1
|
Garvey M. Medical Device-Associated Healthcare Infections: Sterilization and the Potential of Novel Biological Approaches to Ensure Patient Safety. Int J Mol Sci 2023; 25:201. [PMID: 38203372 PMCID: PMC10778788 DOI: 10.3390/ijms25010201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Healthcare-associated infections caused by multi-drug-resistant pathogens are increasing globally, and current antimicrobial options have limited efficacy against these robust species. The WHO details the critically important bacterial and fungal species that are often associated with medical device HAIs. The effective sterilization of medical devices plays a key role in preventing infectious disease morbidity and mortality. A lack of adherence to protocol and limitations associated with each sterilization modality, however, allows for the incidence of disease. Furthermore, issues relating to carcinogenic emissions from ethylene oxide gas (EtO) have motivated the EPA to propose limiting EtO use or seeking alternative sterilization methods for medical devices. The Food and Drug Administration supports the sterilization of healthcare products using low-temperature VH2O2 as an alternative to EtO. With advances in biomaterial and medical devices and the increasing use of combination products, current sterilization modalities are becoming limited. Novel approaches to disinfection and sterilization of medical devices, biomaterials, and therapeutics are warranted to safeguard public health. Bacteriophages, endolysins, and antimicrobial peptides are considered promising options for the prophylactic and meta-phylactic control of infectious diseases. This timely review discusses the application of these biologics as antimicrobial agents against critically important WHO pathogens, including ESKAPE bacterial species.
Collapse
Affiliation(s)
- Mary Garvey
- Department of Life Science, Atlantic Technological University, F91 YW50 Sligo, Ireland;
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, F91 YW50 Sligo, Ireland
| |
Collapse
|
2
|
Žiemytė M, Escudero A, Díez P, Ferrer MD, Murguía JR, Martí-Centelles V, Mira A, Martínez-Máñez R. Ficin-Cyclodextrin-Based Docking Nanoarchitectonics of Self-Propelled Nanomotors for Bacterial Biofilm Eradication. CHEMISTRY OF MATERIALS : A PUBLICATION OF THE AMERICAN CHEMICAL SOCIETY 2023; 35:4412-4426. [PMID: 37332683 PMCID: PMC10269336 DOI: 10.1021/acs.chemmater.3c00587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/21/2023] [Indexed: 06/20/2023]
Abstract
Development of bioinspired nanomotors showing effective propulsion and cargo delivery capabilities has attracted much attention in the last few years due to their potential use in biomedical applications. However, implementation of this technology in realistic settings is still a barely explored field. Herein, we report the design and application of a multifunctional gated Janus platinum-mesoporous silica nanomotor constituted of a propelling element (platinum nanodendrites) and a drug-loaded nanocontainer (mesoporous silica nanoparticle) capped with ficin enzyme modified with β-cyclodextrins (β-CD). The engineered nanomotor is designed to effectively disrupt bacterial biofilms via H2O2-induced self-propelled motion, ficin hydrolysis of the extracellular polymeric matrix (EPS) of the biofilm, and controlled pH-triggered cargo (vancomycin) delivery. The effective synergic antimicrobial activity of the nanomotor is demonstrated in the elimination of Staphylococcus aureus biofilms. The nanomotor achieves 82% of EPS biomass disruption and a 96% reduction in cell viability, which contrasts with a remarkably lower reduction in biofilm elimination when the components of the nanomotors are used separately at the same concentrations. Such a large reduction in biofilm biomass in S. aureus has never been achieved previously by any conventional therapy. The strategy proposed suggests that engineered nanomotors have great potential for the elimination of biofilms.
