Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens
Abstract
:1. Introduction
2. Hospital-Acquired Infections
3. Biofilm Formation on Medical Devices
4. Most Common Pathogenic Bacteria Involved in Medical Device-Associated Biofilm Infections
4.1. Escherichia coli
4.2. Klebsiella pneumoniae
4.3. Proteus mirabilis
4.4. Pseudomonas aeruginosa
4.5. Acinetobacter baumannii
4.6. Staphylococcus aureus
4.7. Staphylococcus epidermidis
4.8. Enterococcus spp.
5. Pathogenesis of Venous Catheter Contamination and Catheter-Associated Bloodstream Infections (CA-BSIs)
6. Pathogenesis of Urinary Catheter Colonization and Catheter-Associated Urinary Tract Infections (CA-UTIs)
7. Prevention of CA-BSIs
7.1. Education, Training and Surveillance
7.2. Aseptic Techniques
7.3. Catheter Insertion Site
7.4. Catheter Lock Solutions
7.5. Dressing
7.6. Antimicrobial Agents Release
7.7. Contact Kill Systems
7.8. Antifouling Approaches
8. Prevention of CA-UTIs
8.1. Avoidance of Urinary Catheter Use
8.2. Alternatives to Indwelling UC
8.3. Education and Training
8.4. Aseptic Techniques for Insertion and Maintenance of UCs
8.5. Antimicrobial Coatings
8.6. Antifouling Approaches
9. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Pathogen | Virulence Factor | Characteristics and Function | Reference |
---|---|---|---|
E. coli | Type I fimbriae | Encoded by fim operon located on the chromosome of UPEC isolates; Binding specifically to D-mannose which is found on the glycoproteins of the epithelial cells; Represents 95% of the virulence factors of E. coli; A major adhesin in colonization of UCs and biofilm formation during CA-UTIs. | [94,97,98,103,104,105] |
P fimbriae | Pyelonephritis-associated pili (Pap); The second important adhesin expressed by UPEC and coded by the pap operon; Binding to di-galactoside moiety present in the urinary tract epithelium. | [100,106,107] | |
Curli Csg A | Key components of the extracellular biofilm matrix of E. coli in which CsgA is the major subunit of curli; Bacterial binding with fibronectin, laminin, plasminogen; Aggregation, adhesion to surfaces, and biofilm development. | [108,109] | |
PGA (Poly-β-1,6-N-acetyl-D-glucosamine) | Encoded by pgaABCDoperon; A primary component of the biofilm matrix; Attachment of E. coli to surfaces and autoagregation of cells. | [82,89] | |
Ag 43 (Antigen 43 adhesin) | One of the major auto-transporter in E. coli encoded by the gene flu; Translocation to the outer membrane; Adhesion and auto-aggregation (cell-to-cell) facilitating the formation of the biofilm. | [89] | |
Hemolysin F | Encoded by the gene hlyF; Over-expression of hlyF promotes the biosynthesis of the outer membrane vesicles (OMVs) which release toxins involved in virulence. | [110,111] | |
α-hemolysin | Encoded by the gene hlyA; A pore-forming cytotoxin, responsible for lysis of the cell membrane of hosts (leukocytes, erythrocytes, and endothelial cells). | [112] | |
Siderophores | Survival and colonization in iron-deficient sites. | [78] | |
CNF-1 (cytotoxic necrotizing factor 1) | Responsible for the apoptosis of urothelial cells then increase bacterial entry to the bladder. | [89] | |
LPS (Lipopolysacharide) | An endotoxin that induces septic shock caused by over-expression of pro-inflammatory cytokines. | [113] | |
Capsule | Adherence to host cells; Biofilm formation; Binding to C4 binding protein (C4BP) and inhibits complement cascade; Bacterial protection from phagocytosis; Binding to catioinc antimicrobial agents; Bacterial protection from macrophage recognition. | [114] | |
Quorum sensing | Main quorum sensing systems: LuxS and SdiA, producers of autoinducer-2 molecules; Cell-to-cell communication; Role in bacterial behaviour coordination and regulation of virulence genes. | [115] | |
K. pneumoniae | Types 1 fimbriae | Encoded by fimAICDFGHK operon; Adhesion mediation to mannose-containing structures present on host tissue and extracellular matrix; A major role in biofilm formation on UCs, invasion and colonization of host cells, and persistence in catheters-associated infections. | [116,117] |
