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Gupta N, Haughton S, Kemper S, Koehler M, Antoon R, Edwards CG, Bardin A. The antimicrobial effectiveness of chlorhexidine and chlorhexidine-silver sulfadiazine impregnated central venous catheters against the emerging fungal pathogen Candida auris. Am J Infect Control 2024:S0196-6553(24)00576-5. [PMID: 38944155 DOI: 10.1016/j.ajic.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Candida auris is an emerging multidrug-resistant fungus associated with catheter-related bloodstream infections (CRBSI). In-vitro efficacy of chlorhexidine (CHX) and CHX/silver sulfadiazine-impregnated (CHX-S) antimicrobial central venous catheters (CVCs) against C. auris was investigated. MATERIAL AND METHODS Minimum inhibitory (MIC) and bactericidal (MBC) CHX concentrations were determined against nineteen C. auris isolates. To assess extraluminal efficacy, segments from CVCs impregnated externally (CHX-S1) and both externally and internally (CHX-S2) were plasma-conditioned for 1- and 6-days, and to assess intraluminal efficacy CHX-S2 CVCs were pre-conditioned with saline-lock for 6-days, followed by 24-hour C. auris inoculation and microbial adherence determination on impregnated and non-impregnated CVCs. RESULTS CHX inhibited all C. auris isolates with MIC and MBC range of 8-128 μg/mL. C. auris adherence was reduced on CHX-S1 and CHX-S2 extraluminally by 100% on day-1, 86.96%-100% on day-7, and intraluminally on CHX-S2 by 56.86%-90.52% on day-7. DISCUSSION CHX and CHX-S CVCs performance against C. auris observed in this study is consistent with antimicrobial benefits observed in prior pre-clinical and randomized controlled clinical studies. CONCLUSIONS CHX showed strong inhibitory and cidal effects on C. auris. CHX-S CVCs proved highly efficacious against this pathogen under in vitro conditions. Additional studies, however, are required to confirm clinical benefit.
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Affiliation(s)
- Nisha Gupta
- Research and Development, Vascular Division, Teleflex Incorporated, 35 Innovation Way, Wyomissing, PA 19610, USA.
| | - Shanna Haughton
- Research and Development, Vascular Division, Teleflex Incorporated, 35 Innovation Way, Wyomissing, PA 19610, USA.
| | - Sydney Kemper
- Research and Development, Vascular Division, Teleflex Incorporated, 35 Innovation Way, Wyomissing, PA 19610, USA.
| | - Monica Koehler
- Research and Development, Vascular Division, Teleflex Incorporated, 35 Innovation Way, Wyomissing, PA 19610, USA.
| | - Roula Antoon
- 41 Twyford Rd., Toronto, Ontario M9A 1W3, Canada.
| | - Colin G Edwards
- Global Scientific Communications, Teleflex Incorporated, 550 E. Swedesford Rd., Suite 400, Wayne, PA 19087, USA.
| | - Amy Bardin
- Clinical and Medical Affairs, Vascular and Interventional Divisions, Teleflex Incorporated, 3015 Carrington Mill Blvd., Morrisville, NC 27560, USA.
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2
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Tan M, Wang F, Yang J, Zhong Z, Chen G, Chen Z. Hydroxyl silicone oil grafting onto a rough thermoplastic polyurethane surface created durable super-hydrophobicity. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1359-1378. [PMID: 38490948 DOI: 10.1080/09205063.2024.2329453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
Indwelling medical catheters are frequently utilized in medical procedures, but they are highly susceptible to infection, posing a vital challenge for both health workers and patients. In this study, the superhydrophobic micro-nanostructure surface was constructed on the surface of thermoplastic polyurethane (TPU) membrane using heavy calcium carbonate (CaCO3) template. To decrease the surface free energy, hydroxyl silicone oil was grafted onto the surface, forming a super-hydrophobic surface. The water contact angle (WCA) increased from 91.1° to 143 ± 3° when the concentration of heavy calcium CaCO3 was 20% (weight-to-volume (w/v)). However, the increased WCA was unstable and tended to decrease over time. After grafting hydroxyl silicone oil, the WCA rose to 152.05 ± 1.62° and remained consistently high for a period of 30 min. Attenuated total reflection infrared spectroscopy (ATR-FTIR) analysis revealed a chemical crosslinking between silicone oil and the surface of TPU. Furthermore, Scanning electron microscope (SEM) image showed the presence of numerous nanoparticles on the micro surface. Atomic force microscope (AFM) testing indicated a significant improvement in surface roughness. This method of creating a hydrophobic surface demonstrated several advantages, including resistance to cell, bacterial, protein, and platelet adhesion and good biosecurity. Therefore, it holds promising potential for application in the development of TPU-based medical catheters with antibacterial properties.
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Affiliation(s)
- Miaomiao Tan
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Fuping Wang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Jinlan Yang
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Zhengpeng Zhong
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Guobao Chen
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Zhongmin Chen
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
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3
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Pisney L, Camplese L, Greene MT, Saint S, Fowler KE, Chopra V. Practices to prevent central line-associated bloodstream infection: A 2021 survey of infection preventionists in US hospitals. Infect Control Hosp Epidemiol 2024:1-5. [PMID: 38654493 DOI: 10.1017/ice.2024.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To determine prevalence of technical and behavioral interventions aimed at preventing central line-associated bloodstream infection (CLABSI) following the COVID19 pandemic. DESIGN Cross-sectional survey. SETTING US acute care hospitals. PARTICIPANTS Infection preventionists at participating hospitals. METHODS Surveys were sent to infection preventionists from a national random sample of 881 US acute care hospitals. Questions covered use of technical interventions to prevent CLABSI (eg, alcohol-containing chlorhexidine gluconate [CHG] for skin antisepsis, use of coated catheters), socio-adaptive interventions (eg, feedback of CLABSI rates, use of appropriateness criteria), and leadership support for CLABSI prevention. RESULTS Survey response rate was 47% (415/881). Technical interventions such as maximal sterile barriers (99%) or CHG-impregnated dressings (92%) were highly prevalent, but routine use of CHG bathing was less common (68% indicated regular use in intensive care unit [ICU] vs 18% in non-ICU settings). Although 97% of respondents indicated use of systems to monitor CLABSI, feedback to providers on CLABSI events was reported by 89%. Only 53% of respondents indicated regular use of tools to determine appropriateness of central venous catheters (CVC). Three-quarters of respondents indicated their hospital assessed CVC necessity daily, but only 23% reported strategies to reduce routine blood cultures. CLABSI prevention was extremely important to hospital leadership at 82% of responding hospitals. CONCLUSIONS Most US hospitals continue to use evidence-based methods to prevent CLABSI as recommended by leading organizations. Opportunities to focus on socio-adaptive interventions such as feedback of infection rates, use of appropriateness criteria for CVC placement, and improving the "culture of pan-culturing" remain.
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Affiliation(s)
- Larissa Pisney
- The Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
- University of Colorado Health System, Aurora, CO, USA
| | - Lisa Camplese
- University of Colorado Health System, Aurora, CO, USA
| | - M Todd Greene
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sanjay Saint
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen E Fowler
- VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
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Jayakumar J, Vinod V, Arumugam T, Sathy BN, Biswas L, Kumar VA, Biswas R. Efficacy of Lysostaphin functionalized silicon catheter for the prevention of Staphylococcus aureus biofilm. Int J Biol Macromol 2024; 256:128547. [PMID: 38048926 DOI: 10.1016/j.ijbiomac.2023.128547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 12/06/2023]
Abstract
Staphylococcus aureus readily forms biofilms on tissue and indwelling catheter surfaces. These biofilms are resistant to antibiotics. Consequently, effective prevention and treatment strategies against staphylococcal biofilms are actively being pursued over the past two decades. One of the proposed strategies involve the incorporation of antibiotics and antiseptics into catheters, however, a persistent concern regarding the possible emergence of antimicrobial resistance is associated with these medical devices. In this study, we developed two types of silicone catheters: one with Lysostaphin (Lst) adsorbed onto the surface, and the other with Lst functionalized on the surface. To confirm the presence of Lst protein on the catheter surface, we conducted FTIR-ATR and SEM-EDS analysis. Both catheters exhibited hemocompatibility, biocompatibility, and demonstrated antimicrobial and biofilm prevention activities against both methicillin-sensitive and resistant strains of S. aureus. Furthermore, the silicone catheters that were surface-functionalized with Lst showed substantially better and more persistent anti-biofilm effects when compared to the catheters where Lst was surface-adsorbed, both under in vitro static and flow conditions, as well as in vivo in BALB/c mice. These results indicate that surface-functionalized Lst catheters have the potential to serve as a promising new medical device for preventing S. aureus biofilm infections in humans.