Collapse
Affiliation(s)
- Miglė Žiemytė
- Genomics
& Health Department, FISABIO Foundation, 46020 València, Spain
| | - Andrea Escudero
- Instituto
Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico
(IDM), Universitat Politècnica de València, Universitat
de València, València 46022, Spain
- Unidad
Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València,
Instituto de Investigación Sanitaria La Fe, 46026 València, Spain
- CIBER
de Bioingeniería, Biomateriales y
Nanomedicina (CIBER-BBN), Instituto Carlos III, 28029 Madrid, Spain
| | - Paula Díez
- Instituto
Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico
(IDM), Universitat Politècnica de València, Universitat
de València, València 46022, Spain
- Unidad
Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València,
Instituto de Investigación Sanitaria La Fe, 46026 València, Spain
- CIBER
de Bioingeniería, Biomateriales y
Nanomedicina (CIBER-BBN), Instituto Carlos III, 28029 Madrid, Spain
| | - María D. Ferrer
- Genomics
& Health Department, FISABIO Foundation, 46020 València, Spain
- CIBER of
Epidemiology and Public Health (CIBERESP), Instituto Carlos III, 28029 Madrid, Spain
- Departamento
de Química, Universitat Politècnica
de València, Cami
de Vera s/n, 46022 València, Spain
| | - Jose R. Murguía
- Instituto
Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico
(IDM), Universitat Politècnica de València, Universitat
de València, València 46022, Spain
- Unidad
Mixta UPV-CIPF de Investigación en Mecanismos de Enfermedades
y Nanomedicina, València, Universitat
Politècnica de València, Centro de Investigación
Príncipe Felipe, 46012 València, Spain
- CIBER
de Bioingeniería, Biomateriales y
Nanomedicina (CIBER-BBN), Instituto Carlos III, 28029 Madrid, Spain
| | - Vicente Martí-Centelles
- Instituto
Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico
(IDM), Universitat Politècnica de València, Universitat
de València, València 46022, Spain
- CIBER
de Bioingeniería, Biomateriales y
Nanomedicina (CIBER-BBN), Instituto Carlos III, 28029 Madrid, Spain
| | - Alex Mira
- Genomics
& Health Department, FISABIO Foundation, 46020 València, Spain
- CIBER of
Epidemiology and Public Health (CIBERESP), Instituto Carlos III, 28029 Madrid, Spain
- Departamento
de Química, Universitat Politècnica
de València, Cami
de Vera s/n, 46022 València, Spain
| | - Ramón Martínez-Máñez
- Instituto
Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico
(IDM), Universitat Politècnica de València, Universitat
de València, València 46022, Spain
- Unidad
Mixta UPV-CIPF de Investigación en Mecanismos de Enfermedades
y Nanomedicina, València, Universitat
Politècnica de València, Centro de Investigación
Príncipe Felipe, 46012 València, Spain
- Unidad
Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València,
Instituto de Investigación Sanitaria La Fe, 46026 València, Spain
- CIBER
de Bioingeniería, Biomateriales y
Nanomedicina (CIBER-BBN), Instituto Carlos III, 28029 Madrid, Spain
- Departamento
de Química, Universitat Politècnica
de València, Cami
de Vera s/n, 46022 València, Spain
| |
Collapse
|
3
|
Copling A, Akantibila M, Kumaresan R, Fleischer G, Cortes D, Tripathi RS, Carabetta VJ, Vega SL. Recent Advances in Antimicrobial Peptide Hydrogels. Int J Mol Sci 2023; 24:ijms24087563. [PMID: 37108725 PMCID: PMC10139150 DOI: 10.3390/ijms24087563] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Advances in the number and type of available biomaterials have improved medical devices such as catheters, stents, pacemakers, prosthetic joints, and orthopedic devices. The introduction of a foreign material into the body comes with a risk of microbial colonization and subsequent infection. Infections of surgically implanted devices often lead to device failure, which leads to increased patient morbidity and mortality. The overuse and improper use of antimicrobials has led to an alarming rise and spread of drug-resistant infections. To overcome the problem of drug-resistant infections, novel antimicrobial biomaterials are increasingly being researched and developed. Hydrogels are a class of 3D biomaterials consisting of a hydrated polymer network with tunable functionality. As hydrogels are customizable, many different antimicrobial agents, such as inorganic molecules, metals, and antibiotics have been incorporated or tethered to them. Due to the increased prevalence of antibiotic resistance, antimicrobial peptides (AMPs) are being increasingly explored as alternative agents. AMP-tethered hydrogels are being increasingly examined for antimicrobial properties and practical applications, such as wound-healing. Here, we provide a recent update, from the last 5 years of innovations and discoveries made in the development of photopolymerizable, self-assembling, and AMP-releasing hydrogels.
