Microorganisms universally attach to surfaces, resulting in biofilm formation. These biofilms entail a serious problem in daily clinical practice because of the great prevalence of implantable device-related infections. Differences in antibiotic activity against planktonic and sessile bacteria may relate to clinical failures in the treatment of biofilm-related infections (BRI). Bacteriophages have several characteristics that make them potentially attractive therapeutic agents in some selected clinical settings, like for example BRI. They are highly specific and very effective in lysing targeted bacteria, moreover, they appear to be safe for humans. Many studies have shown the potential of phages for the treatment of infectious diseases in plants and animals, including infections with highly drug-resistant bacteria. The therapeutic use of bacteriophages, possibly in combination with antibiotics, may be a valuable approach in BRI. However, many important questions still remain that must be addressed before phages can be endorsed for therapeutic use in humans.
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Affiliation(s)
- J.L. Del Pozo
- Division of Infectious Diseases and Clinical Microbiology, Clínica Universitaria de Navarra, Pamplona - Spain
- Department of Microbiology, Clínica Universitaria de Navarra, Pamplona - Spain
| | - M. Alonso
- Department of Microbiology, Clínica Universitaria de Navarra, Pamplona - Spain
| | - C.R. Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute of Bologna and Department of Experimental Pathology of the University of Bologna, Bologna - Italy
| | - R. Gonzalez
- Department of Microbiology, Clínica Universitaria de Navarra, Pamplona - Spain
| | - J. Leiva
- Department of Microbiology, Clínica Universitaria de Navarra, Pamplona - Spain
| | - I. Lasa
- Laboratory of Microbial Biofilms, Instituto de Agrobiotecnología y Departamento de Producción Agraria, Universidad Pública de Navarra-CSIC, Pamplona - Spain
| | - J. Penades
- Centro Investigación y Tecnología Animal, Instituto Valenciano de Investigaciones Agrarias, Valencia - Spain
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25
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Arciola CR, Balaban N, Baldassarri L, Fromm K, HÄnsch GM, Obst U, Presterl E, Stefani S, Verran J, Visai L, Arciola CR, Balaban N, Baldassarri L, Fromm K, Hänsch GM, Obst U, Presterl E, Stefani S, Verran J, Visai L. Combating Implant Infections. Remarks by a Women's Team. Int J Artif Organs 2018; 31:858-64. [DOI: 10.1177/039139880803100915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Research on implant infections requires cooperative efforts and integration between basic and clinical expertises. An international group of women scientists is acting together in this field. The main research topics of the participants of this group are described. Formation of bacterial biofilms, antibiotic resistance and production of virulence factors like adhesins and toxins are investigated. New biomaterials, coatings and drugs designed to inhibit microbial adhesion are evaluated, and infection-resistant biomaterials are under study, such as a novel heparinizable polycarbonate-urethane (Bionate) or incorporation of diamino-diamide-diol (PIME) to reduce bacterial attachment. The correlation between biofilm production and the accessory-gene-regulator (agr) is investigated in Staphylococcus aureus. The ability to form biofilm has also been shown to be one of the important virulence factors of Enterococcus faecalis, favouring colonization of inert and biological surfaces. The study of quorum sensing has led to the discovery of a quorum sensing inhibitor termed RIP that suppresses staphylococcal biofilm and infections. The immune response and the local defence mechanisms of the host against implant-associated infections, activation and infiltration of immunocompetent cells into the sites of infection have been studied in patients with implant-associated osteomyelitis. Production of monoclonal antibodies (mAbs) as possible vaccines against the staphylococcal collagen-binding MSCRAMMs is in progress. (Int J Artif Organs 2008; 31: 858–64)
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Affiliation(s)
- C. R. Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute and Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - N. Balaban
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts - USA
| | - L. Baldassarri
- Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome - Italy
| | - K. Fromm
- Chemistry Department, University of Fribourg, Fribourg - Switzerland
| | - G. M. HÄnsch
- Institute for Immunology of the University of Heidelberg, Heidelberg - Germany
| | - U. Obst
- Department of Environmental Microbiology, Institute for Technical Chemistry-Water Technology and Geotechnology, Eggenstein-Leopoldshafen - Germany
| | - E. Presterl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, University of Vienna, Vienna - Austria
| | - S. Stefani
- Department of Microbiological and Gynecological Sciences, University of Catania, Catania - Italy
| | - J. Verran
- Manchester Metropolitan University, Manchester - United Kingdom
| | - L. Visai
- University of Pavia, Department of Biochemistry, Pavia - Italy
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26
