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Bonfield TL, Zuckerman ST, Sutton MT, Korley JN, von Recum HA. Polymerized cyclodextrin microparticles for sustained antibiotic delivery in lung infections. J Biomed Mater Res A 2024; 112:1305-1316. [PMID: 38380736 DOI: 10.1002/jbm.a.37680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/22/2024]
Abstract
Pulmonary infections complicate chronic lung diseases requiring attention to both the pathophysiology and complexity associated with infection management. Patients with cystic fibrosis (CF) struggle with continuous bouts of pulmonary infections, contributing to lung destruction and eventual mortality. Additionally, CF patients struggle with airways that are highly viscous, with accumulated mucus creating optimal environments for bacteria colonization. The unique physiology and altered airway environment provide an ideal niche for bacteria to change their phenotype often becoming resistant to current treatments. Colonization with multiple pathogens at the same time further complicate treatment algorithms, requiring drug combinations that can challenge CF patient tolerance to treatment. The goal of this research initiative was to explore the utilization of a microparticle antibiotic delivery system, which could provide localized and sustained antibiotic dosing. The outcome of this work demonstrates the feasibility of providing efficient localized delivery of antibiotics to manage infection using both preclinical in vitro and in vivo CF infection models. The studies outlined in this manuscript demonstrate the proof-of-concept and unique capacity of polymerized cyclodextrin microparticles to provide site-directed management of pulmonary infections.
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Affiliation(s)
- Tracey L Bonfield
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sean T Zuckerman
- Affinity Therapeutics, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Morgan T Sutton
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Hospital, Memphis, Tennessee, USA
| | | | - Horst A von Recum
- Affinity Therapeutics, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Moghadam MT, Mojtahedi A, Salamy S, Shahbazi R, Satarzadeh N, Delavar M, Ashoobi MT. Phage therapy as a glimmer of hope in the fight against the recurrence or emergence of surgical site bacterial infections. Infection 2024; 52:385-402. [PMID: 38308075 DOI: 10.1007/s15010-024-02178-0] [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: 09/19/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE Over the last decade, surgery rates have risen alarmingly, and surgical-site infections are expanding these concerns. In spite of advances in infection control practices, surgical infections continue to be a significant cause of death, prolonged hospitalization, and morbidity. As well as the presence of bacterial infections and their antibiotic resistance, biofilm formation is one of the challenges in the treatment of surgical wounds. METHODS This review article was based on published studies on inpatients and laboratory animals receiving phage therapy for surgical wounds, phage therapy for tissue and bone infections treated with surgery to prevent recurrence, antibiotic-resistant wound infections treated with phage therapy, and biofilm-involved surgical wounds treated with phage therapy which were searched without date restrictions. RESULTS It has been shown in this review article that phage therapy can be used to treat surgical-site infections in patients and animals, eliminate biofilms at the surgical site, prevent infection recurrence in wounds that have been operated on, and eradicate antibiotic-resistant infections in surgical wounds, including multi-drug resistance (MDR), extensively drug resistance (XDR), and pan-drug resistance (PDR). A cocktail of phages and antibiotics can also reduce surgical-site infections more effectively than phages alone. CONCLUSION In light of these encouraging results, clinical trials and research with phages will continue in the near future to treat surgical-site infections, biofilm removal, and antibiotic-resistant wounds, all of which could be used to prescribe phages as an alternative to antibiotics.
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Affiliation(s)
- Majid Taati Moghadam
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Mojtahedi
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shakiba Salamy
- Department of Microbiology, Faculty of Pharmacy, Islamic Azad University, Tehran, Iran
| | - Razieh Shahbazi
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Naghmeh Satarzadeh
- Student Research Committee, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Majid Delavar
- Vice President of Health and Executive Vice President, Rey Health Center, Tehran University of Medical Sciences, Tehran, Iran
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Hu R, Chen Y, Hu J, Yi L. Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study. Qual Manag Health Care 2024:00019514-990000000-00069. [PMID: 38427344 DOI: 10.1097/qmh.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. METHODS We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. RESULTS We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). CONCLUSION Evidence-based nursing-sensitive quality indicators for the CSSD were established.