Collapse
Affiliation(s)
- Aryanna Copling
- Department of Molecular & Cellular Biosciences, Rowan University, Glassboro, NJ 08028, USA
| | - Maxwell Akantibila
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Raaha Kumaresan
- Department of Biomedical Engineering, Rowan University, Glassboro, NJ 08028, USA
| | - Gilbert Fleischer
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Dennise Cortes
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Rahul S Tripathi
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Valerie J Carabetta
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Sebastián L Vega
- Department of Biomedical Engineering, Rowan University, Glassboro, NJ 08028, USA
- Department of Orthopedic Surgery, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| |
Collapse
|
4
|
Ibáñez-Cervantes G, Cruz-Cruz C, Durán-Manuel EM, Loyola-Cruz MÁ, Cureño-Díaz MA, Castro-Escarpulli G, Lugo-Zamudio GE, Rojo-Gutiérrez MI, Razo-Blanco Hernández DM, López-Ornelas A, Bello-López JM. Disinfection efficacy of ozone on ESKAPE bacteria biofilms: Potential use in difficult-to-access medical devices. Am J Infect Control 2023; 51:11-17. [PMID: 35483519 DOI: 10.1016/j.ajic.2022.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Medical devices can be reservoirs of multidrug-resistant bacteria that may be involved in the acquisition of infections since bacteria with the ability to form biofilms that are difficult to eradicate, mainly in mechanical ventilators. The aim of this work was to evaluate the efficacy of O3 against biofilms of bacteria ESKAPE group through disinfection studies. METHODS The formation of biofilms of ESKAPE group bacteria was induced in vitro. O3 was injected at different exposure times at a constant dose of 600 mg/h. The recovery of surviving bacteria after O3 treatment was assessed by bacterial counts and biofilm disruption was analyzed. Finally, the viability and integrity of biofilms after O3 treatment was determined by confocal laser scanning microscopy (CLSM). RESULTS O3 showed bactericidal activity on biofilms from 12 min/7.68 ppm for A. baumannii and C. freundii. P. aeruginosa, K. pneumoniae and S. aureus were killed after 15 min/9.60 ppm. Correlation analyses showed inversely proportional relationships between the variables "disruption versus O3". CLSM revealed that death was time-dependent of biofilms upon O3 exposure. Orthogonal plane analysis showed that bacteria located in the outer region of the biofilms were the ones that initially suffered damage from O3 exposure. CONCLUSIONS Our findings suggest that this method could be an alternative for the disinfection in mechanical ventilators colonized by bacteria biofilm forming.
Collapse
Affiliation(s)
- Gabriela Ibáñez-Cervantes
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Clemente Cruz-Cruz
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico
| | | | - Miguel Ángel Loyola-Cruz
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | | | | | | | | | - Adolfo López-Ornelas
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Laboratorio de Reprogramación Celular, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, Mexico.