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Campoccia D, Montanaro L, Arciola CR. Current Methods for Molecular Epidemiology Studies of Implant Infections. Int J Artif Organs 2018; 32:642-54. [DOI: 10.1177/039139880903200914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Over the last few decades, the number of surgical procedures involving prosthetic materials has greatly multiplied, along with the rising medical and economic impact of implant-associated infections. The need to appropriately counteract and deal with this phenomenon has led to growing efforts to elucidate the etiology, pathogenesis and epidemiology of these types of infections, characterized by opportunistic pathogens. Molecular epidemiology studies have progressively emerged as a leading multitask tool to identify and fingerprint bacterial strains, unveil the complex clonal nature of important pathogens, detect outbreak events, track the origin of the infections, assess the clinical significance of individual strain types, survey their distribution, recognize associations of strain types with specific virulence determinants and/or pathological conditions, assess the role played by the specific components of the virulon, and reveal the phylogeny and the mechanisms through which new strain types have emerged. Despite the many advances that have been made thanks to these flourishing new approaches to molecular epidemiology, a number of critical aspects remain challenging. In this paper, we briefly discuss the current limitations and possible developments of molecular epidemiology methods in the investigation and surveillance of implant infections.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna - Italy
- Department of Experimental Pathology, University of Bologna, Bologna - Italy
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27
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Sun Z, Li P, Liu F, Bian H, Wang D, Wang X, Zou Y, Sun C, Xu W. Synergistic antibacterial mechanism of the Lactobacillus crispatus surface layer protein and nisin on Staphylococcus saprophyticus. Sci Rep 2017; 7:265. [PMID: 28325944 PMCID: PMC5428217 DOI: 10.1038/s41598-017-00303-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/17/2017] [Indexed: 01/28/2023] Open
Abstract
SlpB, a surface layer protein isolated from Lactobacillus crispatus, has the potential to enhance the antimicrobial activity of nisin. Previous research indicated that, when combined with nisin, SlpB acted synergistically to inhibit Staphylococcus saprophyticus growth, thus extending the shelf life of chicken meat. In order to understand how SlpB enhances the antibacterial activity of nisin, electron microscopy, confocal laser scanning microscopy, flow cytometry and transmembrane electrical potential analysis were used to study cell wall organization and cell membrane integrity. No remarkable bacteriolytic effects were observed, indicating that cell death could not be attributed to cell lysis, although SlpB caused dramatic modifications of cell wall, thereby altering cell shape. The combination of SlpB and nisin also induced the release of ATP or UV-absorbing materials, as well as sudden dissipation of the transmembrane electrical potential by compromising membrane integrity. Considering that SlpB led to structural disorganization of the cell wall, and nisin access is enhanced to form a stable pore, cell death is a predictable outcome. SlpB significantly enhanced the effect of nisin at half of the minimum inhibitory concentration, which resulted in cell death by destroying the cell wall and cell membrane, therefore providing a new, feasible approach in food preservation.
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Affiliation(s)
- Zhilan Sun
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China
| | - Pengpeng Li
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China
| | - Fang Liu
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China.
| | - Huan Bian
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China
| | - Daoying Wang
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China. .,Key Laboratory of Meat Processing and Quality Control, Ministry of Education, Nanjing Agricultural University, Nanjing, 210095, PR China.
| | - Xiaomeng Wang
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China
| | - Ye Zou
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China
| | - Chong Sun
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China
| | - Weimin Xu
- Institute of Agricultural Products Processing, Jiangsu Academy of Agricultural Sciences, Nanjing, 210014, PR China.,Key Laboratory of Meat Processing and Quality Control, Ministry of Education, Nanjing Agricultural University, Nanjing, 210095, PR China
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28
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Rosenbaum J, Versace DL, Abbad-Andallousi S, Pires R, Azevedo C, Cénédese P, Dubot P. Antibacterial properties of nanostructured Cu–TiO2surfaces for dental implants. Biomater Sci 2017; 5:455-462. [DOI: 10.1039/c6bm00868b] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The influence of copper derived TiO2surfaces (nCu–nT-TiO2) on the death of nosocomialStaphylococcus aureus(Sa) andEscherichia coli(Ec), was investigated.