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Affiliation(s)
- Ruixue Hu
- Author Affiliations: Department of Sterile processing Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Santana JA, Zanon IP, Sarsur Ribeirode Freitas RJ, Viegas FM, de Campos BH, Bicalho GC, de Almeida LR, Hemetrio NS, Nogueira de Carvalho MP, Silveira Silva RO. DISTRIBUTION AND ANTIMICROBIAL RESISTANCE OF STAPHYLOCOCCI ISOLATED FROM FREE-LIVING SOUTH AMERICAN COATI ( NASUA NASUA) IN AN URBAN PARK IN MINAS GERAIS, BRAZIL. J Zoo Wildl Med 2023; 54:578-583. [PMID: 37817624 DOI: 10.1638/2022-0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 10/12/2023] Open
Abstract
The scientific information regarding staphylococci in procyonids is scarce. Hence, the aim of this study was to evaluate the frequency, distribution, and pattern of antimicrobial resistance of staphylococcal species isolated from free-roaming coatis (Nasua nasua) in an urban park in Belo Horizonte, Minas Gerais, Brazil. Rectal swabs from 55 free-living coatis were plated onto mannitol salt agar for isolating staphylococci, and species were identified using matrix-assisted laser desorption/ionization-time of flight mass spectrometry, polymerase chain reaction (PCR) of nuc, and sequencing of 16S rRNA and rpoB when needed. Antimicrobial susceptibility was investigated using the disk diffusion method, and the presence of the mecA gene was investigated by PCR. A total of 72.7% of the animals tested positive for staphylococci. Nine different species were identified, and Staphylococcus intermedius (60.4%) and S. delphini (20.9%) were the most frequently isolated species. Most of the isolates were susceptible to most of the antimicrobials evaluated, with a resistance pattern seen for penicillin (13.9%). One isolate was multidrug-resistant (MDR). The present study suggests that coatis are natural hosts of S. intermedius and S. delphini and, despite living in a heavily anthropized environment, the Staphylococcus spp. isolates showed a low incidence of drug resistance.
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Affiliation(s)
- Jordana Almeida Santana
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil
| | - Isabela Pádua Zanon
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil
| | | | - Flávia Mello Viegas
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil
| | - Bruna Hermine de Campos
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil
| | - Gustavo Canesso Bicalho
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil
| | - Lara Ribeiro de Almeida
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil
| | - Nadja Simbera Hemetrio
- Municipal Parks and Zoobotanic Foundation of Belo Horizonte, Belo Horizonte, MG 31365-450, Brazil
| | | | - Rodrigo Otávio Silveira Silva
- Escola de Veterinária, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos, Belo Horizonte, MG 31270-901, Brazil,
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Risk and economic burden of surgical site infection following spinal fusion in adults. Infect Control Hosp Epidemiol 2023; 44:88-95. [PMID: 35322778 DOI: 10.1017/ice.2022.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spinal fusion surgery (SFS) is one of the most common operations in the United States, >450,000 SFSs are performed annually, incurring annual costs >$10 billion. OBJECTIVES We used a nationwide longitudinal database to accurately assess incidence and payments associated with management of postoperative infection following SFS. METHODS We conducted a retrospective, observational cohort analysis of 210,019 patients undergoing SFS from 2014 to 2018 using IBM MarketScan commercial and Medicaid-Medicare databases. We assessed rates of superficial/deep incisional SSIs, from 3 to 180 days after surgery using Cox proportional hazard regression models. To evaluate adjusted payments for patients with/without SSIs, adjusted for inflation to 2019 Consumer Price Index, we used generalized linear regression models with log-link and γ distribution. RESULTS Overall, 6.6% of patients experienced an SSI, 1.7% superficial SSIs and 4.9% deep-incisional SSIs, with a median of 44 days to presentation for superficial SSIs and 28 days for deep-incisional SSIs. Selective risk factors included surgical approach, admission type, payer, and higher comorbidity score. Postoperative incremental commercial payments for patients with superficial SSI were $20,800 at 6 months, $26,937 at 12 months, and $32,821 at 24 months; incremental payments for patients with deep-incisional SSI were $59,766 at 6 months, $74,875 at 12 months, and $93,741 at 24 months. Corresponding incremental Medicare payments for patients with superficial incisional at 6, 12, 24-months were $11,044, $17,967, and $24,096; while payments for patients with deep-infection were: $48,662, $53,757, and $73,803 at 6, 12, 24-months. CONCLUSIONS We identified a 4.9% rate of deep infection following SFS, with substantial payer burden. The findings suggest that the implementation of robust evidence-based surgical-care bundles to mitigate postoperative SFS infection is warranted.