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Affiliation(s)
- Jayalakshmi Jayakumar
- Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - Vivek Vinod
- Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - Thennavan Arumugam
- Central Lab Animal Facility, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, India
| | - Binulal Nelson Sathy
- Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - Lalitha Biswas
- Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - V Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India
| | - Raja Biswas
- Center for Nanosciences and Molecular Medicine, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India.
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5
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Wu Y, Liu Y, Wang B, Feng B. Efficacy of antimicrobial peripherally inserted central catheters in line-associated bloodstream infections: A systematic review and meta-analysis. Am J Infect Control 2023; 51:1425-1429. [PMID: 37088441 DOI: 10.1016/j.ajic.2023.04.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Several studies have investigated the safety and efficacy of antimicrobial peripherally inserted central catheters (PICCs), and the results are conflicting. Therefore, in this systematic review and meta-analysis, we aimed to summarize and identify the effect of antimicrobial PICCs on central line-associated bloodstream infection (CLABSI) risk. METHODS A systematic search of PubMed, Ovid MEDLINE, Ovid Embase, and Web of Science was performed to identify relevant studies up to December 2022. RESULTS A total of 9 studies were included for analysis. There were 7 retrospective/prospective cohort studies and 2 randomized controlled trials. The 9 studies involved 51,373 patients with PICCs. Among these patients, 6,563 (12.8%) antimicrobial-coated/impregnated PICCs and 44,810 (87.2%) nonantimicrobial-impregnated PICCs were inserted. The meta-analysis showed that antimicrobial PICCs had a nonsignificant association with lower CLABSI risk compared with noncoated PICCs (relative risk [RR] = 0.67; 95% CI, 0.43-1.05). In the subgroup analysis, minocycline-rifampin-(RR = 0.30; 95% CI, 0.19-0.49) or chlorhexidine-coated (RR = 0.61; 95% CI, 0.04-8.55) PICCs showed an association with reduced risk of CLABSI. In the adult population, antimicrobial PICCs had a nonsignificant association with lower CLABSI risk (RR = 0.50; 95% CI, 0.20-1.22). CONCLUSIONS This systematic review and meta-analysis suggested that antimicrobial PICCs had a nonsignificant association with lower CLABSI risk compared with noncoated PICCs. Minocycline-rifampin-or chlorhexidine-coated PICCs showed an association with reduced risk of CLABSI.
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Affiliation(s)
- Yanyan Wu
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yaqiong Liu
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bei Wang
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bilong Feng
- Department of Radiotherapy and Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Valtin J, Behrens S, Ruland A, Schmieder F, Sonntag F, Renner LD, Maitz MF, Werner C. A New In Vitro Blood Flow Model for the Realistic Evaluation of Antimicrobial Surfaces. Adv Healthc Mater 2023; 12:e2301300. [PMID: 37498721 DOI: 10.1002/adhm.202301300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/13/2023] [Indexed: 07/29/2023]
Abstract
Device-associated bloodstream infections can cause serious medical problems and cost-intensive postinfection management, defining a need for more effective antimicrobial coatings. Newly developed coatings often show reduced bacterial colonization and high hemocompatibility in established in vitro tests, but fail in animal studies or clinical trials. The poor predictive power of these models is attributed to inadequate representation of in vivo conditions. Herein, a new single-pass blood flow model, with simultaneous incubation of the test surface with bacteria and freshly-drawn human blood, is presented. The flow model is validated by comparative analysis of a recently developed set of antiadhesive and contact-killing polymer coatings, and the corresponding uncoated polycarbonate surfaces. The results confirm the model's ability to differentiate the antimicrobial activities of the studied surfaces. Blood activation data correlate with bacterial surface coverage: low bacterial adhesion is associated with low inflammation and hemostasis. Shear stress correlates inversely with bacterial colonization, especially on antiadhesive surfaces. The introduced model is concluded to enable the evaluation of novel antimicrobial materials under in vivo-like conditions, capturing interactions between bacteria and biomaterials surfaces in the presence of key components of the ex vivo host response.
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Affiliation(s)
- Juliane Valtin
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Stephan Behrens
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - André Ruland
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Florian Schmieder
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - Frank Sonntag
- Fraunhofer Institute for Material and Beam Technology IWS, 01277, Dresden, Germany
| | - Lars D Renner
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Manfred F Maitz
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
| | - Carsten Werner
- Leibniz Institute of Polymer Research Dresden, Institute of Biofunctional Polymer Materials, Hohe Strasse 6, 01069, Dresden, Germany
- Technische Universität Dresden, Cluster of Excellence Physics of Life, Center for Regenerative Therapies Dresden and Faculty of Chemistry and Food Chemistry, 01307, Dresden, Germany
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Amer MA, Wasfi R, Hamed SM. Biosurfactant from Nile Papyrus endophyte with potential antibiofilm activity against global clones of Acinetobacter baumannii. Front Cell Infect Microbiol 2023; 13:1210195. [PMID: 37520441 PMCID: PMC10373939 DOI: 10.3389/fcimb.2023.1210195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
Acinetobacter baumannii is a leading cause of biofilm-associated infections, particularly catheter-related bloodstream infections (CRBSIs) that are mostly recalcitrant to antimicrobial therapy. One approach to reducing the burden of CRBSIs is inhibiting biofilm formation on catheters. Owing to their prodigious microbial diversity, bacterial endophytes might be a valuable source of biosurfactants, which are known for their great capacity to disperse microbial biofilms. With this in mind, our study aimed to screen bacterial endophytes from plants growing on the banks of the River Nile for the production of powerful biosurfactants capable of reducing the ability of A. baumannii to form biofilms on central venous catheters (CVCs). This was tested on multidrug- and extensive drug-resistant (M/XDR) clinical isolates of A. baumannii that belong to high-risk global clones and on a standard strain of A. baumannii ATCC 19606. The drop collapse and oil dispersion assays were employed in screening the cell-free supernatants (CFS) of all endophytes for biosurfactant activity. Of the 44 bacterial endophytes recovered from 10 plants, the CFS of Bacillus amyloliquefaciens Cp24, isolated from Cyperus papyrus, showed the highest biosurfactant activity. The crude biosurfactant extract of Cp24 showed potent antibacterial activity with minimum inhibitory concentrations (MICs) ranging from 0.78 to 1.56 mg/ml. It also showed significant antibiofilm activity (p-value<0.01). Sub-MICs of the extract could reduce biofilm formation by up to 89.59%, while up to 87.3% of the preformed biofilms were eradicated by the MIC. A significant reduction in biofilm formation on CVCs impregnated with sub-MIC of the extract was demonstrated by CV assay and further confirmed by scanning electron microscopy. This was associated with three log10 reductions in adhered bacteria in the viable count assay. GC-MS analysis of the crude biosurfactant extract revealed the presence of several compounds, such as saturated, unsaturated, and epoxy fatty acids, cyclopeptides, and 3-Benzyl-hexahydro-pyrrolo [1, 2-a] pyrazine-1,4-dione, potentially implicated in the potent biosurfactant and antibiofilm activities. In the present study, we report the isolation of a B. amyloliquefaciens endophyte from the plant C. papyrus that produces a biosurfactant with potent antibiofilm activity against MDR/XDR global clones of A. baumannii. The impregnation of CVCs with the biosurfactant was demonstrated to reduce biofilms and, hence, proposed as a potential strategy for reducing CRBSIs.
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Felix L, Whitely C, Tharmalingam N, Mishra B, Vera-Gonzalez N, Mylonakis E, Shukla A, Fuchs BB. Auranofin coated catheters inhibit bacterial and fungal biofilms in a murine subcutaneous model. Front Cell Infect Microbiol 2023; 13:1135942. [PMID: 37313344 PMCID: PMC10258325 DOI: 10.3389/fcimb.2023.1135942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/24/2023] [Indexed: 06/15/2023] Open
Abstract
Microbe entry through catheter ports can lead to biofilm accumulation and complications from catheter-related bloodstream infection and ultimately require antimicrobial treatment and catheter replacement. Although strides have been made with microbial prevention by applying standardized antiseptic techniques during catheter implantation, both bacterial and fungal microbes can present health risks to already sick individuals. To reduce microbial adhesion, murine and human catheters were coated with polyurethane and auranofin using a dip coating method and compared to non-coated materials. Upon passage of fluid through the coated material in vitro, flow dynamics were not impacted. The unique antimicrobial properties of the coating material auranofin has shown inhibitory activity against bacteria such as Staphylococcus aureus and fungi such as Candida albicans. Auranofin coating on catheters at 10mg/mL reduced C. albicans accumulation in vitro from 2.0 x 108 to 7.8 x 105 CFU for mouse catheters and from 1.6 x 107 to 2.8 x 106 for human catheters, showing an impact to mature biofilms. Assessment of a dual microbe biofilm on auranofin-coated catheters resulted in a 2-log reduction in S. aureus and a 3-log reduction in C. albicans compared to uncoated catheters. In vivo assessment in a murine subcutaneous model demonstrated that catheters coated with 10 mg/mL auranofin reduced independent S. aureus and C. albicans accumulation by 4-log and 1-log, respectively, compared to non-coated catheters. In conclusion, the auranofin-coated catheters demonstrate proficiency at inhibiting multiple pathogens by decreasing S. aureus and C. albicans biofilm accumulation.