Types 3 fimbriae | Encoded by mrkABCD operon; Adhesion to different structures in kidney, lung tissue, endothelial and bladder epithelial cells; A major role in biofilm formation on UCs, invasion and colonization of host cells, and persistence in catheter-associated infections. | ||
PGA (poly-β-1,6-N-acetyl-D-glucosamine) | Encoded by pgaABCD operon; Cell-cell communication; Intercellular adhesion; Adhesion to abiotic surfaces. | [118] | |
Capsule polysaccharides (magA, k2A and wcaG) | Resistance to phagocytosis; Complement-mediated lysis inhibition and opsonization; Host defense escape. | [119,120] | |
Lipopolysaccharides (wabG, uge, ycfM) | Inhibition of complement pathway; Inactivation of the seditious response; Block the effect of peptides via lipid A; Host defence escape. | ||
Siderophores (iutA, iroN, entB) | Acquisition of iron from host iron-chelating proteins for survival and growth during infections; Biofilm formation; Host defence escape. | ||
Quorum sensing | QS regulator systems: Type 2 quorum sensing luxS; Cell–cell communication; Intercellular adhesion and adhesion to abiotic surfaces; Bacterial behaviour coordination; Regulation of virulence genes. | [118,121] | |
P. mirabilis | MR/P (Mannose resistant Proteus-like fimbriae) | Binding to uroepithelial cells; Attachment to urinary catheters; Biofilm formation. | [33,122,123] |
PMP (P. mirabilis P-like pili) | |||
PMF (P. mirabilisfimbriae) | |||
ATF (Ambient-temperature fimbriae) | |||
UCA (Uroepithelial cell adhesin) | |||
Flagella | A major role in swarming; Migration of pathogenic strains to the upper urinary tract, causing pyelonephritis; Dispersion of biofilm from urinary catheters to the urinary tract. | [33,124,125] | |
Hemolysin HpmA | Ability to lyse erythrocytes, bladder epithelial cells, and monocytes; High cytotoxicity towards human renal proximal tubular epithelial cells (HRPTECs); Dessimination of P. mirabilis into the kidneys and development of pyelonephritis. | [122,126,127] | |
Proteus toxigenin Pta | An autotransporter which promotes autoaggregation of the bacteria. Mediates lysis of bladder epithelial cells. | ||
ZaPA(zinc metalloproteinases) | Degradation of immunoglobulins IgA and IgG, human β-defensin 1, and other celluar components (fibronectin, collagen); Escape immune responses during infection. | ||
LPS (Lipopolysccharides) | Mediation of the induction of proinflammatory cytokine responses; Induction of apoptosis; Septic shock. | ||
Iron acquisition system | Production of iron carriers to take iron from the host and use it for its survival during urinary infections. | ||
Urease (a nickel-dependent metalloenzyme) | Degradation of urea into carbon dioxide and ammonia, increasing the urine pH up to 8.2; Formation of crystals, struvite (ammonium and magnesium phosphate) and apatite (calcium phosphate); Causing the obstruction of urinary catheters; Causing pyelonephritis and increasing the risk of sepsis. | [128,129] | |
Quorum sensing | QS system regulator: luxS/luxR system; Autoinducer-1 molecules controlled by the luxR genes and autoinducer-2 molecules controlled by the luxS genes; Role in swarmingcoordination; Regulation of biofilm formation and virulence genes expression. | [125] | |
P. aeruginosa | Flagella Type IV pili | Important role swimming, twitching, and swarming motility; Adhesion to host epithelial cells; Attachment to surfaces and biofilm formation. | [130] |
LPS (Lipopolysccharides) | Antibiotic tolerance, tissue damage, and biofilm formation; The complement system induction; Activation of inflammatory cytokines TNF-α and IL-1β; Induction of immune responses via Toll-like receptor 4 (TLR4) and cystic fibrosis transmembrane conductance regulator (CFTR); Induction of phagocytosis; Neutrophil activation for neutrophil extracellular trap (NET) releasing which contain pathogens. | [131,132] | |
Exopolysaccharides (alginate, PEL and PSL) | Crucial role in initial attachment to surface; Biofilm formation, its stability and maintenance; Bacterial protection from phagocytosis and opsonization, Biofilm maturation, and prevention of antibiotic diffusion. | [133] | |