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Scavello F, Kharouf N, Lavalle P, Haikel Y, Schneider F, Metz-Boutigue MH. The antimicrobial peptides secreted by the chromaffin cells of the adrenal medulla link the neuroendocrine and immune systems: From basic to clinical studies. Front Immunol 2022; 13:977175. [PMID: 36090980 PMCID: PMC9452953 DOI: 10.3389/fimmu.2022.977175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
The increasing resistance to antibiotic treatments highlights the need for the development of new antimicrobial agents. Antimicrobial peptides (AMPs) have been studied to be used in clinical settings for the treatment of infections. Endogenous AMPs represent the first line defense of the innate immune system against pathogens; they also positively interfere with infection-associated inflammation. Interestingly, AMPs influence numerous biological processes, such as the regulation of the microbiota, wound healing, the induction of adaptive immunity, the regulation of inflammation, and finally express anti-cancer and cytotoxic properties. Numerous peptides identified in chromaffin secretory granules from the adrenal medulla possess antimicrobial activity: they are released by chromaffin cells during stress situations by exocytosis via the activation of the hypothalamo-pituitary axis. The objective of the present review is to develop complete informations including (i) the biological characteristics of the AMPs produced after the natural processing of chromogranins A and B, proenkephalin-A and free ubiquitin, (ii) the design of innovative materials and (iii) the involvement of these AMPs in human diseases. Some peptides are elective biomarkers for critical care medicine, may play an important role in the protection of infections (alone, or in combination with others or antibiotics), in the prevention of nosocomial infections, in the regulation of intestinal mucosal dynamics and of inflammation. They could play an important role for medical implant functionalization, such as catheters, tracheal tubes or oral surgical devices, in order to prevent infections after implantation and to promote the healing of tissues.
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Affiliation(s)
- Francesco Scavello
- Department of Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de recherche (UMR) S 1121, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
- IRCCS Humanitas Research Hospital, Milan, Italy
- *Correspondence: Francesco Scavello,
| | - Naji Kharouf
- Department of Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de recherche (UMR) S 1121, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, Strasbourg, France
| | - Philippe Lavalle
- Department of Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de recherche (UMR) S 1121, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
| | - Youssef Haikel
- Department of Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de recherche (UMR) S 1121, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
- Department of Endodontics and Conservative Dentistry, Faculty of Dental Medicine, University of Strasbourg, Strasbourg, France
| | - Francis Schneider
- Department of Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de recherche (UMR) S 1121, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
- Médecine Intensive-Réanimation, Hautepierre Hospital, Hôpitaux Universitaires, Strasbourg, Federation of Translational Medicine, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marie-Hélène Metz-Boutigue
- Department of Biomaterials and Bioengineering, Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de recherche (UMR) S 1121, Federation of Translational Medicine, Strasbourg University, Strasbourg, France
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Edmiston CE, Leaper DJ. Prevention of Orthopedic Prosthetic Infections Using Evidence-Based Surgical Site Infection Care Bundles: A Narrative Review. Surg Infect (Larchmt) 2022; 23:645-655. [PMID: 35925775 DOI: 10.1089/sur.2022.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The number of primary/revision total joint replacements (TJR) are expected to increase substantially with an aging population and increasing prevalence of comorbid conditions. The 30-day re-admission rate, in all orthopedic specialties, is 5.4% (range, 4.8%-6.0%). A recent publication has documented that the surgical site infection (SSI) infection rate associated with revision total knee (rTKR, 15.6%) and revision total hip (rTHR, 8.6%) arthroplasties are four to seven times the rate of the primary procedures (2.1%-2.2%). These orthopedic infections prolong hospital stays, double re-admissions, and increase healthcare costs by a factor of 300%. Methods: A search of PubMed/MEDLINE, EMBASE and the Cochrane Library publications, which reported the infection risk after TKR and THR, was undertaken (January 1, 1995 to December 31, 2021). The search also included documentation of evidence-based practices that lead to improved post-operative outcomes. Results: The evidence-based approach to reducing the risk of SSI was grouped into pre-operative, peri-operative, and post-operative periods. Surgical care bundles have existed within other surgical disciplines for more than 20 years, although their use is relatively new in peri-operative orthopedic surgical care. Pre-admission chlorhexidine gluconate (CHG) showers/cleansing, staphylococcal decolonization, maintenance of normothermia, wound irrigation, antimicrobial suture wound closure, and post-operative wound care has been shown to improve clinical outcome in randomized controlled studies and meta-analyses. Conclusions: Evidence-based infection prevention care bundles have improved clinical outcomes in all surgical disciplines. The significant post-operative morbidity, mortality, and healthcare cost, associated with SSIs after TJR can be reduced by introduction of evidence-based pre-operative, intra-operative, and post-operative interventions.