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Affiliation(s)
- LewisOscar Felix
- Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, Alpert Medical School and Brown University, Providence, RI, United States
| | - Cutler Whitely
- Center for Biomedical Engineering, School of Engineering, Institute for Molecular and Nanoscale Innovation, Brown University, Providence, RI, United States
| | - Nagendran Tharmalingam
- Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, Alpert Medical School and Brown University, Providence, RI, United States
| | - Biswajit Mishra
- Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, Alpert Medical School and Brown University, Providence, RI, United States
| | - Noel Vera-Gonzalez
- Center for Biomedical Engineering, School of Engineering, Institute for Molecular and Nanoscale Innovation, Brown University, Providence, RI, United States
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, Alpert Medical School and Brown University, Providence, RI, United States
| | - Anita Shukla
- Center for Biomedical Engineering, School of Engineering, Institute for Molecular and Nanoscale Innovation, Brown University, Providence, RI, United States
| | - Beth Burgwyn Fuchs
- Division of Infectious Diseases, Rhode Island Hospital, The Miriam Hospital, Alpert Medical School and Brown University, Providence, RI, United States
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Alves D, Grainha T, Pereira MO, Lopes SP. Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress. Acta Biomater 2023; 158:32-55. [PMID: 36632877 DOI: 10.1016/j.actbio.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. STATEMENT OF SIGNIFICANCE: The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed.
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Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Susana Patrícia Lopes
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
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Mundi MS, Mohamed Elfadil O, Hurt RT, Bonnes S, Salonen BR. Management of long-term home parenteral nutrition: Historical perspective, common complications, and patient education and training. JPEN J Parenter Enteral Nutr 2023; 47 Suppl 1:S24-S34. [PMID: 36468330 DOI: 10.1002/jpen.2424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 12/12/2022]
Abstract
Intestinal failure (IF) is a rare disease that requires ongoing intravenous supplementation to sustain growth and health. Advancements in parenteral nutrition (PN) and central venous access in the 1960s and 1970s transformed a life-limiting disease to a chronic one in which patients are able to administer hydration, electrolytes, micronutrients, and macronutrients in the comfort of their home. However, despite ongoing advancements in the field of home PN (HPN), complications-whether related to central venous catheters or PN itself-remain common and can be associated with significant morbidity and mortality. Central venous access can be associated with thrombosis, central line-associated bloodstream infection, or damage and can result in loss of access over time. PN can be associated with IF-associated liver disease or hyperglycemia. The key to preserving central venous access and quality of life and maintaining health for patients with chronic IF (CIF) is education focused on prevention and prompt management of CIF complications as they arise. This education typically takes place at the time of initiation of HPN, either in the hospital setting or in the patient's home. The present manuscript describes the historical progression of HPN, prevalence and characteristics of CIF, and an in-depth discussion of the most common catheter-related and PN-related complications and their management, along with a discussion of our education and training process.
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Affiliation(s)
- Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Osman Mohamed Elfadil
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Malhotra A, Chauhan SR, Rahaman M, Tripathi R, Khanuja M, Chauhan A. Phyto-assisted synthesis of zinc oxide nanoparticles for developing antibiofilm surface coatings on central venous catheters. Front Chem 2023; 11:1138333. [PMID: 37035110 PMCID: PMC10076889 DOI: 10.3389/fchem.2023.1138333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Medical devices such as Central Venous Catheters (CVCs), are routinely used in intensive and critical care settings. In the present scenario, incidences of Catheter-Related Blood Stream Infections (CRBSIs) pose a serious challenge. Despite considerable advancements in the antimicrobial therapy and material design of CVCs, clinicians continue to struggle with infection-related complications. These complications are often due colonization of bacteria on the surface of the medical devices, termed as biofilms, leading to infections. Biofilm formation is recognized as a critical virulence trait rendering infections chronic and difficult to treat even with 1,000x, the minimum inhibitory concentration (MIC) of antibiotics. Therefore, non-antibiotic-based solutions that prevent bacterial adhesion on medical devices are warranted. In our study, we report a novel and simple method to synthesize zinc oxide (ZnO) nanoparticles using ethanolic plant extracts of Eupatorium odoratum. We investigated its physio-chemical characteristics using Field Emission- Scanning Electron Microscopy and Energy dispersive X-Ray analysis, X-Ray Diffraction (XRD), Photoluminescence Spectroscopy, UV-Visible and Diffuse Reflectance spectroscopy, and Dynamic Light Scattering characterization methods. Hexagonal phase with wurtzite structure was confirmed using XRD with particle size of ∼50 nm. ZnO nanoparticles showed a band gap 3.25 eV. Photoluminescence spectra showed prominent peak corresponding to defects formed in the synthesized ZnO nanoparticles. Clinically relevant bacterial strains, viz., Proteus aeruginosa PAO1, Escherichia coli MTCC 119 and Staphylococcus aureus MTCC 7443 were treated with different concentrations of ZnO NPs. A concentration dependent increase in killing efficacy was observed with 99.99% killing at 500 μg/mL. Further, we coated the commercial CVCs using green synthesized ZnO NPs and evaluated it is in vitro antibiofilm efficacy using previously optimized in situ continuous flow model. The hydrophilic functionalized interface of CVC prevents biofilm formation by P. aeruginosa, E. coli and S. aureus. Based on our findings, we propose ZnO nanoparticles as a promising non-antibiotic-based preventive solutions to reduce the risk of central venous catheter-associated infections.
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Affiliation(s)
- Akshit Malhotra
- Department of Microbiology, Tripura University, Suryamaninagar, Tripura, India
- Invisiobiome, New Delhi, India
| | - Suchitra Rajput Chauhan
- Centre for Advanced Materials and Devices (CAMD), School of Engineering and Technology, BML Munjal University, Gurgaon, Haryana, India
| | - Mispaur Rahaman
- Central Instrumentation Centre, Tripura University, Suryamaninagar, Tripura, India
| | - Ritika Tripathi
- Centre for Advanced Materials and Devices (CAMD), School of Engineering and Technology, BML Munjal University, Gurgaon, Haryana, India
| | - Manika Khanuja
- Centre for Nanoscience and Nanotechnology, Jamia Millia Islamia, New Delhi, India
| | - Ashwini Chauhan
- Department of Microbiology, Tripura University, Suryamaninagar, Tripura, India
- *Correspondence: Ashwini Chauhan,
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12
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Chug MK, Brisbois EJ. Recent Developments in Multifunctional Antimicrobial Surfaces and Applications toward Advanced Nitric Oxide-Based Biomaterials. ACS MATERIALS AU 2022; 2:525-551. [PMID: 36124001 PMCID: PMC9479141 DOI: 10.1021/acsmaterialsau.2c00040] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/08/2023]
Abstract
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Implant-associated infections arising from biofilm development
are known to have detrimental effects with compromised quality of
life for the patients, implying a progressing issue in healthcare.
It has been a struggle for more than 50 years for the biomaterials
field to achieve long-term success of medical implants by discouraging
bacterial and protein adhesion without adversely affecting the surrounding
tissue and cell functions. However, the rate of infections associated
with medical devices is continuously escalating because of the intricate
nature of bacterial biofilms, antibiotic resistance, and the lack
of ability of monofunctional antibacterial materials to prevent the
colonization of bacteria on the device surface. For this reason, many
current strategies are focused on the development of novel antibacterial
surfaces with dual antimicrobial functionality. These surfaces are
based on the combination of two components into one system that can
eradicate attached bacteria (antibiotics, peptides, nitric oxide,
ammonium salts, light, etc.) and also resist or release
adhesion of bacteria (hydrophilic polymers, zwitterionic, antiadhesive,
topography, bioinspired surfaces, etc.). This review
aims to outline the progress made in the field of biomedical engineering
and biomaterials for the development of multifunctional antibacterial
biomedical devices. Additionally, principles for material design and
fabrication are highlighted using characteristic examples, with a
special focus on combinational nitric oxide-releasing biomedical interfaces.