OMVs (Outer membrane vesicles) | Expression of 26 OMPs of which the porin OprF is the most abundant; Transport of molecules (e.g.,toluene, siderophores, nitrates, and nitrites); Bacterial adhesion and biofilm formation; Implication in drug resistance; Protection from macrophage clearance during chronic infections; Remove of competing bacteria from the environment during infections. | [134,135] | |
Siderophores (Pyoverdine and Pyochelin) | Iron chelation from transferrin and lactoferrin needed during growth and virulence. | [131,136] | |
Elastase A [LasA] and B [LasB] | Degradation of elastin; Host tissues damage. | ||
Protease IV | Degradation ofcomplement components, immunoglobulins, and surfactant protein; Raising of bacterial infection via fibrinogen, lactoferrin, transferrin degradation; Host tissues damage. | ||
toxins (Pyocyanin; T3SS effectors [ExoS, ExoT, ExoU and ExoY]; Exolysin [ExlA]; Exotoxin A [PEA]; Lipase A [LipA] and Leukocidin) | Pyocyanin: induction of oxidative stress for the host to avoid bacterial elimination; T3SS effectors: inhibition of phagocytosis and bacterial elimination, disruption of the host actin cytoskeleton, and apoptosis induction; ExlA: induction of membrane permeabilization and cell death through its cytolysin activity; PEA: inhibition of host protein synthesis by ADP ribosylation activity and stimulatation of programmed cell death; Lipase A: degradation of lipid dipalmitoylphosphatidylcholine (lung surfactant) and drug resistance mediation by interacting with alginate; Leukocidin: leukocytes swelling by increased permeability of their membrane. | ||
Quorum sensing | MainQSsystems: Las, Rhl, Pqs and Iqs; Regulationof biofilm formation and other virulence factors; Coordination of bacterial behaviour and persistance during infection. | [137,138] | |
A. baumannii | Csu (Chaperone-usher pili) | Encoded by csuA/BABCDE operon; Involved in the initial ahesion onto abiotic surfaces but not biotic surfaces. | [139,140] |
OmpA (Outer membrane protein A) | A β-barrel porin, one of the most abundant porins in the outer membrane of A. baumannii. Role in the virulence of A. baumannii, including interaction with the host, cytotoxicity, apoptosis, and biofilm formation. | [139,141,142,143] | |
Bap (Biofilm-associated protein) | Formation of water channels; Maitainingthe structure and integrety of biofilm; Biofilm formation on abiotic and biotic surfaces. | [139,144] | |
PNAG (Poly-N-acetyl β-1-6 glucosamine) | Major component of the A. baumannii biofilm matrix and encoded by the pgaABCD operon; Role in the integrity of the biofilm; Tolerance to desiccation stress; Incredible persistence in natural environments and care facilities. | [144,145] | |
Type V secretion systems | Transport exoproteins; Transport mobile genetic elements; Role in bacterial competition; Biofilm formation on abiotic and biotic surfaces. | ||
Phospholipases C and D | Hydrolytic activity towards phosphatidylcholine; Hemolytic activity against erythrocytes. | ||
Capsule | A protection barrier. Resistance to some antibiotics. Regulation of the K locus genes for exopolysaccharides production, important for biofilm formation. | ||
Iron-chelator proteins | Uptake of iron from host environnement in iron deficiency conditions. | [140] | |
Quorum sensing | Two-component regulatory system: AbaI/AbaR system Regulation of several virulence factors such as biofilm formation and motility. | [139] | |
S. aureus | PIA (Intracellular adhesion polysaccharide) or PNAG (o poly-N-acetyl β-1-6 glucosamine). | Encoded by the icaADBC operon; Important in cell-to-cell adhesion, adhesion to surfaces, biofilm formation; Antimicrobial resistance; Immune evasion; Bacterial protection from phagocytosis. | [146,147,148] |