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Affiliation(s)
- Charles E Edmiston
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin USA
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Biofilms in Surgical Site Infections: Recent Advances and Novel Prevention and Eradication Strategies. Antibiotics (Basel) 2022; 11:antibiotics11010069. [PMID: 35052946 PMCID: PMC8773207 DOI: 10.3390/antibiotics11010069] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 12/24/2022] Open
Abstract
Surgical site infections (SSIs) are common postoperative occurrences due to contamination of the surgical wound or implanted medical devices with community or hospital-acquired microorganisms, as well as other endogenous opportunistic microbes. Despite numerous rules and guidelines applied to prevent these infections, SSI rates are considerably high, constituting a threat to the healthcare system in terms of morbidity, prolonged hospitalization, and death. Approximately 80% of human SSIs, including chronic wound infections, are related to biofilm-forming bacteria. Biofilm-associated SSIs are extremely difficult to treat with conventional antibiotics due to several tolerance mechanisms provided by the multidrug-resistant bacteria, usually arranged as polymicrobial communities. In this review, novel strategies to control, i.e., prevent and eradicate, biofilms in SSIs are presented and discussed, focusing mainly on two attractive approaches: the use of nanotechnology-based composites and natural plant-based products. An overview of new therapeutic agents and strategic approaches to control epidemic multidrug-resistant pathogenic microorganisms, particularly when biofilms are present, is provided alongside other combinatorial approaches as attempts to obtain synergistic effects with conventional antibiotics and restore their efficacy to treat biofilm-mediated SSIs. Some detection and real-time monitoring systems to improve biofilm control strategies and diagnosis of human infections are also discussed.
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Santana JA, Colombo SA, Silva BA, Diniz AN, de Almeida LR, Oliveira Junior CA, Lobato FCF, de Souza Trindade G, Paglia AP, Silva ROS. Clostridioides difficile and multi-drug-resistant staphylococci in free-living rodents and marsupials in parks of Belo Horizonte, Brazil. Braz J Microbiol 2021; 53:401-410. [PMID: 34761356 DOI: 10.1007/s42770-021-00640-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/21/2021] [Indexed: 12/18/2022] Open
Abstract
The global emergence of antimicrobial resistance (AMR) has become a serious threat to human and animal health. Recent studies have shown that synanthropic animals can act as reservoirs and disseminators of pathogens and resistant bacteria. The aim of this study was to evaluate the frequency, distribution, and antimicrobial susceptibility of staphylococcal species and Clostridioides difficile isolated from the feces of free-living rodents and marsupials from two urban parks in Belo Horizonte, Brazil. During a 12-month period, fecal samples from 159 free-living animals, including 136 rodents and 23 marsupials, were collected from two urban parks in Belo Horizonte, Minas Gerais, Brazil. Staphylococcus spp. were more likely to be isolated from rodents than marsupials (p = 0.0164). Eight different staphylococcal species were isolated from 36 (26.5%) rodents and one marsupial (4.3%). S. saprophyticus (48.6%) was the most frequently isolated species, and almost a quarter of the isolates (24.3%) were resistant to at least one antimicrobial agent, four (10.8%) of which were multi-drug resistant (MDR). Two (5.4%) strains were resistant to cefoxitin and were then classified as methicillin-resistant staphylococci, and one also tested positive for the mecA gene. C. difficile was isolated from two rodents (1.5%), and one strain was toxigenic and classified as ribotype 064. One isolate was resistant to rifampicin, but both strains were susceptible to all other antimicrobials tested, including metronidazole and vancomycin. All C. difficile isolates and all staphylococcal strains resistant to antimicrobials were recovered from the same park. The present study suggests that free-living rodents in Belo Horizonte (Brazil) are mainly colonized by S. saprophyticus and may act as reservoirs of antimicrobial-resistant Staphylococcus spp. and C. difficile strains. This is the first study to evaluate the presence of staphylococci and C. difficile from free-living opossums and suggest a low fecal shedding of these organisms by these mammals.