A brief perspective on future research directions for engineering
of dual-function antibacterial surfaces is also presented.
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Affiliation(s)
- Manjyot Kaur Chug
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Elizabeth J. Brisbois
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia 30602, United States
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13
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Gallart E, Delicado M, Nuvials X. [Update of the recommendations of the Bacteraemia Zero Project]. ENFERMERIA INTENSIVA 2022; 33:S31-S39. [PMID: 35911623 PMCID: PMC9315357 DOI: 10.1016/j.enfi.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
El proyecto Bacteriemia Zero (BZ) fue el primero de los Proyectos Zero que se implementó en las Unidades de Cuidados Intensivos (UCI), consiguiendo una disminución de las tasas de infección relacionadas con catéter por debajo de las recomendadas por los estándares de calidad de las sociedades científicas. A raíz de la pandemia causada por el SARS-CoV-2 en las UCI, se ha observado un incremento importante de estas tasas de infección. El incremento de las tasas de infección y la necesidad de incorporar en la práctica clínica la mejor evidencia disponible, justifica la necesidad de actualizar las recomendaciones del proyecto BZ. Se constituyó un grupo de trabajo formado por miembros de las diferentes sociedades científicas que consideró que el paquete de medidas obligatorias del proyecto no debía modificarse debido a su eficacia demostrada y decidió incorporar, después de su revisión, las siguientes medidas opcionales: uso de catéteres impregnados con antimicrobianos, uso de apósitos impregnados con clorhexidina, uso de tapones con solución antiséptica en los conectores e higiene corporal diaria con clorhexidina.
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Affiliation(s)
- E Gallart
- Unidad de Cuidados Intensivos, Hospital Universitari Vall d'Hebron, Grupo de Investigación Multidisciplinar de Enfermería, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - M Delicado
- Organización Sanitaria Integrada Bilbao-Basurto Basurto, España
| | - X Nuvials
- Servicio de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Grupo de Investigación SODIR, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, España
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14
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Blood compatibility of widely used central venous catheters; an experimental study. Sci Rep 2022; 12:8600. [PMID: 35597879 PMCID: PMC9124179 DOI: 10.1038/s41598-022-12564-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 05/12/2022] [Indexed: 12/16/2022] Open
Abstract
An inserted central venous catheter (CVC) is considered foreign material by the inert host defence systems and induce inflammation and thrombus formation. The objective of this study was to evaluate blood compatibility of six commonly used CVCs. Three coated and three uncoated CVC materials were tested in a modified Chandler loop model. Each catheter material circulated in blood from ten different healthy volunteers for 1 h. Blood cell counts and measurements of the inert host defence systems were performed on blood samples from the loop. All the tested catheters demonstrated impact on blood cells, contact coagulation, the complement system, or inflammatory markers, although the impact varied significantly. Of the catheters we evaluated, the most unfavourable blood compatibility profile was found for the polyurethane CVC coated with chlorohexidine and silver sulfadiazine. The greatest variation in blood compatibility between test runs was noted for the silicone dialysis catheter. Poor blood compatibility should be taken seriously but given the experimental design of the current study the clinical significance remains to be evaluated.
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15
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Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:553-569. [PMID: 35437133 PMCID: PMC9096710 DOI: 10.1017/ice.2022.87] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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16
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Chug MK, Massoumi H, Wu Y, Brisbois EJ. Prevention of medical device infections via multi-action nitric oxide and chlorhexidine diacetate releasing medical grade silicone biointerfaces. J Biomed Mater Res A 2022; 110:1263-1277. [PMID: 35170212 DOI: 10.1002/jbm.a.37372] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 12/25/2022]
Abstract
The presence of bacteria and biofilm on medical device surfaces has been linked to serious infections, increased health care costs, and failure of medical devices. Therefore, antimicrobial biointerfaces and medical devices that can thwart microbial attachment and biofilm formation are urgently needed. Both nitric oxide (NO) and chlorhexidine diacetate (CHXD) possess broad-spectrum antibacterial properties. In the past, individual polymer release systems of CHXD and NO donor S-nitroso-N-acetylpenicillamine (SNAP) incorporated polymer platforms have attracted considerable attention for biomedical/therapeutic applications. However, the combination of the two surfaces has not yet been explored. Herein, the synergy of NO and CHXD was evaluated to create an antimicrobial medical-grade silicone rubber. The 10 wt% SNAP films were fabricated using solvent casting with a topcoat of CHXD (1, 3, and 5 wt%) to generate a dual-active antibacterial interface. Chemiluminescence studies confirmed the NO release from SNAP-CHXD films at physiologically relevant levels (0.5-4 × 10-10 mol min-1 cm-2 ) for at least 3 weeks and CHXD release for at least 7 days. Further characterization of the films via SEM-EDS confirmed uniform distribution of SNAP and presence of CHXD within the polymer films without substantial morphological changes, as confirmed by contact angle hysteresis. Moreover, the dual-active SNAP-CHXD films were able to significantly reduce Escherichia coli and Staphylococcus aureus bacteria (>3-log reduction) compared to controls with no explicit toxicity towards mouse fibroblast cells. The synergy between the two potent antimicrobial agents will help combat bacterial contamination on biointerfaces and enhance the longevity of medical devices.
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Affiliation(s)
- Manjyot Kaur Chug
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia, USA
| | - Hamed Massoumi
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia, USA
| | - Yi Wu
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia, USA
| | - Elizabeth J Brisbois
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, Athens, Georgia, USA
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17
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Naganthran A, Verasoundarapandian G, Khalid FE, Masarudin MJ, Zulkharnain A, Nawawi NM, Karim M, Che Abdullah CA, Ahmad SA. Synthesis, Characterization and Biomedical Application of Silver Nanoparticles. MATERIALS (BASEL, SWITZERLAND) 2022; 15:427. [PMID: 35057145 PMCID: PMC8779869 DOI: 10.3390/ma15020427] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
Silver nanoparticles (AgNPs) have been employed in various fields of biotechnology due to their proven properties as an antibacterial, antiviral and antifungal agent. AgNPs are generally synthesized through chemical, physical and biological approaches involving a myriad of methods. As each approach confers unique advantages and challenges, a trends analysis of literature for the AgNPs synthesis using different types of synthesis were also reviewed through a bibliometric approach. A sum of 10,278 publications were analyzed on the annual numbers of publication relating to AgNPs and biological, chemical or physical synthesis from 2010 to 2020 using Microsoft Excel applied to the Scopus publication database. Furthermore, another bibliometric clustering and mapping software were used to study the occurrences of author keywords on the biomedical applications of biosynthesized AgNPs and a total collection of 224 documents were found, sourced from articles, reviews, book chapters, conference papers and reviews. AgNPs provides an excellent, dependable, and effective solution for seven major concerns: as antibacterial, antiviral, anticancer, bone healing, bone cement, dental applications and wound healing. In recent years, AgNPs have been employed in biomedical sector due to their antibacterial, antiviral and anticancer properties. This review discussed on the types of synthesis, how AgNPs are characterized and their applications in biomedical field.
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Affiliation(s)
- Ashwini Naganthran
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (A.N.); (G.V.); (F.E.K.)
| | - Gayathiri Verasoundarapandian
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (A.N.); (G.V.); (F.E.K.)
| | - Farah Eryssa Khalid
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (A.N.); (G.V.); (F.E.K.)
| | - Mas Jaffri Masarudin
- Department of Cell and Molecular Biology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Azham Zulkharnain
- Department of Bioscience and Engineering, Shibaura Institute of Technology, College of Systems Engineering and Science, 307 Fukasaku, Saitama 337-8570, Japan;
| | - Norazah Mohammad Nawawi
- Institute of Bio-IT Selangor, Universiti Selangor, Jalan Zirkon A7/A, Seksyen 7, Shah Alam 40000, Selangor, Malaysia;
- Centre for Foundation and General Studies, Universiti Selangor, Jalan Timur Tambahan, Bestari Jaya 45600, Selangor, Malaysia
| | - Murni Karim
- Department of Aquaculture, Faculty of Agriculture, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Laboratory of Sustainable Aquaculture, International Institute of Aquaculture and Aquatic Sciences, Universiti Putra Malaysia, Port Dickson 71050, Negeri Sembilan, Malaysia
| | - Che Azurahanim Che Abdullah
- Department of Physics, Faculty of Science, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
- Material Synthesis and Characterization Laboratory, Institute of Advanced Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Siti Aqlima Ahmad
- Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (A.N.); (G.V.); (F.E.K.)