FnBPA and FnBPB (Fibronectin-binding proteins) | Categorised as “microbial surface component recognising adhesive matrix molecules (MSCRAMM)”; Implication in binding host matrix components (fibronectin, fibrinogen, collagen, elastin, laminin); Initial cell attachment and/or biofilm formation; Implication in colonization; Immune evasion. | [146,149,150] | |
ClfA and ClfB (Clumping factors) | |||
Can (Collagen adhesin) | |||
EbpS (Elastin binding protein) | |||
Fib (Fibrinogen binding protein) | |||
Eno (Laminin-binding protein) | |||
SdrC, SdrD, SdrE (Serine aspartate repeat proteins C, D, and E) | |||
Atl (Autolysin) | Primary attachment through non-specific hydrophobic interactions with uncoated surfaces; Bindin to host extracellular matrix proteins and involvment in cell separation during cell division. | [151,152] | |
Bap (Biofilm-associated protein) | Contributionin initial adhesion to abiotic surfaces; Induction of strong intercellular adhesion. | [153,154] | |
Quorum sensing | Global regulatory systems [accessory gene regulator (agr), staphylococcal accessory element (sae), the staphylococcal accessory regulator A (sarA)]; Regulation of the expression of virulence factor secretion and biofilm formation. | [155] | |
S. epidermidis | PIA (Intracellular adhesion polysaccharide) | Adhesion and biofilm accumulation. | [156] |
AtlE (Autolysin E) | Attachment to plastic surfaces. | [157] | |
Bap homolog protein Bhp | Adherence to a polystyrene surface, intercellular adhesion, and biofilm formation. | ||
Ssp-1,Ssp-2 (Staphylococcal surface proteins 1 and 2) | Cell-to-cell adhesion; Biofilm formation. | ||
Serine-aspartate repeat protein G (SdrG/Fbe) binding to fibrinogen | Adhesion to the host proteins (fibrinogen, collagen, fibronectin); Adhesion to abiotic surfaces. | [158] | |
SdrF (Serine-aspartate repeat protein F) binding to collagen | |||
Extracellular matrix-binding protein (Embp) | |||
Phenol-soluble modulins (PSMα, PSMδ, PSMε, δ-toxin [PSMγ], and PSMβ [PSMβ1, PSMβ2]) | Acquisition of the characteristic three-dimensional structure-like mushrooms; Role in biofilmdispersion. | [157,159] | |
Homolog of the SspB | Role in the degradation/dispersion of the biofilm. | [157] | |
Homolog of SspA V8 | |||
Metalloprotease SepA | |||
Nucleases | |||
Quorum sensing | Two key systems: the agr and the sar regulators; Expression/repression of virulence genes in a coordinated manner during infection. | [160] | |
En. faecalis | Esp (Enterococcal surface protein) | Primary adhesion in UTIs; Colonization of the urinary tract. | [161,162] |
Asa1 (Aggregation substance) | Adhesion to host cells and bacterial aggregation. | ||
Collagen binding protein (Ace) | Adhesion to extracellular matrix and type 1 collagen. | ||
EfaA(En. faecalis endocarditis antigen A) | Adhesion to biotic and abiotic surfaces. | ||
Epa (Enterococcal polysaccharide antigen) | Colonization, translocation through epithelial cells, bacterial adhesion, biofilm formation, and antibiotic resistance. | [163] | |
Ebp A,B,C (Endocarditis and Biofilm-Associated Pili) | Important in initial attachment, biofilm formation, and endocarditis. | [164,165] | |
CylA (Cytolysin A) | Killing other bacteria (especially Gram-negative bacteria) and eukaryotic cells (red blood cells); Biofilm formation. | [162,165,166] | |
Hyl (Hyaluronidase) | Degradation of hyaluronic acid to permeabilize host tissues; Induction of autoimmune diseases. | ||
GelE (Gelatinase) | Degradation of the collagen adhesion protein (Ace) which contributes in colonization and biofilm formation; Degradation of gelatin, collagen, fibrin, fibrinogen, hemoglobin, and complement components (C3, C3a, C5a); Cell lysis. | ||
SprE (Serine protease) | Degradation of casein; Release of eDNA. | ||
Quorum sensing | Regulator system: the Fsr (fecal streptococci regulator) quorum-sensing system, encoded by fsrA, fsrB and fsrC genes; Regulation of communication through peptide pheromones cpd, cob, and ccf; Control of biofilm formation via regulation of gelatinase production. | [167] |
Strategy | Agent Used | Approach Used for Coating VC | Microorganism | Reference |
---|---|---|---|---|
Release killing | Antirhumatic | |||