| | | |
Collapse
|
5
|
Garvey M, Meade E, Rowan NJ. Effectiveness of front line and emerging fungal disease prevention and control interventions and opportunities to address appropriate eco-sustainable solutions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 851:158284. [PMID: 36029815 DOI: 10.1016/j.scitotenv.2022.158284] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Fungal pathogens contribute to significant disease burden globally; however, the fact that fungi are eukaryotes has greatly complicated their role in fungal-mediated infections and alleviation. Antifungal drugs are often toxic to host cells and there is increasing evidence of adaptive resistance in animals and humans. Existing fungal diagnostic and treatment regimens have limitations that has contributed to the alarming high mortality rates and prolonged morbidity seen in immunocompromised cohorts caused by opportunistic invasive infections as evidenced during HIV and COVID-19 pandemics. There is a need to develop real-time monitoring and diagnostic methods for fungal pathogens and to create a greater awareness as to the contribution of fungal pathogens in disease causation. Greater information is required on the appropriate selection and dose of antifungal drugs including factors governing resistance where there is commensurate need to discover more appropriate and effective solutions. Popular azole fungal drugs are widely detected in surface water and sediment due to incomplete removal in wastewater treatment plants where they are resistant to microbial degradation and may cause toxic effects on aquatic organisms such as algae and fish. UV has limited effectiveness in destruction of anti-fungal drugs where there is increased interest in the combination approaches such as novel use of pulsed-plasma gas-discharge technologies for environmental waste management. There is growing interest in developing alternative and complementary green eco-biocides and disinfection innovation. Fungi present challenges for cleaning, disinfection and sterilization of reusable medical devices such as endoscopes where they (example, Aspergillus and Candida species) can be protected when harboured in build-up biofilm from lethal processing. Information on the efficacy of established disinfection and sterilization technologies to address fungal pathogens including bottleneck areas that present high risk to patients is lacking. There is a need to address risk mitigation and modelling to inform efficacy of appropriate intervention technologies that must consider all contributing factors where there is potential to adopt digital technologies to enable real-time analysis of big data, such as use of artificial intelligence and machine learning. International consensus on standardised protocols for developing and reporting on appropriate alternative eco-solutions must be reached, particularly in order to address fungi with increasing drug resistance where research and innovation can be enabled using a One Health approach.
Collapse
Affiliation(s)
- Mary Garvey
- Department of Life Science, Atlantic Technological University, Sligo, Ireland; Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, Sligo, Ireland
| | - Elaine Meade
- Department of Life Science, Atlantic Technological University, Sligo, Ireland; Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, Sligo, Ireland
| | - Neil J Rowan
- Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone, Ireland; Centre for Decontamination, Sterilization and Biosecurity, Technological University of the Shannon Midlands Midwest, Athlone, Ireland; Empower Eco Sustainability Hub, Technological University of the Shannon Midlands Midwest, Athlone, Ireland.
| |
Collapse
|
6
|
Combined sterilization and fabrication of drug-loaded scaffolds using supercritical CO 2 technology. Int J Pharm 2022; 612:121362. [PMID: 34896562 DOI: 10.1016/j.ijpharm.2021.121362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/16/2023]
Abstract
The access of biodegradable scaffolds to the clinical arena is constrained by the absence of a suitable sterilization technique for the processing of advanced polymeric materials. Sterilization with supercritical CO2 (scCO2) may circumvent some technological limitations (e.g., low temperature, no chemical residues on the material), although scCO2 can plasticize the polymer depending on the processing conditions used. In this latter case, the integration of the manufacturing and sterilization processes is of particular interest to obtain sterile and customized scaffolds in a single step. In this work, scCO2 was exploited as a concomitantly foaming and sterilizing agent for the first time, developing a one-step process for the production of vancomycin-loaded poly(ε-caprolactone) (PCL) bone scaffolds. The effect of the CO2 contact time on the sterility levels of the procedure was investigated, and the sterilization efficiency was evaluated against dry spores (Bacillus stearothermophilus, Bacillus pumilus and Bacillus atrophaeus). Vancomycin-loaded PCL scaffolds had relevant sustained release profiles for the prophylaxis of infections at the grafted area, even those caused by methicillin-resistant Staphylococcus aureus (MRSA). The biological performance of the scaffolds was evaluated in vitro regarding human mesenchymal stem cells (hMSCs) attachment and growth. Finally, the biocompatibility and angiogenic response of the manufactured sterile scaffolds was assessed in ovo through chick chorioallantoic membrane (CAM) assays.
Collapse
|