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Affiliation(s)
| | - Davy Louis Versace
- Institut de Chimie et des Matériaux de Paris-Est
- Université Paris-Est
- CNRS
- Thiais
- UMR7182
| | | | - Remi Pires
- Institut de Chimie et des Matériaux de Paris-Est
- Université Paris-Est
- CNRS
- Thiais
- UMR7182
| | | | - Pierre Cénédese
- Institut de Chimie et des Matériaux de Paris-Est
- Université Paris-Est
- CNRS
- Thiais
- UMR7182
| | - Pierre Dubot
- Institut de Chimie et des Matériaux de Paris-Est
- Université Paris-Est
- CNRS
- Thiais
- UMR7182
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29
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Clonality, virulence and the occurrence of genes encoding antibiotic resistance among Staphylococcus warneri isolates from bloodstream infections. J Med Microbiol 2016; 65:828-836. [DOI: 10.1099/jmm.0.000287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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30
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Campoccia D, Testoni F, Ravaioli S, Cangini I, Maso A, Speziale P, Montanaro L, Visai L, Arciola CR. Orthopedic implant infections: Incompetence of Staphylococcus epidermidis, Staphylococcus lugdunensis, and Enterococcus faecalis to invade osteoblasts. J Biomed Mater Res A 2015; 104:788-801. [PMID: 26378773 DOI: 10.1002/jbm.a.35564] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/15/2015] [Indexed: 11/11/2022]
Abstract
Septic failure is still the major complication of prosthetic implants. Entering host cells, bacteria hide from host immune defenses, shelter from extracellular antibiotics, and cause chronic infection. Staphylococcus aureus, the leading etiologic agent of orthopedic implant infections, is able to enter bone cells and induce osteoblast apoptosis, osteoclast recruitment, and highly destructive osteomyelitis. Staphylococcus epidermidis, Staphylococcus lugdunensis, and Enterococcus faecalis are opportunistic pathogens causative of implant-related infections. This study investigated the ability to internalize into osteoblastic MG63 cells of 22 S. epidermidis, 9 S. lugdunensis, and 21 E. faecalis clinical isolates from orthopedic implant infections. Isolates were categorized in clusters by ribotyping. Internalization assay was carried out by means of a microtiter plate-based method. S. epidermidis, S. lugdunensis, and E. faecalis strains turned out incompetent to enter osteoblasts, exhibiting negligible internalization into MG63 cells, nearly three orders of magnitude lower than that of S. aureus. Osteoblast invasion does not appear as a pathogenetic mechanism utilized by S. epidermidis, S. lugdunensis, or E. faecalis for infecting orthopedic implants. Moreover, it can be inferred that intracellularly active antimicrobials should not be necessary against implant infections caused by the three bacterial species. Finally, implications with the uptake of biomaterial microparticles by nonphagocytic cells are enlightened. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 788-801, 2016.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Francesca Testoni
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Stefano Ravaioli
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Ilaria Cangini
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandra Maso
- Microbiology Analysis Section of the Musculoskeletal Tissue Bank, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Pietro Speziale
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
| | - Lucio Montanaro
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Livia Visai
- Department of Molecular Medicine, Center for Tissue Engineering (CIT), INSTM UdR of Pavia, University of Pavia, Pavia, Italy.,Department of Occupational Medicine, Ergonomy and Disability, Nanotechnology Laboratory, Salvatore Maugeri Foundation, Pavia, Italy
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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31
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Antibacterial Modification of Kirschner Wires with Polyluteolin toward Methicillin-Resistant Staphylococcus aureus (MRSA). MATERIALS 2015; 8:4876-4883. [PMID: 28793478 PMCID: PMC5455526 DOI: 10.3390/ma8084876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/23/2015] [Accepted: 07/10/2015] [Indexed: 11/16/2022]
Abstract
In this study we report antibacterial modification of Kirschner wires (K-wires) with polyluteolin (PL) toward methicillin-resistant Staphylococcus aureus (MRSA). K-wires were modified by immersing them in the luteolin-containing aqueous solution for 24 h. Characterizations using scanning electron microscopy and electrochemical methods confirmed the presence of the PL coatings on the K-wires. The PL-coated K-wires were further found to show antibacterial activity toward MRSA and remained unimpaired antibacterial activity even after the steam sterilization treatment.
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32
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Abstract
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
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Affiliation(s)
- Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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33
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Cochis A, Azzimonti B, Della Valle C, Chiesa R, Arciola CR, Rimondini L. Biofilm formation on titanium implants counteracted by grafting gallium and silver ions. J Biomed Mater Res A 2014; 103:1176-87. [PMID: 25044610 DOI: 10.1002/jbm.a.35270] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 06/15/2014] [Accepted: 06/30/2014] [Indexed: 01/20/2023]
Abstract
Biofilm-associated infections remain the leading cause of implant failure. Thanks to its established biocompatibility and biomechanical properties, titanium has become one of the most widely used materials for bone implants. Engineered surface modifications of titanium able to thwart biofilm formation while endowing a safe anchorage to eukaryotic cells are being progressively developed. Here surfaces of disks of commercial grade 2 titanium for bone implant were grafted with gallium and silver ions by anodic spark deposition. Scanning electron microscopy of the surface morphology and energy dispersive X-ray spectroscopy were used for characterization. Gallium-grafted titanium was evaluated in comparison with silver-grafted titanium for both in vivo and in vitro antibiofilm properties and for in vitro compatibility with human primary gingival fibroblasts. Surface-modified materials showed: (i) homogeneous porous morphology, with pores of micrometric size; (ii) absence of cytotoxic effects; (iii) ability to support in vitro the adhesion and spreading of gingival fibroblasts; and (iv) antibiofilm properties. Although both silver and gallium exhibited in vitro strong antibacterial properties, in vivo gallium was significantly more effective than silver in reducing number and viability of biofilm bacteria colonies. Gallium-based treatments represent promising titanium antibiofilm coatings to develop new bone implantable devices for oral, maxillofacial, and orthopedic applications.