Auranofin | Auranofin-coated polyurethane catheter. | MRSA | [386] | |
Release killing | Auranofin | Auranofin-coated polyurethane catheter. | S. aureus | [387] |
Release killing | Guanidine derivated | |||
poly(hexamethylene biguanide) hydrochloride–sodium stearate (PHMB–SS) | Coating developed using electrostatic interaction based on polyelectrolyte. | E. coli S. aureus | [388] | |
Antimicrobial peptides | ||||
Contact killing | ε-Poly-ʟ-lysine | Electrostatic interaction between cation PL and anion surfactant, 1,4-bis(2-ethylhexyl) sodium sulfosuccinate (AOT). | E. coli S. aureus | [389] |
Contact killing | Poly(methacrylic acid) (PMAA) | Polyurethane surface-initiated atom-transfer radical polymerization (SI-ATRP) | E. coli S. aureus | [390] |
Nitrix oxide | ||||
Release killing | Boron carbon nitride (BCN) | Boron carbon nitride nano-coating using RF magnetron sputtering technique. | E. coli | [391] |
Release killing | S-nitroso-N-acetyl-penicillamine (SNAP) | Incorporation of a nitric oxide (NO) donor molecule, S-nitroso-N-acetyl-penicillamine (SNAP) in a hydrophobic medical grade polymer, Elasteon-E2As and coated with fibronogen. | E. coli S. aureus | [392] |
Metal | ||||
Release killing | Silver nanoparticles (AgNP) Zinc oxide (ZnO) | Incorporation of silver nanoparticles (AgNP) and ZnO nanowires with polyvinylchloride(PVC). | S. aureus | [393] |
Release killing | Silver | Synthesized novel silver(I) cyanoximates Ag(ACO), Ag(BCO), Ag(CCO), Ag(ECO), Ag(PiCO), Ag(PICO) (yellow and red polymorphs), Ag(BIHCO), Ag(BIMCO), Ag(BOCO), Ag(BTCO), Ag(MCO) and Ag(PiPCO). | P. aeruginosa S. aureus | [394] |
Quaternary ammonium compounds | ||||
Contact killing | Quaternary ammonium thiol compound (Q8-SH) | Grafting a quaternary ammonium thiol compound (Q8-SH) to a thermoplastic polyurethane containing allyl ether (allyl-TPU) side-chain functionality. | E. coli P. aeruginosa S. aureus | [395] |
Graphene derivated | ||||
Contact killing | Graphene oxide | Immobilization of oxidized graphene nanoplatelets (GNP-M5ox) on the surface of silicone rubber by dip and spray coating. | S. epidermidis | [396] |
Other compounds | ||||
Contact killing | poly(dimethylsiloxane) (PDMS) | Hydrophobic hyperbranched coating resin was covalently attached to PDMS. | E. coli P. mirabilis S. aureus S. epidermidis | [397] |
Hydrophilic polymer | ||||
Surface modification | Poly(ethylene glycol) PEG | Microcrystalline sulfamethoxazole (SMZ) and trimethoprim (TMP) were immobilized with PEG. | E. coli S. aureus | [398] |
Surface modification | Fluoropolymer | A commercially polyurethane PICC catheter was modified by a three-step lamination process, with thin fluoropolymer layers to yield fluoropolymer–polyurethane–fluoropolymer composite structure before applying the liquid perfluorocarbon (LP) | S. aureus S. epidermidis | [337] |
Hydrophobic polymer | ||||
Surface modification | Polytetrafluroethylene (PTFE) | SiO2 nanosphere was coated on PTFE catheter. | E. coli S. aureus | [399] |
Strategy | Composite Used | Approach Used for Coating VC | Tested Microorganism | Reference |
---|---|---|---|---|
Release killing | Metal | |||
Silver (Ag) | Silver–polytetrafluoroethylene (Ag-PTFE) nanocomposite coated UCs. | E. coli P. mirabilis | [409] | |
Release killing | copper ions (Cu) | Copper ions (Cu) and a polyphenol tannic acid (TA) were coated on urinary catheters (TA-Cu coated urinary catheters) using using one-step coordination method. | E. coli P. mirabilis S. aureus | [412] |
Release killing | Nanoparticles | |||
Silver (Ag-NPs) | Silver nanoparticles–polydopamine (AgNPs-PDA) coated catheters were designed. | E. coli | [413] | |
Release killing | Copper oxide (CuO-NPs) | Zn-doped CuO-NPs were coated on urinary catheters by sonochemical method. | E. coli P. mirabilis S. aureus | [414] |
Release killing | Zinc oxide (ZnO NPs) | Zinc oxide nanoparticles (ZnO NPs) were decorated with amylase (biofilm matrix-degrading enzyme) by sonochemical method. | E. coli S. aureus | [415] |
Release killing | Antibiotics | |||