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Affiliation(s)
- Jordana Almeida Santana
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Salene Angelini Colombo
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Brendhal Almeida Silva
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Amanda Nádia Diniz
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Lara Ribeiro de Almeida
- Institute of Biological Sciences, Federal University of Minas Gerais, Antônio Carlos Avenue, Belo Horizonte, MG, 662731270-901, Brazil
| | - Carlos Augusto Oliveira Junior
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Francisco Carlos Faria Lobato
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil
| | - Giliane de Souza Trindade
- Institute of Biological Sciences, Federal University of Minas Gerais, Antônio Carlos Avenue, Belo Horizonte, MG, 662731270-901, Brazil
| | - Adriano Pereira Paglia
- Institute of Biological Sciences, Federal University of Minas Gerais, Antônio Carlos Avenue, Belo Horizonte, MG, 662731270-901, Brazil
| | - Rodrigo Otávio Silveira Silva
- Veterinary School, Federal University of Minas Gerais, Antônio Carlos Avenue, 6627, Belo Horizonte, MG, 31270-901, Brazil.
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Yan P, Daliri EBM, Oh DH. New Clinical Applications of Electrolyzed Water: A Review. Microorganisms 2021; 9:136. [PMID: 33435548 PMCID: PMC7827692 DOI: 10.3390/microorganisms9010136] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 12/21/2022] Open
Abstract
As the situation of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is still deteriorating, there has been a huge increase in the demand and use of disinfectants. Electrolyzed water (EW), as a novel broad-spectrum disinfectant and cleaner, has been widely used for several years. EW can be produced in an electrolysis chamber which contains dilute salt and tap water. It is an effective antimicrobial and antibiofilm agent, with several advantages such as on-the-spot, cheap, environmentally friendly and safe for human beings. Therefore, EW holds potential significance for high-risk settings in hospitals and other clinical facilities. EW can also be applied for wound healing, advanced tissue care, and dental clinics. The present review article highlights the latest developments and new perspectives of EW, especially in clinical fields. Furthermore, the main action modes of antibiofilm and antimicrobial will be summarized.
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Affiliation(s)
| | | | - Deog-Hwan Oh
- Department of Food Science and Biotechnology, Kangwon National University, Chuncheon 24341, Korea; (P.Y.); (E.B.-M.D.)
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11
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Azevedo MM, Lisboa C, Cobrado L, Pina-Vaz C, Rodrigues A. Hard-to-heal wounds, biofilm and wound healing: an intricate interrelationship. ACTA ACUST UNITED AC 2020; 29:S6-S13. [PMID: 32167817 DOI: 10.12968/bjon.2020.29.5.s6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hard-to-heal wounds are a major public health problem that incur high economic costs. A major source of morbidity, they can have an overwhelming impact on patients, caregivers and society. In contrast to acute wound healing, which follows an 'orderly and timely reparative process', the healing of hard-to-heal wounds is delayed because the usual biological progression is interrupted. This article discusses hard-to-heal wounds, the impact they have on patients and healthcare systems, and how biofilms and other factors affect the wound-healing process. Controlling and preventing infection is of utmost importance for normal wound healing. Rational use of anti-infectious agents is crucial and is particularly relevant in the context of rising healthcare costs. Knowledge of the complex relationship between hard-to-heal wounds, biofilm formation and wound healing is vital for efficient management of hard-to-heal wounds.