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Affiliation(s)
- Andrea Cochis
- Department of Health Sciences, University of Piemonte Orientale "A. Avogadro", Novara, Italy; National Interuniversity Consortium for Materials Science and Technology (INSTM), Florence, Italy
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An overview of the methodological approach to the in vitro study of anti-infective biomaterials. Int J Artif Organs 2013; 35:800-16. [PMID: 23065889 DOI: 10.5301/ijao.5000140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 02/05/2023]
Abstract
Biomaterial-associated infections have an enormous impact in terms of morbidity of the patients and costs to national health systems. Perioperative antibiotics and aseptic procedures have not proved sufficient to eradicate the occurrence of this type of infections which often lead to devastating effects. Adjunctive strategies for preventing the establishment of infections are increasingly being centered on the development of new biomaterials with anti-infective properties. The creation of new anti-infective biomaterials can be obtained by alternative approaches oriented to achieve either bacteria-repellent surfaces or bioactive surfaces expressing self-sterilizing properties when not even able to treat pre-existing infections in the surrounding tissues. Here, we offer a short overview of the currently available in vitro methods that can be used to investigate and assess the performance of anti-infective biomaterials, with special emphasis on those whose mechanism of action is based on bacteria-repellent surfaces.
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35
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Campoccia D, Montanaro L, Arciola CR. A review of the biomaterials technologies for infection-resistant surfaces. Biomaterials 2013; 34:8533-54. [PMID: 23953781 DOI: 10.1016/j.biomaterials.2013.07.089] [Citation(s) in RCA: 762] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 07/26/2013] [Indexed: 02/06/2023]
Abstract
Anti-infective biomaterials need to be tailored according to the specific clinical application. All their properties have to be tuned to achieve the best anti-infective performance together with safe biocompatibility and appropriate tissue interactions. Innovative technologies are developing new biomaterials and surfaces endowed with anti-infective properties, relying either on antifouling, or bactericidal, or antibiofilm activities. This review aims at thoroughly surveying the numerous classes of antibacterial biomaterials and the underlying strategies behind them. Bacteria repelling and antiadhesive surfaces, materials with intrinsic antibacterial properties, antibacterial coatings, nanostructured materials, and molecules interfering with bacterial biofilm are considered. Among the new strategies, the use of phages or of antisense peptide nucleic acids are discussed, as well as the possibility to modulate the local immune response by active cytokines. Overall, there is a wealth of technical solutions to contrast the establishment of an implant infection. Many of them exhibit a great potential in preclinical models. The lack of well-structured prospective multicenter clinical trials hinders the achievement of conclusive data on the efficacy and comparative performance of anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
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36
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Campoccia D, Montanaro L, Arciola CR. A review of the clinical implications of anti-infective biomaterials and infection-resistant surfaces. Biomaterials 2013; 34:8018-29. [PMID: 23932292 DOI: 10.1016/j.biomaterials.2013.07.048] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 07/15/2013] [Indexed: 12/28/2022]
Abstract
Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. The important social, clinical and economic impacts of implant-related infections are promoting the efforts to obviate these severe diseases. In this context, the development of anti-infective biomaterials and of infection-resistant surfaces is being regarded as the main strategy to prevent the establishment of implant colonisation and biofilm formation by bacteria. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Via di Barbiano 1/10, 40136 Bologna, Italy
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In Vitro Activity of Gentamicin-Loaded Bioabsorbable Beads against Different Microorganisms. MATERIALS 2013; 6:3284-3293. [PMID: 28811436 PMCID: PMC5525159 DOI: 10.3390/ma6083284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/15/2013] [Accepted: 07/26/2013] [Indexed: 11/17/2022]
Abstract
Osteomyelitis is responsible for high treatment costs, long hospital stays, and results in substantial morbidity. Treatment with surgical debridement and antibiotic-impregnated Polymethylmetacrylate (PMMA) beads is the standard of care, providing high local but low serum antibiotic concentrations, thereby avoiding systemic toxicity. However, for several reasons, the beads require surgical removal. Alternative antibiotic delivery systems should improve the treatment of bone infection, actively encourage bone healing and require no additional surgery for removal. We investigated the activity of gentamicin-loaded bioabsorbable beads against different microorganisms (Staphylococcus epidermidis, S. aureus, Escherichia coli, Enterococcus faecalis, Candida albicans) commonly causing surgical site bone infection, by microcalorimetry. Calcium sulphate beads containing gentamicin were incubated in microcalorimetry ampoules containing different concentrations of the corresponding microorganism. Growth medium with each germ and unloaded beads was used as positive control, growth medium with loaded beads alone as negative control. Bacterial growth-related heat production at 37 °C was measured for 24 h. Cultures without gentamicin-loaded beads produced heat-flow peaks corresponding to the exponential growth of the corresponding microorganisms in nutrient-rich medium. In contrast, cultures with gentamicin-loaded beads completely suppressed heat production during 24 h, demonstrating their antibiotic activity. Gentamicin-loaded beads effectively inhibited growth of susceptible microorganisms, under the described in vitro conditions.