Chlorhexidine | Chlorhexidine-loaded poly(ε-caprolactone) nanospheres (CHX-NS) spray-adhered on urinary catheters. | E. coli S. aureus | [416] | |
Release killing | Chlorhexidine Triclosan | Chlorhexidine/Triclosan impregnated on silicone catheters. | E. coli K. pneumoniae P. mirabilis E. feacalis | [417] |
Release killing | Sparfloxacin | Sparfloxacin-coated latex catheters using two immobilization methods. | E. coli S. aureus | [418] |
Antimicrobial peptides | ||||
Contact killing | E6 (RRWRIVVIRVRRC) | A cysteine labeled peptide E6-coated polyurethane catheter was designed by covalent immobilization. | P. aeruginosa S. aureus | [419] |
Contact killing | Chain201D (KWIVWRWRFKR) (from crowberry endophytes) | Chain201D coated on silicone surface model was designed by covalent immobilization. | E. coli S. aureus | [420] |
Contact killing | Cys Lasio-III | Cys Lasio-III was immobilized on a commercial silicone catheter via a combination of AGE brush and PEG based chemical coupling. | E. coli P. aeruginosa S. aureus En. faecalis | [421] |
Nitric oxide | ||||
Release killing | Nitrix oxide (NO) | NO-impregnated catheters were designed. | E. coli | [422] |
Bacteriophages | ||||
Contact killing | The anti-Pseudomonas phage cocktail: ΦPaer4, ΦPaer14, M4, 109, ΦE2005-A, and ΦE2005-C The anti-Proteus phage cocktail: ΦPmir1, ΦPmir32, ΦPmir34, and ΦPmir37 | Hydrogel-coated catheters were pretreated with phages. | P. mirabilis P. aeruginosa | [423] |
Contact killing | The phage cocktail (podovirus vB_PmiP_5460 and myovirus vB_PmiM_5461) | Urinary catheters treated with phage cocktail were performed. | P. mirabilis | [33] |
Hydrophilic polymer | ||||
Surface modification | Poly(N,N-dimethylacrylamide) (PDMAA) | The poly(N,N-dimethylacrylamide) (PDMAA) hydrogel coated on polyurethane ureteral stents. | E. coli | [424] |
Surface modification | Poly(N,N-dimethylacrylamide) (PDMAA) | The hydrogel coating layer was formed using UV-crosslinking and swell-peeling methods. | S. aureus | [425] |
Surface modification | Polydopamine/poly(N,N-dimethylacrylamide) | Polydopamine/poly(N,N-dimethylacrylamide)-coated silicone catheters (PDA/uhPDMA) using dip coating approach. | P. aeruginosa | [426] |
Surface modification | Polyethylene glycol PEG | Silver-polyethylene glycol (mPEG-DOPA3) coated urinary catheters by cross-linking approach. | E.coli | [427] |
Surface modification | Sulfobetaine methacrylate (SBMA) | Sulfobetaine methacrylate (SBMA) was grafted on silicone catheters using enzymatic approach. | P. aeruginosa S. aureus | [428] |
Surface modification | Polytetrafluoroethylene PTFE | Silver- polytetrafluoroethylene (Ag-PTFE) nanocomposite grafted catheters were developed via a facile wet chemistry method. | E. coli S. aureus | [429] |
Enzymes | ||||
Surface modification | Acylase | The immobilization of the enzyme on urinary catheters was done by layer-by-layer deposition technique. | P. aeruginosa | [430] |
Surface modification | α-chymotrypsin (α-CT) | α-chymotrypsin (α-CT) covalently immobilized on low-density polyethylene surfaces (LDPE-α-CT). | E. coli | [431] |
Surface modification | Glycoside hydrolases (Ghs) | PslGh modified surfaces using amine functionalization (APTMS) and glutaraldehyde (GDA)7 Linking. | P. aeruginosa | [432] |
Surface modification | Cellobiose deshydrogenase (CDH) | CDH was covalently grafted onto plasma-activated urinary polydimethylsiloxane (PDMS) catheter surfaces. | S. aureus | [433] |
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Bouhrour, N.; Nibbering, P.H.; Bendali, F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens 2024, 13, 393. https://doi.org/10.3390/pathogens13050393
Bouhrour N, Nibbering PH, Bendali F. Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens. Pathogens. 2024; 13(5):393. https://doi.org/10.3390/pathogens13050393
Chicago/Turabian StyleBouhrour, Nesrine, Peter H. Nibbering, and Farida Bendali. 2024. "Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens" Pathogens 13, no. 5: 393. https://doi.org/10.3390/pathogens13050393