- Laboratory of Bioresource Management, Institute of Tropical Forestry and Forest Products (INTROP), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
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18
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Bayoumi MAA, van Rens MFPT, Chandra P, Masry A, D'Souza S, Khalil AM, Shadad A, Alsayigh S, Masri RM, Shyam S, Alobaidan F, Elmalik EE. Does the antimicrobial-impregnated peripherally inserted central catheter decrease the CLABSI rate in neonates? Results from a retrospective cohort study. Front Pediatr 2022; 10:1012800. [PMID: 36507144 PMCID: PMC9730802 DOI: 10.3389/fped.2022.1012800] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The use of antimicrobial-impregnated peripherally inserted central catheters (PICCs) has been introduced in the last few years to neonatal units aiming to reduce central line-associated bloodstream infection (CLABSI). METHODS This retrospective observational study aimed to compare the CLABSI rates and other catheter-related parameters including the insertion success rates and catheter-related complications in the antimicrobial-impregnated and conventional (ordinary) PICCs in NICU between 2017 and 2020. RESULTS Our dedicated PICC team including physicians and nurses inserted 1,242 conventional (PremiCath and NutriLine) and 791 antimicrobial-impregnated PICCs (PremiStar) over the study period from 2017 to 2020. Of those 1,242 conventional PICCs, 1,171 (94.3%) were 1 Fr single lumen and only 71 (5.7%) were 2 Fr double lumen. The mean ± SD [median (IQR)] for the birth weight in all babies who had a PICC line was 1,343.3 ± 686.75 [1,200 (900, 1,500)] g, while the mean ± SD for the gestational age was 29.6 ± 4.03 [29 (27, 31)] weeks. The mean ± SD [median (IQR)] age at the time of insertion for all catheters was 9.3 ± 21.47 [2 (1, 9)] days, while the mean ± SD [median (IQR)] dwell time was 15.7 ± 14.03 [12 (8, 17)] days. The overall success rate of the PICC insertion is 1,815/2,033 (89.3%), while the first attempt success rate is 1,290/2,033 (63.5%). The mean ± SD [median (IQR)] gestational age, birth weight, age at catheter insertion, and catheter dwell time were 28.8 ± 3.24 [29, (26, 31)] weeks, 1,192.1 ± 410.3 [1,150, (900, 1,450)] g, 6.3 ± 10.85 [2, (1, 8)] days, and 17.73 ± 17.532 [13, (9, 18)] days in the antimicrobial-impregnated catheter compared with 30.1 ± 4.39 [29, (27, 32)] weeks (P < 0.001), 1,439.5 ± 800.8 [1,240, (920, 1,520)] g (P < 0.001), 11.1 ± 25.9 [1, (1, 9)] days (P < 0.001), and 14.30 ± 10.964 [12, (8, 17)] days (P < 0.001), respectively, in the conventional PICCs. The use of the antimicrobial-impregnated catheter was not associated with any significant reduction in the CLABSI rate (per 1,000 days dwell time), either the overall [P = 0.11, risk ratio (RR) (95% CI): 0.60 (0.32, 1.13)] or the yearly CLABSI rates. CONCLUSIONS The use of miconazole and rifampicin-impregnated PICCs did not reduce the CLABSI rate in neonates compared with conventional PICCs. However, it has a higher overall rate of elective removal after completion of therapy and less extravasation/infiltration, occlusion, and phlebitis compared with the conventional PICCs. Further large RCTs are recommended to enrich the current paucity of evidence and to reduce the risk of bias. Neonatal PICCs impregnation by other antimicrobials is a recommendation for vascular access device manufacturers.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Matheus F P T van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alaa Masry
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha D'Souza
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Amr M Khalil
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Afaf Shadad
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Safaa Alsayigh
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Razan M Masri
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha Shyam
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar.,VERITADYNE Strategic Consulting Pvt. Ltd., Delhi, India
| | - Fatima Alobaidan
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
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19
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Deng Z, Qin J, Sun H, Xv F, Ma Y. Effectiveness of Impregnated Central Venous Catheters on Catheter-Related Bloodstream Infection in Pediatrics. Front Pediatr 2022; 10:795019. [PMID: 35311042 PMCID: PMC8927082 DOI: 10.3389/fped.2022.795019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The efficacy and safety of impregnated central venous catheters (CVCs) in pediatrics remain controversial. The purpose of this study was to evaluate the efficacy of impregnations for the prevention of catheter-related bloodstream infection (CRBSI). METHODS We searched the following five electronic databases: Medline, PubMed, Cochrane, Embase, and the Web of Science for randomized controlled trials (RCTs) up to March 2021. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a fixed-effects model. Assessment of publication biases was evaluated by Egger's test. Heterogeneity between studies was assessed based on the chi-square test and I 2 statistics, and sensitivity analysis and subgroup analysis were also performed. RESULTS A total of six RCTs with 3,091 patients were included. Impregnated CVCs provided significant benefits in reducing the risk of CRBSI (RR = 0.41, 95% CI: 0.26-0.66) in pediatric patients, especially in the pediatric group. No publication bias was observed in the Egger test for the risk of CRBSI. Drug type is a source of heterogeneity. CONCLUSION Antimicrobial-impregnated CVCs are beneficial to prevent CVC-related complications in pediatrics.
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Affiliation(s)
- Zhengrong Deng
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jiangwei Qin
- West China Hospital, Sichuan University, Chengdu, China
| | - Huanbin Sun
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Furong Xv
- Wuyuzhang Honors College, Sichuan University, Chengdu, China
| | - Yimei Ma
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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20
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Corrêa Carvalho G, Miguel Sábio R, Spósito L, de Jesus Andreoli Pinto T, Chorilli M. An overview of the use of central venous catheters impregnated with drugs or with inorganic nanoparticles as a strategy in preventing infections. Int J Pharm 2022; 615:121518. [DOI: 10.1016/j.ijpharm.2022.121518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/17/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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21
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Laird CT, Cox S, Nakayama DK. Vascular access: Centuries of progress. Semin Pediatr Surg 2021; 30:151118. [PMID: 34930588 DOI: 10.1016/j.sempedsurg.2021.151118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chris T Laird
- Division of Pediatric General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO, United States.
| | - Sharon Cox
- Division of Paediatric Surgery, University of Cape Town, Cape Town, South Africa
| | - Don K Nakayama
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, United States
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22
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Shahid A, Aslam B, Muzammil S, Aslam N, Shahid M, Almatroudi A, Allemailem KS, Saqalein M, Nisar MA, Rasool MH, Khurshid M. The prospects of antimicrobial coated medical implants. J Appl Biomater Funct Mater 2021; 19:22808000211040304. [PMID: 34409896 DOI: 10.1177/22808000211040304] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The implants are increasingly being a part of modern medicine in various surgical procedures for functional or cosmetic purposes. The progressive use of implants is associated with increased infectious complications and prevention of such infections always remains precedence in the clinical settings. The preventive approaches include the systemic administration of antimicrobial agents before and after the surgical procedures as well as the local application of antibiotics. The relevant literature and existing clinical practices have highlighted the role of antimicrobial coating approaches in the prevention of implants associated infections, although the applications of these strategies are not yet standardized, and the clinical efficacy is not much clear. The adequate data from the randomized control trials is challenging because of the unavailability of a large sample size although it is compulsory in this context to assess the clinical efficacy of preemptive practices. This review compares the efficacy of preventive approaches and the prospects of antimicrobial-coated implants in preventing implant-related infections.
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Affiliation(s)
- Aqsa Shahid
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Bilal Aslam
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Saima Muzammil
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Nosheen Aslam
- Department of Biochemistry, Government College University, Faisalabad, Pakistan
| | - Muhammad Shahid
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Khaled S Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Muhammad Saqalein
- Department of Microbiology, Government College University, Faisalabad, Pakistan
| | - Muhammad Atif Nisar
- Department of Microbiology, Government College University, Faisalabad, Pakistan.,College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | | | - Mohsin Khurshid
- Department of Microbiology, Government College University, Faisalabad, Pakistan
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23
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Abstract
PURPOSE OF REVIEW Short-term intravascular catheters are instrumental in the care of critically ill patients. Despite their benefits, they also are potential entries for systemic infections. There is a growing body of literature on catheter use and the prevention of intravascular catheter infections in intensive care. This review highlights major recent contributions to the topic and put them into perspective to recommendations on best practice procedures. RECENT FINDINGS Many studies published in the last years have evaluated prevention strategies applying technology and addressing behavior change. Skin disinfection with 2% alcoholic chlorhexidine-gluconate (CHG) and CHG-impregnated dressings are increasingly used in clinical practice. However, the role of universal CHG bathing remains controversial. A number of new and innovative technologies are in development. Recent qualitative research offers new perspectives about behavior change interventions to improve implementation. SUMMARY Many options for effective intravascular catheter infection prevention are currently available. A number of recent systematic reviews and meta-analyses not only confirmed measures targeting best practice and technology at catheter insertion and catheter care but also challenged interventions, such as CHG bathing. More focus should be put to implementation strategies.
