Microbiological diagnosis of device‐related biofilm infections

Xu, Yijuan; Larsen, Lone Heimann; Lorenzen, Jan; Hall-Stoodley, Luanne; Kikhney, Judith; Moter, Annette; Thomsen, Trine Rolighed

doi:10.1111/apm.12676

Cited by 38 publications

(44 citation statements)

References 102 publications

(130 reference statements)

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“…Therefore, microbiological culture results are often the most critical diagnostic criteria. Since the microbes grow in biofilms on the foreign material and in necrotic bone tissue, cultivation and identification of the disease-causing pathogens may require the culture of several intraoperative tissue samples and removal of the implant for appropriate sampling (Costerton et al, 2011 ; Xu et al, 2017 ). To increase the yield of positive cultures, it is advised to terminate antibiotic therapy before sampling, acquire at least three tissue biopsies, and to perform sonication of removed hardware to remove biofilm-associated bacteria from the surface (Trampuz and Zimmerli, 2006 ; Trampuz et al, 2007 ; Puig-Verdie et al, 2013 ; Yano et al, 2014 ; Dapunt et al, 2015 ; Metsemakers et al, 2016 ).…”

Section: S Epidermidis As a Pathogenmentioning

confidence: 99%

Pathogenic Mechanisms and Host Interactions in Staphylococcus epidermidis Device-Related Infection

et al. 2017

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Staphylococcus epidermidis is a permanent member of the normal human microbiota, commonly found on skin and mucous membranes. By adhering to tissue surface moieties of the host via specific adhesins, S. epidermidis is capable of establishing a lifelong commensal relationship with humans that begins early in life. In its role as a commensal organism, S. epidermidis is thought to provide benefits to human host, including out-competing more virulent pathogens. However, largely due to its capacity to form biofilm on implanted foreign bodies, S. epidermidis has emerged as an important opportunistic pathogen in patients receiving medical devices. S. epidermidis causes approximately 20% of all orthopedic device-related infections (ODRIs), increasing up to 50% in late-developing infections. Despite this prevalence, it remains underrepresented in the scientific literature, in particular lagging behind the study of the S. aureus. This review aims to provide an overview of the interactions of S. epidermidis with the human host, both as a commensal and as a pathogen. The mechanisms retained by S. epidermidis that enable colonization of human skin as well as invasive infection, will be described, with a particular focus upon biofilm formation. The host immune responses to these infections are also described, including how S. epidermidis seems to trigger low levels of pro-inflammatory cytokines and high levels of interleukin-10, which may contribute to the sub-acute and persistent nature often associated with these infections. The adaptive immune response to S. epidermidis remains poorly described, and represents an area which may provide significant new discoveries in the coming years.

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Section: S Epidermidis As a Pathogenmentioning

confidence: 99%

Pathogenic Mechanisms and Host Interactions in Staphylococcus epidermidis Device-Related Infection

et al. 2017

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“…Molecular technologies (e.g. PCR) that amplify bacterial DNA in samples have improved the culture‐ independent detection and identification of microorganisms in the past years . These techniques can be very sensitive and fast but must be thoroughly evaluated for the respective experimental setting.…”

Section: Bacteriological Aspects Of Odri Studiesmentioning

confidence: 99%

“…Since culture as well as amplification‐based methods require disintegration of the sample (and therefore disruption of biofilms), microscopic techniques are the only methods to date that can differentiate between the presence of single cells, microcolonies, and biofilms in tissues . In addition to Gram staining or immunohistochemical methods, FISH combines molecular detection of microorganisms with fluorescence microscopy and has been increasingly used for analysis of biofilm‐associated infections . FISH can be applied to in vitro samples as well as to ex vivo samples from animal models or patients .…”

Section: Bacteriological Aspects Of Odri Studiesmentioning

confidence: 99%

Recommendations for design and conduct of preclinical in vivo studies of orthopedic device‐related infection