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Hoene A, Prinz C, Walschus U, Lucke S, Patrzyk M, Wilhelm L, Neumann HG, Schlosser M. In vivo evaluation of copper release and acute local tissue reactions after implantation of copper-coated titanium implants in rats. Biomed Mater 2013; 8:035009. [PMID: 23598370 DOI: 10.1088/1748-6041/8/3/035009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Copper (Cu) based coatings can reduce infections for titanium (Ti) implants. However, Cu is also cytotoxic. To examine the balance of antibacterial versus adverse tissue effects, this study aimed at evaluating a Cu coating regarding in vivo Cu release and local inflammatory reactions for 72 h. TiAl6V4 plates received either plasma electrolytic oxidation only (Ti), or an additional galvanic Cu deposition (Ti-Cu). No Staphylococcus aureus were found in vitro on Ti-Cu after 24 h. Following simultaneous intramuscular implantation of two Ti and two Ti-Cu plates into nine rats, serum Cu was elevated until 48 h and residual Cu on explanted samples reduced accordingly after 48 h. Total and tissue macrophages around implants increased until 72 h for both series, and were increased for Ti-Cu. As numbers of total and tissue macrophages were comparable, macrophages were probably tissue-derived. MHC-class-II-positive cells increased for Ti-Cu only. T-lymphocytes had considerably lower numbers than macrophages, did not increase or differ between both series, and thus had minor importance. Tissue reactions increased beyond Cu release, indicating effects of either surface-bound Cu or more likely the implants themselves. Altogether, Ti-Cu samples possessed antibacterial effectiveness in vitro, released measurable Cu amounts in vivo and caused a moderately increased local inflammatory response, demonstrating anti-infective potential of Cu coatings.
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Affiliation(s)
- Andreas Hoene
- Department of Surgery, Ernst Moritz Arndt University Greifswald, Ferdinand-Sauerbruch-Str., D-17489 Greifswald, Germany
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Hoene A, Patrzyk M, Walschus U, Straňák V, Hippler R, Testrich H, Meichsner J, Finke B, Rebl H, Nebe B, Zietz C, Bader R, Podbielski A, Schlosser M. In vivo examination of the local inflammatory response after implantation of Ti6Al4V samples with a combined low-temperature plasma treatment using pulsed magnetron sputtering of copper and plasma-polymerized ethylenediamine. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:761-771. [PMID: 23314622 DOI: 10.1007/s10856-012-4839-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 12/12/2012] [Indexed: 06/01/2023]
Abstract
Copper (Cu) could serve as antibacterial coating for Ti6Al4V implants. An additional cell-adhesive layer might compensate Cu cytotoxicity. This study aimed at in vitro and in vivo evaluation of low-temperature plasma treatment of Ti6Al4V plates with Ti/Cu magnetron sputtering (Ti6Al4V-Ti/Cu), plasma-polymerized ethylenediamine (Ti6Al4V-PPEDA), or both (Ti6Al4V-Ti/Cu-PPEDA). Ti6Al4V-Ti/Cu and Ti6Al4V-Ti/Cu-PPEDA had comparable in vitro Cu release and antibacterial effectiveness. Following intramuscular implantation of Ti6Al4V-Ti/Cu, Ti6Al4V-PPEDA, Ti6Al4V-Ti/Cu-PPEDA and Ti6Al4V controls for 7, 14 and 56 days with 8 rats/day, peri-implant tissue was immunohistochemically examined for different inflammatory cells. Ti6Al4V-PPEDA had more mast cells and NK cells than Ti6Al4V, and more tissue macrophages, T lymphocytes, mast cells and NK cells than Ti6Al4V-Ti/Cu-PPEDA. Ti6Al4V-Ti/Cu had more mast cells than Ti6Al4V and Ti6Al4V-Ti/Cu-PPEDA. Results indicate that PPEDA-mediated cell adhesion counteracted Cu cytotoxicity. Ti6Al4V-Ti/Cu-PPEDA differed from Ti6Al4V only for mast cells on day 56. Altogether, implants with both plasma treatments had antibacterial properties and did not increase inflammatory reactions.