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Lai L, Yue X. Efficacy of Antimicrobial-Impregnated Catheters for Prevention of Bloodstream Infections in Pediatric Patients: A Meta-Analysis. Front Pediatr 2021; 9:632308. [PMID: 34136437 PMCID: PMC8200408 DOI: 10.3389/fped.2021.632308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Multiple Randomized controlled trials (RCTs) have evaluated the efficacy of antimicrobial-impregnated catheters to prevent catheter-related bloodstream infections (CRBSI). However, the RCTs showed contradictory results, the studies were limited in sample size and methodology quality. Thus, we conducted a meta-analysis to overcome these RCT limitations. Methods: We designed a meta-analysis of RCTs comparing antimicrobial-impregnated and conventional catheters for the prevention of CRBSI. We conducted a detailed search of various databases for RCTs published before November 2019. We calculated mean differences (MDs) and pooled odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model. Results: We included five RCTs with a total of 2,294 patients. The incidence of CRBSI between the two groups was 0.50 (95% CI, 0.19-1.27), with evidence of heterogeneity (I 2 = 55%). The difference was not statistically significant (p = 0.15). On subgroup analysis based on the age of the sample, there was no difference in the rate of CRBSI in the neonatal population [0.42 (95% CI, 0.08-2.27 I 2 = 61% p = 0.31] as well as pediatric population [0.45 (95% CI, 0.12-1.67 I 2 = 39% p = 0.23]. The summary OR on the incidence of catheter colonization between antimicrobial-impregnated and conventional catheters was 0.64 (95% CI, 0.17-2.35), with no evidence of heterogeneity (I 2 = 0%) and a non-significant difference (p = 0.50). Conclusions: To conclude, analysis of a limited number of heterogeneous studies mostly with a small sample indicates that the CRBSI and catheter colonization rates are similar between conventional and antimicrobial-impregnated catheters in the pediatric and neonatal population. There is an urgent need for large-scale RCTs focusing on different antimicrobial-impregnated catheters in these patients to further enhance current evidence.
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Affiliation(s)
- Li Lai
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xuan Yue
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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María LT, Alejandro GS, María Jesús PG. Central venous catheter insertion: Review of recent evidence. Best Pract Res Clin Anaesthesiol 2020; 35:135-140. [PMID: 33742573 DOI: 10.1016/j.bpa.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. New evidence is emerging regarding, e.g., antiseptic-antimicrobial impregnated catheters or the use of passive disinfection of closed connectors. These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.
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Affiliation(s)
- Lema Tomé María
- Anesthesiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain; Member of the ESAIC Patient Safety and Quality Committee, Spain; Patient Safety Expert and Coordinator in Madrid for SENSAR (Spanish Anesthesia Incident Reporting System), Spain.
| | - Garrido Sánchez Alejandro
- Anesthesiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain; Medical Simulation Instructor at Hospital Virtual de Valdecilla (Santander) and Institute for Medical Simulation (Boston), Spain; Patient Safety Expert and Vice-president of SENSAR (Spanish Anesthesia Incident Reporting System), Spain
| | - Pérez-Granda María Jesús
- Anesthesiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain; Ciber de Enfermedades Respiratorias (CIBERES) CIBER (CB06/06/0058) Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón Madrid, Spain
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26
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Baker JE, Seitz AP, Boudreau RM, Skinner MJ, Beydoun A, Kaval N, Caldwell CC, Gulbins E, Edwards MJ, Gobble RM. Doxycycline-Coated Silicone Breast Implants Reduce Acute Surgical-Site Infection and Inflammation. Plast Reconstr Surg 2020; 146:1029-1041. [PMID: 33141530 DOI: 10.1097/prs.0000000000007277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgical-site infection after implant-based breast reconstruction remains a leading cause of morbidity. Doxycycline is an antibiotic used to treat soft-tissue infections. The authors hypothesize that doxycycline-coated breast implants will significantly reduce biofilm formation, surgical-site infection, and inflammation after bacterial infection. METHODS Pieces of silicone breast implants were coated in doxycycline. In vitro studies to characterize the coating include Fourier transmission infrared spectroscopy, elution data, and toxicity assays (n = 4). To evaluate antimicrobial properties, coated implants were studied after methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa inoculation in vitro and in a mouse model at 3 and 7 days (n = 8). Studies included bacterial quantification, cytokine profiles, and histology. RESULTS Coated silicone breast implants demonstrated a color change, increased mass, and Fourier transmission infrared spectroscopy consistent with a doxycycline coating. Coated implants were nontoxic to fibroblasts and inhibited biofilm formation and bacterial adherence after MRSA and P. aeruginosa incubation in vitro, and measurable doxycycline concentrations at 24 hours were seen. In a mouse model, a significant reduction of MRSA and P. aeruginosa bacterial colonization after 3 and 7 days in the doxycycline-coated implant mice was demonstrated when compared to the control mice, control mice treated with intraperitoneal doxycycline, and control mice treated with a gentamicin/cefazolin/bacitracin wash. Decreased inflammatory cytokines and inflammatory cell infiltration were demonstrated in the doxycycline-coated mice. CONCLUSIONS A method to coat silicone implants with doxycycline was developed. The authors' doxycycline-coated silicone implants significantly reduced biofilm formation, surgical-site infections, and inflammation. Further studies are needed to evaluate the long-term implications.
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Affiliation(s)
- Jennifer E Baker
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Aaron P Seitz
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Ryan M Boudreau
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Mitchell J Skinner
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Ahmed Beydoun
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Necati Kaval
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Charles C Caldwell
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Erich Gulbins
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Michael J Edwards
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
| | - Ryan M Gobble
- From the Sections of Surgical Research and Plastic, Reconstructive, and Hand Surgery, Department of Surgery, and the Department of Chemistry, College of Arts and Science, University of Cincinnati; the Division of Surgery, Shriners Hospital for Children; and the Department of Molecular Biology, University Hospital Essen, University of Duisburg-Essen
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Lara HH, Lopez-Ribot JL. Inhibition of Mixed Biofilms of Candida albicans and Methicillin-Resistant Staphylococcus aureus by Positively Charged Silver Nanoparticles and Functionalized Silicone Elastomers. Pathogens 2020; 9:E784. [PMID: 32992727 PMCID: PMC7600790 DOI: 10.3390/pathogens9100784] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
Both bacterial and fungal organisms display the ability to form biofilms; however, mixed bacterial/fungal biofilms are particularly difficult to control and eradicate. The opportunistic microbial pathogens Candida albicans and Staphylococcus aureus are among the most frequent causative agents of healthcare-acquired infections, and are often co-isolated forming mixed biofilms, especially from contaminated catheters. These mixed species biofilms display a high level of antibiotic resistance; thus, these infections are challenging to treat resulting in excess morbidity and mortality. In the absence of effective conventional antibiotic treatments, nanotechnology-based approaches represent a promising alternative for the treatment of highly recalcitrant polymicrobial biofilm infections. Our group has previously reported on the activity of pure positively charged silver nanoparticles synthesized by a novel microwave technique against single-species biofilms of C. albicans and S. aureus. Here, we have expanded our observations to demonstrate that that silver nanoparticles display dose-dependent activity against dual-species C. albicans/S. aureus biofilms. Moreover, the same nanoparticles were used to functionalize catheter materials, leading to the effective inhibition of the mixed fungal/bacterial biofilms. Overall, our results indicate the potent activity of silver nanoparticles against these cross-kingdom biofilms. More studies are warranted to examine the ability of functionalized catheters in the prevention of catheter-related bloodstream infections.