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Affiliation(s)
- Maria-Manuel Azevedo
- Department of Pathology and Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal
| | - Carmen Lisboa
- Teacher, Department of Pathology and Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal, and Physician, Department of Dermatovenereology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Luís Cobrado
- Department of Pathology and Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal
| | - Cidália Pina-Vaz
- Teacher, Department of Pathology and Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal
| | - Acácio Rodrigues
- Teacher and Head, Microbiology Department, Department of Pathology and Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Portugal, and Physician, Burn Unit, Department of Plastic and Reconstructive Surgery, Hospital São João, Porto, Portugal
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Reffuveille F, Josse J, Velard F, Lamret F, Varin-Simon J, Dubus M, Haney EF, Hancock REW, Mongaret C, Gangloff SC. Bone Environment Influences Irreversible Adhesion of a Methicillin-Susceptible Staphylococcus aureus Strain. Front Microbiol 2018; 9:2865. [PMID: 30538688 PMCID: PMC6277558 DOI: 10.3389/fmicb.2018.02865] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022] Open
Abstract
Prosthesis and joint infections are an important threat in public health, especially due to the development of bacterial biofilms and their high resistance to antimicrobials. Biofilm-associated infections increase mortality and morbidity rates as well as hospitalization costs. Prevention is the best strategy for this serious issue, so there is an urgent need to understand the signals that could induce irreversible bacterial adhesion on a prosthesis. In this context, we investigated the influence of the bone environment on surface adhesion by a methicillin-susceptible Staphylococcus aureus strain. Using static and dynamic biofilm models, we tested various bone environment factors and showed that the presence of Mg2+, lack of oxygen, and starvation each increased bacterial adhesion. It was observed that human osteoblast-like cell culture supernatants, which contain secreted components that would be found in the bone environment, increased bacterial adhesion capacity by 2-fold (p = 0.015) compared to the medium control. Moreover, supernatants from osteoblast-like cells stimulated with TNF-α to mimic inflammatory conditions increased bacterial adhesion by almost 5-fold (p = 0.003) without impacting on the overall biomass. Interestingly, the effect of osteoblast-like cell supernatants on bacterial adhesion could be counteracted by the activity of synthetic antibiofilm peptides. Overall, the results of this study demonstrate that factors within the bone environment and products of osteoblast-like cells directly influence S. aureus adhesion and could contribute to biofilm initiation on bone and/or prosthetics implants.
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Affiliation(s)
- Fany Reffuveille
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France
| | - Jérôme Josse
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France.,CIRI, INSERM U1111 - CNRS UMR5308 - ENS Lyon, Team "Staphylococcal Pathogenesis", Lyon 1 University, Lyon, France
| | - Frédéric Velard
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France
| | - Fabien Lamret
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France
| | - Jennifer Varin-Simon
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France
| | - Marie Dubus
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France
| | - Evan F Haney
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Robert E W Hancock
- Centre for Microbial Diseases and Immunity Research, Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Céline Mongaret
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France.,Pharmacy Department, University Hospital of Reims, Reims, France
| | - Sophie C Gangloff
- EA 4691 Biomaterials and Inflammation in Bone Site (BIOS), SFR Cap Santé (FED 4231), University of Reims-Champagne-Ardenne, Reims, France
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13
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Edmiston CE, Spencer M, Leaper D. Antiseptic Irrigation as an Effective Interventional Strategy for Reducing the Risk of Surgical Site Infections. Surg Infect (Larchmt) 2018; 19:774-780. [PMID: 30300563 DOI: 10.1089/sur.2018.156] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A surgical site infection (SSI) can occur at several anatomic sites related to a surgical procedure: Superficial or deep incisional or organ/space. The SSIs are the leading cause of health-care-associated infection (HAI) in industrialized Western nations. Patients in whom an SSI develops require longer hospitalization, incur significantly greater treatment costs and reduction in quality of life, and after selective surgical procedures experience higher mortality rates. Effective infection prevention and control requires the concept of the SSI care bundle, which is composed of a defined number of evidence-based interventional strategies, because of the many risk factors that can contribute to the development of an SSI. Intra-operative irrigation has been a mainstay of surgical practice for well over 100 years, but lacks standardization and compelling evidence-based data to validate its efficacy. In an era of antibiotic stewardship, with a widespread prevalence of bacterial resistance to multiple antibiotic agents, there has emerged an interest in using intra-operative antiseptic irrigation to reduce microbial contamination in the surgical site before closure and possibly reduce the need for antibiotic agents. This approach has gained added appeal in an era of biomedical device implantation, especially with the recognition that most, if not all, device-related infections are associated with biofilm formation. This review focuses on the limited, evidence-based rationale for the use of antiseptic agents as an effective risk reduction strategy for prevention of SSIs.