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Affiliation(s)
- Andreas Hoene
- Department of Surgery, University of Greifswald, Greifswald, Germany
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Staphylococcus Lugdunensis, An Aggressive Coagulase-Negative Pathogen not to be Underestimated. Int J Artif Organs 2012; 35:742-53. [DOI: 10.5301/ijao.5000142] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2012] [Indexed: 01/06/2023]
Abstract
The new emerging coagulase-negative pathogen Staphylococcus lugdunensis is responsible for severe cardiac and joint infections. Since the biochemical phenotypic systems designed for the identification of CoNS do not appear to be species specific and are hardly reliable for the discrimination of S. lugdunensis from other staphylococci, its precise identification requires fine molecular methods. The pathogenic mechanisms by which S. lugdunensis causes severe infections are not yet completely elucidated and in this review its virulence and toxic determinants are surveyed as well as its adhesins and biofilm production.
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Interactions of Staphylococci with Osteoblasts and Phagocytes in the Pathogenesis of Implant-Associated Osteomyelitis. Int J Artif Organs 2012; 35:713-26. [DOI: 10.5301/ijao.5000158] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2012] [Indexed: 11/20/2022]
Abstract
In spite of great advancements in the field of biomaterials and in surgical techniques, the implant of medical devices is still associated with a high risk of bacterial infection. Implant-associated osteomyelitis is a deep infection of bone around the implant. The continuous inflammatory destruction of bone tissues characterizes this serious bone infectious disease. Staphylococcus aureus and Staphylococcus epidermidis are the most prevalent etiologic agents of implant-associated infections, together with the emerging pathogen Staphylococcus lugdunensis. Various interactions between staphylococci, osteoblasts, and phagocytes occurring in the peri-prosthesis environment play a crucial role in the pathogenesis of implant-associated osteomyelitis. Here we focus on two main events: internalization of staphylococci into osteoblasts, and bacterial interactions with phagocytic cells.
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Richter C, Hollstein S, Woloszyn J, Kaase M, Gatermann SG, Szabados F. Evaluation of species-specific score cut-off values for various Staphylococcus species using a MALDI Biotyper-based identification. J Med Microbiol 2012; 61:1409-1416. [DOI: 10.1099/jmm.0.042606-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cindy Richter
- Institute for Hygiene and Microbiology, Department of Medical Microbiology, Ruhr-University Bochum, Germany
| | - Stephan Hollstein
- Institute for Hygiene and Microbiology, Department of Medical Microbiology, Ruhr-University Bochum, Germany
| | - Jaroslaw Woloszyn
- Institute for Hygiene and Microbiology, Department of Medical Microbiology, Ruhr-University Bochum, Germany
| | - Martin Kaase
- Institute for Hygiene and Microbiology, Department of Medical Microbiology, Ruhr-University Bochum, Germany
| | - Sören G. Gatermann
- Institute for Hygiene and Microbiology, Department of Medical Microbiology, Ruhr-University Bochum, Germany
| | - Florian Szabados
- Institute for Hygiene and Microbiology, Department of Medical Microbiology, Ruhr-University Bochum, Germany
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Dale H, Fenstad AM, Hallan G, Havelin LI, Furnes O, Overgaard S, Pedersen AB, Kärrholm J, Garellick G, Pulkkinen P, Eskelinen A, Mäkelä K, Engesæter LB. Increasing risk of prosthetic joint infection after total hip arthroplasty. Acta Orthop 2012; 83:449-58. [PMID: 23083433 PMCID: PMC3488170 DOI: 10.3109/17453674.2012.733918] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The risk of revision due to infection after primary total hip arthroplasty (THA) has been reported to be increasing in Norway. We investigated whether this increase is a common feature in the Nordic countries (Denmark, Finland, Norway, and Sweden). MATERIALS AND METHODS The study was based on the Nordic Arthroplasty Register Association (NARA) dataset. 432,168 primary THAs from 1995 to 2009 were included (Denmark: 83,853, Finland 78,106, Norway 88,455, and Sweden 181,754). Adjusted survival analyses were performed using Cox regression models with revision due to infection as the endpoint. The effect of risk factors such as the year of surgery, age, sex, diagnosis, type of prosthesis, and fixation were assessed. RESULTS 2,778 (0.6%) of the primary THAs were revised due to infection. Compared to the period 1995-1999, the relative risk (with 95% CI) of revision due to infection was 1.1 (1.0-1.2) in 2000-2004 and 1.6 (1.4-1.7) in 2005-2009. Adjusted cumulative 5-year revision rates due to infection were 0.46% (0.42-0.50) in 1995-1999, 0.54% (0.50-0.58) in 2000-2004, and 0.71% (0.66-0.76) in 2005-2009. The entire increase in risk of revision due to infection was within 1 year of primary surgery, and most notably in the first 3 months. The risk of revision due to infection increased in all 4 countries. Risk factors for revision due to infection were male sex, hybrid fixation, cement without antibiotics, and THA performed due to inflammatory disease, hip fracture, or femoral head necrosis. None of these risk factors increased in incidence during the study period. INTERPRETATION We found increased relative risk of revision and increased cumulative 5-year revision rates due to infection after primary THA during the period 1995-2009. No change in risk factors in the NARA dataset could explain this increase. We believe that there has been an actual increase in the incidence of prosthetic joint infections after THA.