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Affiliation(s)
- Humberto H. Lara
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Jose L. Lopez-Ribot
- Department of Biology and South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX 78249, USA
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28
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Estrada-Orozco K, Cantor-Cruz F, Larrotta-Castillo D, Díaz-Ríos S, Ruiz-Cardozo MA. Central venous catheter insertion and maintenance: Evidence-based clinical recommendations. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:115-162. [PMID: 32770871 DOI: 10.18597/rcog.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To share with clinicians supporting evidence of the safest and the most effective processes for central venous catheter insertion and maintenance as a strategy to prevent catheter-associated bloodstream infections. METHODS A literature search was conducted in the Medline via PubMed, Embase Central and Lilacs databases based on a set of clinical questions aimed at improving safety and effectiveness at key moments in the process of central venous catheter insertion and maintenance. The rapid literature review methodology was used. The studies identified were assessed from the quality point of view, using the Joanna Briggs Institute (JBI) tools for qualitative and quantitative studies and for systematic reviews. Clinical practice guidelines were assessed using the AGREE II tool. The evidence is presented in the form of evidence-based clinical recommendations, which were graded in accordance with the JBI methodology. RESULTS Twelve clinical evidence summaries containing evidence related to the safe and effective use of central venous catheters are presented, including the following topics: central venous catheter insertion (CVC), peripherally inserted central catheters (PICC), preoperative assessment, the use of analgesia, field preparation, choice between CVC or PICC, CVC care and maintenance, prevention of complications, and general considerations pertaining to the use of central venous catheters in oncologic patients and in parenteral nutrition. CONCLUSIONS Recommendations on the safe and effective use of central venous access catheters in relation to CVC insertion and maintenance processes are presented in the evidence-based summary model. It is necessary to evaluate their implementation in health outcomes in the institutions where they are developed.
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Affiliation(s)
- Kelly Estrada-Orozco
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Centro de Evidencia e Implementación, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Francy Cantor-Cruz
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Diego Larrotta-Castillo
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Stefany Díaz-Ríos
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Miguel A Ruiz-Cardozo
- Grupo de Evaluación de Tecnologías y Políticas en Salud (GETS), Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Unidad de Investigación en Seguridad del Paciente, Hospital Universitario Nacional de Colombia, Bogotá, Colombia. Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
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Milford K, von Delft D, Majola N, Cox S. Long-term vascular access in differently resourced settings: a review of indications, devices, techniques, and complications. Pediatr Surg Int 2020; 36:551-562. [PMID: 32200406 DOI: 10.1007/s00383-020-04640-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
Abstract
Central venous access is frequently essential for the management of many acute and chronic conditions in children. Millions of central venous access devices (CVADs) are placed each year. In this review article, we discuss the indications for long-term vascular access, the types of devices available, the state of the art of central venous cannulation and device placement, and the complications of long-term central venous access. We pay a special attention to the challenges of, and options for long-term central venous access, also those in developing countries, with limited financial, human, and material resources.
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Affiliation(s)
- Karen Milford
- The Division of Urology, The Hospital for Sick Children, The University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Dirk von Delft
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nkululeko Majola
- Department of Paediatric Surgery, Frere Hospital, Walter Sisulu University, East London, South Africa
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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30
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Pospíšilová Š, Malík I, Bezouskova K, Kauerova T, Kollar P, Csöllei J, Oravec M, Cizek A, Jampilek J. Dibasic Derivatives of Phenylcarbamic Acid as Prospective Antibacterial Agents Interacting with Cytoplasmic Membrane. Antibiotics (Basel) 2020; 9:E64. [PMID: 32041117 PMCID: PMC7168207 DOI: 10.3390/antibiotics9020064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
1-[2-[({[2-/3-(Alkoxy)phenyl]amino}carbonyl)oxy]-3-(dipropylammonio)propyl]pyrrolidinium/azepan- ium oxalates or dichlorides (alkoxy = butoxy to heptyloxy) were recently described as very promising antimycobacterial agents. These compounds were tested in vitro against Staphylococcus aureus ATCC 29213, Enterococcus faecalis ATCC 29212 (reference and control strains), three methicillin-resistant isolates of S. aureus, and three isolates of vancomycin-resistant E. faecalis. 1-[3-(Dipropylammonio)-2-({[3-(pentyloxy-/hexyloxy-/heptyloxy)phenyl]carbamoyl}oxy)propyl]pyrrolidinium dichlorides showed high activity against staphylococci and enterococci comparable with or higher than that of used controls (clinically used antibiotics and antiseptics). The screening of the cytotoxicity of the compounds as well as the used controls was performed using human monocytic leukemia cells. IC50 values of the most effective compounds ranged from ca. 3.5 to 6.3 µM, thus, it can be stated that the antimicrobial effect is closely connected with their cytotoxicity. The antibacterial activity is based on the surface activity of the compounds that are influenced by the length of their alkoxy side chain, the size of the azacyclic system, and hydro-lipophilic properties, as proven by in vitro experiments and chemometric principal component analyses. Synergistic studies showed the increased activity of oxacillin, gentamicin, and vancomycin, which could be explained by the direct activity of the compounds against the bacterial cell wall. All these compounds demonstrate excellent antibiofilm activity, when they inhibit and disrupt the biofilm of S. aureus in concentrations close to minimum inhibitory concentrations against planktonic cells. Expected interactions of the compounds with the cytoplasmic membrane are proven by in vitro crystal violet uptake assays.
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Affiliation(s)
- Šárka Pospíšilová
- Regional Centre of Advanced Technologies and Materials, Faculty of Science, Palacky University, Slechtitelu 27, 783 71 Olomouc, Czech Republic;
| | - Ivan Malík
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
| | - Kristyna Bezouskova
- Department of Infectious Diseases and Microbiology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Palackeho 1946/1, 612 42 Brno, Czech Republic; (K.B.); (A.C.)
| | - Tereza Kauerova
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic; (T.K.); (P.K.)
| | - Peter Kollar
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic; (T.K.); (P.K.)
| | - Jozef Csöllei
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences in Brno, Palackeho 1946/1, 612 42 Brno, Czech Republic;
| | - Michal Oravec
- Global Change Research Institute CAS, Belidla 986/4a, 603 00 Brno, Czech Republic;
| | - Alois Cizek
- Department of Infectious Diseases and Microbiology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Palackeho 1946/1, 612 42 Brno, Czech Republic; (K.B.); (A.C.)
| | - Josef Jampilek
- Regional Centre of Advanced Technologies and Materials, Faculty of Science, Palacky University, Slechtitelu 27, 783 71 Olomouc, Czech Republic;
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta 9, 845 10 Bratislava, Slovakia
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Graf A, Finkel J, Chauvet AAP, Rtimi S. Deciphering the Mechanisms of Bacterial Inactivation on HiPIMS Sputtered Cu xO-FeO x-PET Surfaces: From Light Absorption to Catalytic Bacterial Death. ACS APPLIED MATERIALS & INTERFACES 2019; 11:45319-45329. [PMID: 31696713 DOI: 10.1021/acsami.9b17380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The production of nontoxic, affordable, and efficient antibacterial surfaces is key to the well-being of our societies. In this aim, antibacterial thin films have been prepared using earth-abundant metals deposited using high-power impulse magnetron sputtering (HiPIMS). The sputtered FeOx, CuxO, and mixed CuxO-FeOx films exhibited fast bacterial inactivation properties under exposure to indoor light (340-720 nm) showing total bacterial inactivation within 180, 120, and 60 min, respectively. The photocatalytic mechanisms of these films were investigated, from the absorption of photons up to the bacteria's fate, by means of ultrafast transient spectroscopy, flow cytometry, and malondialdehyde (MDA) quantification justifying the cell wall disruption. The primary driving force leading to bacterial inactivation was found to be the oxidative stress at the interface between the sputtered thin films and the microorganism. This was justified by using engineered porinless bacteria disabling the possible ion diffusion leading to internal bacterial inactivation. Such stress is a direct consequence of the photogenerated electron-hole pairs at the interface of the sputtered layers. By diffuse reflectance spectroscopy, we found that both FeOx and CuxO present a band gap of ∼2.9 eV (>425 nm), while the mixed CuxO-FeOx thin film has a band gap below 2.3 eV (>540 nm). The structure and atomic composition of the films were characterized by energy-dispersive X-ray, X-ray photoelectron, and optical spectroscopy. While the composition and metal oxidation states are distinct in all three films, the difference in photocatalytic efficiency can, at first sight, be explained as the direct consequence of their absorbance and the unique interaction between Fe and Cu oxides in the composite film.