Moriarty

Harris

Mooney

et al. 2019

Journal Orthopaedic Research

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Orthopedic device-related infection (ODRI), including both fracture-related infection (FRI) and periprosthetic joint infection (PJI), remain among the most challenging complications in orthopedic and musculoskeletal trauma surgery. ODRI has been convincingly shown to delay healing, worsen functional outcome and incur significant socio-economic costs. To address this clinical problem, ever more sophisticated technologies targeting the prevention and/or treatment of ODRI are being developed and tested in vitro and in vivo. Among the most commonly described innovations are antimicrobial-coated orthopedic devices, antimicrobial-loaded bone cements and void fillers, and dual osteo-inductive/antimicrobial biomaterials. Unfortunately, translation of these technologies to the clinic has been limited, at least partially due to the challenging and still evolving regulatory environment for antimicrobial drugdevice combination products, and a lack of clarity in the burden of proof required in preclinical studies. Preclinical in vivo testing (i.e. animal studies) represents a critical phase of the multidisciplinary effort to design, produce and reliably test both safety and efficacy of any new antimicrobial device. Nonetheless, current in vivo testing protocols, procedures, models, and assessments are highly disparate, irregularly conducted and reported, and without standardization and validation. The purpose of the present opinion piece is to discuss best practices in preclinical in vivo testing of antimicrobial interventions targeting ODRI. By sharing these experience-driven views, we aim to aid others in conducting such studies both for fundamental biomedical research, but also for regulatory and clinical evaluation.

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“…Despite aseptic precautions and antibiotic prophylaxis during implantations, medical device-associated microbial infections still remain a major public health concern and may have serious consequences for the individual patient, including removal of the implant and significant economic costs (Xu et al, 2017). As systemic antibiotic treatment can be toxic to organ systems and promote the spread of antibiotic resistance, localized antimicrobial drug delivery is the subject of recent efforts to combat biofilm formation and infection for both preventive and treatment strategies (Jennings et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Cold Plasma for Direct Deposition of Antibiotics as a Novel Approach for Localized Delivery and Retention of Effect

Los

Ziuzina

Boehm

et al. 2019

Front. Cell. Infect. Microbiol.

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Antimicrobial coating of medical devices has emerged as a potentially effective tool to prevent or ameliorate device-related infections. In this study the plasma deposition process for direct deposition of pharmaceutical drugs on to a range of surfaces and the retention of structure function relationship and antimicrobial efficacy against mono-species biofilms were investigated. Two selected sample antibiotics-ampicillin and gentamicin, were deposited onto two types of surfaces-polystyrene microtiter plates and stainless steel coupons. The antimicrobial efficacy of the antibiotic-coated surfaces was tested against challenge populations of both planktonic and sessile Escherichia coli and Pseudomonas aeruginosa, with responses monitored for up to 14 days. The plasma deposition process bonded the antibiotic to the surfaces, with localized retention of antibiotic activity. The antibiotics deposited on the test surfaces retained a good efficacy against planktonic cells, and importantly prevented biofilm formation of attached cells for up to 96 h. The antibiotic rapidly eluted from the surface of antibiotic-coated surfaces to the surrounding medium, with retention of effect in this surrounding milieu for up to 2 weeks. Control experiments established that there was no independent antimicrobial or growth promoting effect of the plasma deposition process, where there was no antibiotic in the helium plasma assisted delivery stream. Apart from the flexibility offered through deposition on material surfaces, there was no additive or destructive effect associated with the helium assisted plasma deposition process on the antibiotic. The plasma assisted process was a viable mean of coating clinically relevant materials and developing innovative functional materials with retention of antibiotic activity, without employing a linker or plasma modified polymer, thus minimizing bio-compatibility issues for medical device materials. This offers potential to prevent or control instrumented or non-permanent device associated infection localized to the surgical or implant site.

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Microbiological diagnosis of device‐related biofilm infections

Cited by 38 publications

References 102 publications

Pathogenic Mechanisms and Host Interactions in Staphylococcus epidermidis Device-Related Infection

Pathogenic Mechanisms and Host Interactions in Staphylococcus epidermidis Device-Related Infection

Recommendations for design and conduct of preclinical in vivo studies of orthopedic device‐related infection

Efficacy of Cold Plasma for Direct Deposition of Antibiotics as a Novel Approach for Localized Delivery and Retention of Effect

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