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Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital
| | - Anne M Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital
| | - Leif I Havelin
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital,Institute of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital,Institute of Surgical Sciences, University of Bergen, Bergen, Norway
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital,Institute of Clinical Research, University of Southern Denmark, Odense
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan Kärrholm
- Department of Orthopaedics, Institute of Surgical Science, Sahlgrenska University Hospital, Gothenburg University, Mölndal, Sweden
| | - Göran Garellick
- Department of Orthopaedics, Institute of Surgical Science, Sahlgrenska University Hospital, Gothenburg University, Mölndal, Sweden
| | - Pekka Pulkkinen
- Department of Public Health, University of Helsinki, Helsinki
| | | | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland.
| | - Lars B Engesæter
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital,Institute of Surgical Sciences, University of Bergen, Bergen, Norway
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Biofilm formation in Staphylococcus implant infections. A review of molecular mechanisms and implications for biofilm-resistant materials. Biomaterials 2012; 33:5967-82. [PMID: 22695065 DOI: 10.1016/j.biomaterials.2012.05.031] [Citation(s) in RCA: 668] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/15/2012] [Indexed: 02/07/2023]
Abstract
Implant infections in orthopaedics, as well as in many other medical fields, are chiefly caused by staphylococci. The ability of growing within a biofilm enhances the chances of staphylococci to protect themselves from host defences, antibiotic therapies, and biocides. Advances in scientific knowledge on structural molecules (exopolysaccharide, proteins, teichoic acids, and the most recently described extracellular DNA), on the synthesis and genetics of staphylococcal biofilms, and on the complex network of signal factors that intervene in their control are here presented, also reporting on the emerging strategies to disrupt or inhibit them. The attitude of polymorphonuclear neutrophils and macrophages to infiltrate and phagocytise biofilms, as well as the ambiguous behaviour exhibited by these innate immune cells in biofilm-related implant infections, are here discussed. Research on anti-biofilm biomaterials is focused, reviewing materials loaded with antibacterial substances, or coated with anti-adhesive/anti-bacterial immobilized agents, or surfaced with nanostructures. Latter approaches appear promising, since they avoid the spread of antibacterial substances in the neighbouring tissues with the consequent risk of inducing bacterial resistance.
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Bacterial DNA from orthopedic implants after routine removal. Int J Artif Organs 2012; 34:856-62. [PMID: 22094566 DOI: 10.5301/ijao.5000060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
Abstract
Bacterial 16S rDNA was monitored and identified from orthopedic metallic implants after routine or septic removal from patients in a German hospital. From March to June 2009, 28 metallic implants, 10 human biopsies, and 6 foam dressings from 28 patients were investigated. After analysis of this first collective, the methods were optimized to enhance sensitivity and to reduce interference with human DNA. Then a second collective consisting of 21 metallic implants from 21 patients was investigated from June 2009 to January 2010. In the first collective, 71% of the metallic implants were negative for eubacterial DNA. Pathogens such as Staphylococcus aureus and opportunists such as Lactobacillus rhamnosus were identified in 11% of the samples, whereas the residual 18% positive results were classified as from skin sources or could not be confirmed. Tissue, secretion, and bone samples as well as foam dressings from the same collective also contained pathogens and opportunists. After the optimization of the methods, a considerable increase of positive samples was seen: in the second collective 19 of the 21 metallic implants proved to be positive for eubacterial 16S rDNA. Bacterial DNA from environmental sources was detected in 13 samples, and in 20 specimens, predominantly mostly the skin. Opportunistic pathogens were detected in 19 samples. Interestingly, septic complications did not occur despite the presence of bacterial DNA. The results obtained up to now encourage us not only to continue a directed monitoring of bacterial DNA on orthopedic implants in practice but also to look intensely for possible sources of bacterial contamination during and after insertion or during removal of such implants.