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Affiliation(s)
- Charles E Edmiston
- 1 Department of Surgery, Medical College of Wisconsin , Milwaukee, Wisconsin
| | | | - David Leaper
- 3 Institute of Skin Integrity and Infection Prevention University of Huddersfield , Huddersfield, United Kingdom
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14
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Hong B, Winkel A, Ertl P, Stumpp SN, Schwabe K, Stiesch M, Krauss JK. Bacterial colonisation of suture material after routine neurosurgical procedures: relevance for wound infection. Acta Neurochir (Wien) 2018; 160:497-503. [PMID: 29189910 DOI: 10.1007/s00701-017-3404-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Wound healing impairment is a serious problem in surgical disciplines which may be associated with chronic morbidity, increased cost and patient discomfort. Here we aimed to investigate the relevance of bacterial colonisation on suture material using polymerase chain reaction (PCR) to detect and taxonomically classify bacterial DNA in patients with and without wound healing problems after routine neurosurgical procedures. METHODS Repeat surgery was performed in 25 patients with wound healing impairment and in 38 patients with well-healed wounds. To determine the presence of bacteria, a 16S rDNA-based PCR detection method was applied. Fragments of 500 bp were amplified using universal primers which target hypervariable regions within the bacterial 16S rRNA gene. Amplicons were separated from each other by single-strand conformation polymorphism (SSCP) analysis, and finally classified using Sanger sequencing. RESULTS PCR/SSCP detected DNA of various bacteria species on suture material in 10/38 patients with well-healed wounds and in 12/25 patients with wound healing impairment including Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acnes and Escherichia coli. Microbiological cultures showed bacterial growth in almost all patients with wound healing impairment and positive results in PCR/SSCP (10/12), while this was the case in only one patient with a well-healed wound (1/10). CONCLUSIONS Colonisation of suture material with bacteria occurs in a relevant portion of patients with and without wound healing impairment after routine neurosurgical procedures. Suture material may provide a nidus for bacteria and subsequent biofilm formation. Most likely, however, such colonisation of sutures is not a general primer for subsequent wound infection.
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Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Andreas Winkel
- Department of Prosthetic Dentistry and Biomedical Material Science, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Philipp Ertl
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Sascha Nico Stumpp
- Department of Prosthetic Dentistry and Biomedical Material Science, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Material Science, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
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15
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Abstract
INTRODUCTION Biofilm formation represents a protected mode of growth that renders bacterial cells less susceptible to antimicrobials and to killing by host immune effector mechanisms and so enables the pathogens to survive in hostile environments and also to disperse and colonize new niches. Biofilm disease includes device-related infections, chronic infections in the absence of a foreign body, and even malfunction of medical devices. Areas covered: This review puts forward a new medical entity that represents a major public health issue, which we have named 'biofilm-related disease'. We highlight the characteristics of biofilm disease including its pathogenesis, microbiological features, clinical presentation, and treatment challenges. Expert commentary: The diversity of biofilm-associated infections is increasing over time and its impact may be underestimated. This peculiar form of development endows associated bacteria with a high tolerance to conventional antimicrobial agents. A small percentage of persister cells developing within the biofilm is known to be highly tolerant to antibiotics and has typically been involved in causing relapse of infections. Knowledge of the pivotal role played by biofilm-growing microorganisms in related infections will provide new treatment dynamics for this biofilm-related disease.
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Affiliation(s)
- Jose Luis Del Pozo
- a Infectious Diseases Division , Clínica Universidad de Navarra , Pamplona , Spain.,b Department of Clinical Microbiology , Clínica Universidad de Navarra , Pamplona , Spain.,c Laboratory of Microbial Biofilms , Clínica Universidad de Navarra , Pamplona , Spain
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16
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Edmiston CE, Leaper D, Spencer M, Truitt K, Litz Fauerbach L, Graham D, Johnson HB. Considering a new domain for antimicrobial stewardship: Topical antibiotics in the open surgical wound. Am J Infect Control 2017; 45:1259-1266. [PMID: 28596018 DOI: 10.1016/j.ajic.2017.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/07/2017] [Accepted: 04/07/2017] [Indexed: 01/07/2023]
Abstract
The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread. Given the risks inherent in their use and the lack of evidence supporting it, the practice should be monitored as a core part of ASPs, and alternative agents, such as antiseptics, should be considered.
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Affiliation(s)
| | - David Leaper
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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