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Affiliation(s)
- Arthur Graf
- Department of Chemistry , The University of Sheffield , Dainton Building, C94, S10 2TN Sheffield , U.K
| | - Jake Finkel
- Department of Chemistry , The University of Sheffield , Dainton Building, C94, S10 2TN Sheffield , U.K
| | - Adrien A P Chauvet
- Department of Chemistry , The University of Sheffield , Dainton Building, C94, S10 2TN Sheffield , U.K
| | - Sami Rtimi
- EPFL-STI-IMX-LTP, Station 12 , Ecole Polytechnique Fédérale de Lausanne , 1015 Lausanne , Switzerland
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Hill S, Hamblett I, Brady S, Vasileukaya S, Zuzuarregui I, Martin F. Central venous access device-related sheaths: a predictor of infective and thrombotic incidence? ACTA ACUST UNITED AC 2019; 28:S10-S18. [DOI: 10.12968/bjon.2019.28.19.s10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Central vascular access device (CVAD)-related sheaths, sometimes described as ‘fibrin sheaths’, may result in minor or significant sequelae, from persistent withdrawal occlusion (PWO) to infective sheaths associated with increased morbidity and mortality. The authors studied 179 patients who underwent isotope scans, where isotope was infused via the CVAD. Isotope was found to bind to the sheaths around the catheters of some patients. The amount of uptake was taken to be an extent to which a sheath had developed around the CVAD. The degree of uptake of isotope was categorised into three groups: low uptake, moderate uptake and high uptake. Patients were then followed up from the date the CVAD was inserted to 12 months after the date of the isotope scan, until the device was removed or to the date the patient died, to identify incidence of infection, thrombosis and PWO. PWO incidence in all levels of uptake was around 5–7%. Bloodstream infection (BSI) incidence for low uptake was 7% (9/130), moderate uptake 10% (3/30) and for patients with significant uptake 16% (3/19). Thrombosis for no uptake was less than 1% (1/130), moderate uptake 7% (2/30), and significant uptake had no incidence of thrombosis. Total complications: no uptake 15%, moderate uptake 23% and significant uptake 21%. This single-centre study showed that patients with isotope-highlighted sheaths experienced higher incidence of infective, thrombotic and total complications.
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Affiliation(s)
- Steve Hill
- Procedure Team Manager, The Christie Hospital, Manchester
| | - Ian Hamblett
- Nuclear Medicine Clinical Technologist, The Christie Hospital, Manchester
| | - Samantha Brady
- Procedure Nurse Specialist, The Christie Hospital, Manchester
| | | | | | - Fiona Martin
- Procedure Nurse Specialist, The Christie Hospital, Manchester
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Lorente L. [To reduce the current rates of catheter-related bacteremia after the implementation of the Zero programs: This is the challenge]. Med Intensiva 2019; 45:243-245. [PMID: 31615713 DOI: 10.1016/j.medin.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
- L Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España.
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34
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Fused Deposition Modelling as a Potential Tool for Antimicrobial Dialysis Catheters Manufacturing: New Trends vs. Conventional Approaches. COATINGS 2019. [DOI: 10.3390/coatings9080515] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The rising rate of individuals with chronic kidney disease (CKD) and ineffective treatment methods for catheter-associated infections in dialysis patients has led to the need for a novel approach to the manufacturing of catheters. The current process requires moulding, which is time consuming, and coated catheters used currently increase the risk of bacterial resistance, toxicity, and added expense. Three-dimensional (3D) printing has gained a lot of attention in recent years and offers the opportunity to rapidly manufacture catheters, matched to patients through imaging and at a lower cost. Fused deposition modelling (FDM) in particular allows thermoplastic polymers to be printed into the desired devices from a model made using computer aided design (CAD). Limitations to FDM include the small range of thermoplastic polymers that are compatible with this form of printing and the high degradation temperature required for drugs to be extruded with the polymer. Hot-melt extrusion (HME) allows the potential for antimicrobial drugs to be added to the polymer to create catheters with antimicrobial activity, therefore being able to overcome the issue of increased rates of infection. This review will cover the area of dialysis and catheter-related infections, current manufacturing processes of catheters and methods to prevent infection, limitations of current processes of catheter manufacture, future directions into the manufacture of catheters, and how drugs can be incorporated into the polymers to help prevent infection.
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de Sousa JKT, Haddad JPA, de Oliveira AC, Vieira CD, Dos Santos SG. In vitro activity of antimicrobial-impregnated catheters against biofilms formed by KPC-producing Klebsiella pneumoniae. J Appl Microbiol 2019; 127:1018-1027. [PMID: 31278820 DOI: 10.1111/jam.14372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 06/07/2019] [Accepted: 07/01/2019] [Indexed: 12/30/2022]
Abstract
AIM To evaluate the activity and effectiveness of impregnated central venous catheters (CVC) against Klebsiella pneumoniae biofilms. METHODS AND RESULTS The antimicrobial activity and durability of impregnated-CVCs were evaluated over time and the size of zones of inhibition (ZI) was measured. Biofilm formation was observed by quantitative culture and also by scanning electron microscopy. The catheters impregnated with chlorhexidine/silver sulfadiazine (CHX/SS) reduced bacteria counts by 0·3 log and were most effective (P < 0·01) against Klebsiella pneumoniae biofilms N-acetylcysteine/levofloxacin (NAC/LEV) catheters. It was observed that the catheter impregnated with NAC/LEV had initially the largest average ZI size being statistically significant (P < 0·01). The NAC/LEV combination remained active until day 30, whereas the combination of CHX/SS was completely inactivated from day 15 on. CONCLUSIONS The NAC/LEV combination showed greater durability on the catheters, but it was the CHX/SS combination that had the greater initial efficacy in bacterial inhibition. It was also observed that NAC/LEV-impregnated catheters do not prevent the emergence of resistant subpopulations inside the inhibition halos during antimicrobial susceptibility tests. SIGNIFICANCE AND IMPACT OF THE STUDY Our results highlighted that the in vitro efficacy of antimicrobial-impregnated CVCs is limited by time and that their colonization occurred earlier than expected. Our data also demonstrated that NAC/LEV remained active until day 30 of evaluation and CHX/SS combination was completely inactivated from day 15 on. Our findings suggested that implantable devices should be carefully used by medical community.
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Affiliation(s)
- J K T de Sousa
- Oral Microbiology and Anaerobe Laboratory, Institute of Biological Science, Federal University of Minas Gerais - Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
| | - J P A Haddad
- Department of Preventive Veterinary Medicine, Veterinary School-Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
| | - A C de Oliveira
- Department of Basic Nursing, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - C D Vieira
- Oral Microbiology and Anaerobe Laboratory, Institute of Biological Science, Federal University of Minas Gerais - Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
| | - S G Dos Santos
- Oral Microbiology and Anaerobe Laboratory, Institute of Biological Science, Federal University of Minas Gerais - Avenida Presidente Antônio Carlos, Belo Horizonte, MG, Brazil
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Krikava I, Kolar M, Garajova B, Balik T, Sevcikova A, Roschke I, Sevcik P. The efficacy of a non-leaching antibacterial central venous catheter - a prospective, randomized, double-blind study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2019; 164:154-160. [PMID: 31142873 DOI: 10.5507/bp.2019.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/15/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Antimicrobial coatings of central venous catheters (CVC) have the potential to reduce the risk of infectious complications. The aim of this study was to examine the efficacy of a catheter with a non-leaching antimicrobial coating against catheter colonization and bloodstream infections (BSI). METHODS The study was conducted in two centers using a prospective, randomized, double-blind and controlled design (680 intensive care patients; a protective CVC (Certofix® protect) or a standard CVC (Certofix®). Primary objectives were the rates of catheter colonization and BSI in the two groups. Other baseline demographics, APACHE II score, insertion site, location of CVC placement (ICU or theatre), indwelling time and length of ICU stay were comparable for both groups. RESULTS While the rate of catheter colonization between the coated and uncoated CVC (17.4% vs. 18.7%, P=0.7477) and the rate of microbiologically confirmed catheter associated infections were similar (1.4% vs. 1.9%, P=0.7521), the coated CVC showed a significantly lower incidence of BSI (2.0% vs. 6.5%, P=0.0081) and a significantly lower mean incidence of BSI per 1000 catheter days (3.2 vs. 8.3, P=0.0356). CONCLUSION The non-leaching antibacterial coating of the protective catheter was effective in reducing the incidence of BSI but not the rate of catheter colonization. However, the incidence of BSI is a better surrogate marker for the risk of developing clinical signs of infection suggesting that use of the non-leaching protective catheter is effective in this regard. Trial number: ClinicalTrials.gov (ID: NCT00555282), https://clinicaltrials.gov/show/NCT00555282.
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Affiliation(s)
- Ivo Krikava
- Department of Pain Treatment, Department of Paediatric Anaesthesiology and Resuscitation, University Hospital Brno and Department of Paediatric Anaesthesiology and Resuscitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Kolar
- Department of Anesthesiology and Critical Care, University Hospital Kralovske Vinohrady, Prague, and Department of Anaesthesiology and Resuscitation, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Garajova
- Department of Surgery, University Hospital Brno, Brno, Czech Republic
| | - Tomas Balik
- Department of Anesthesiology and Critical Care, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Alena Sevcikova
- Department of Clinical Microbiology, University Hospital Brno, Brno and Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Pavel Sevcik
- Depatment of Anaesthesiology and Resuscitation, University Hospital Ostrava and Department of Intensive Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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