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Concise Survey of Staphylococcus Aureus Virulence Factors that Promote Adhesion and Damage to Peri-Implant Tissues. Int J Artif Organs 2011; 34:771-80. [DOI: 10.5301/ijao.5000046] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2011] [Indexed: 11/20/2022]
Abstract
Staphylococcus aureus is the leading cause of infection in orthopedic implants and of osteomyelitis consequent to it. Here we focus on the wide array of virulence factors that endow S. aureus with its abilities to colonize peri-prosthesis tissues and to attack and damage them. Following an infective strategy orchestrated by agr locus, Staphylococcus aureus first deploys virulence factors for adhesion to the prosthesis and peri-prosthesis tissues and then launches its attack by delivering destructive factors.
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Exopolysaccharide Production by Staphylococcus Epidermidis and its Relationship with Biofilm Extracellular DNA. Int J Artif Organs 2011; 34:832-9. [DOI: 10.5301/ijao.5000048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 11/20/2022]
Abstract
Implant-related infections are difficult to treat because they are very often associated with biofilm-forming micro-organisms capable of resisting host immune defenses and surviving conventional antibiotic treatments. In Staphylococcus epidermidis biofilm-forming strains, the polysaccharide intercellular adhesin (PIA), whose expression is encoded by the icaADBC operon, is recognized as a main staphylococcal accumulation mechanism. Nevertheless, various observations have shown that PIA expression is dispensable and a variety of additional/alternative accumulation mechanisms, including extracellular DNA (eDNA) and several other factors of proteic nature, can compensate for icaADBC low expression or even for its absence. A suggestive hypothesis points to the possibility that changes in biofilm extracellular matrix composition can be induced in different environmental niches. In this study we aimed at investigating the relationship between the exopolysaccharide and eDNA biofilm components, screening 55 S. epidermidis clinical isolates by means of a simple fluorescence-based microtiter-plate assay. Our findings indicate the existence of a certain degree of correlation, although not a strict one, between eDNA and the exopolysaccharide component. The presence of exopolysaccharide greatly varied even in strains belonging to the same strain type determined by automated riboprinting.
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Emerging Pathogenetic Mechanisms of the Implant-Related Osteomyelitis by Staphylococcus Aureus. Int J Artif Organs 2011; 34:781-8. [DOI: 10.5301/ijao.5000052] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2011] [Indexed: 01/23/2023]
Abstract
Implant-related osteomyelitis is a severe and deep infection of bone that arises and develops all around an implant. Staphylococcus aureus is the first cause of osteomyelitis, whether implant-related or not. Bone is an optimal substratum for S. aureus, since this bacterium expresses various adhesins by which can adhere to bone proteins and to the biomaterial surfaces coated with the proteins of the host extracellular matrix. S. aureus is able not only to colonize bone tissues, but also to invade and disrupt them by entering bone cells and inducing cell death and osteolysis. Here we illustrate the pathogenetic mechanisms that can explain how the osteomyelitis sets in and develops around an implant.
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New Trends in Diagnosis and Control Strategies for Implant Infections. Int J Artif Organs 2011; 34:727-36. [DOI: 10.5301/ijao.2011.8784] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 12/17/2022]
Abstract
In implant infections, a quick and reliable identification of the etiological agent is crucial to realizing efficacious therapies. Among molecular methods, automated ribotyping has proven to be an accurate and rapid technique. More recently, MALDI-TOF/MS and PCR-electrospray ionization (ESI)/ MS have been applied successfully to microbiological diagnosis. In implant infections, biofilm is still the major problem for bacterial persistence and recalcitrance to antibiotic therapy. Among biofilm-disrupting agents, enzymes promise the greatest therapeutic possibilities. DNase I degrades biofilm extracellular DNA and has been shown to sensitize biofilm to various biocides and anionic detergents, while dispersin B acts on biofilm exopolysaccharide and, combined with antiseptic, gives a broad-spectrum antibiofilm and antimicrobial activity. The novel antimicrobial approach based on photodynamic treatment (PDT) applies, in combination with antibiotics, to the implant or medical devices reachable by optical fibers. Better progress could be gained by the development of infection-resistant biomaterials able to both inhibit bacterial adhesion and promote tissue integration. New knowledge regarding the fibronectin-mediated internalization of Staphylococcus aureus by osteoblasts, and on its role in the pathogenesis of implant-related osteomyelitis, paves the way for the development of vaccines against staphylococcal adhesins, to prevent both adhesion on biomaterials and bacterial invasion of bone cells.
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Montanaro L, Speziale P, Campoccia D, Ravaioli S, Cangini I, Pietrocola G, Giannini S, Arciola CR. Scenery ofStaphylococcusimplant infections in orthopedics. Future Microbiol 2011; 6:1329-49. [DOI: 10.2217/fmb.11.117] [Citation(s) in RCA: 264] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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