Device-Related Infections and Bacterial Biofilms

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 6338

Special Issue Editor


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Guest Editor
Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
Interests: biofilm; catheter-related infections; device-related infections; prosthesis; joint infections; endotracheal tubes
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Special Issue Information

Dear Colleagues,

Device-related infections (DRIs) are a significant healthcare problem that can occur when medical devices, such as catheters, implants, and prostheses, become colonized by bacteria. Bacterial biofilms are mostly responsible for the development of DRIs.

Biofilms are complex communities of microorganisms that adhere to surfaces, in addition to tissues, and form a protective extracellular matrix. They are particularly problematic in DRIs because they can resist antibiotics and other antimicrobial agents, as well as the immune system, causing chronic infections that require device removal, which becomes an important problem for the patient and for the healthcare.

Several factors contribute to the formation of bacterial biofilms on medical devices, including surface properties of the device material, host factors such as immune function and nutritional status, and microbial factors such as virulence and antibiotic resistance.

Preventing DRIs requires strategies that target both the device and the patient. For example, using materials that resist bacterial adhesion or coating devices with antimicrobial agents can help prevent biofilm formation. Additionally, proper insertion techniques and appropriate care and maintenance of devices can reduce the risk of infection.

Treatment of DRIs often involves removing the infected device. However, this approach may not always be feasible or effective in eradicating biofilms. Alternative treatments include administering local antibiotics directly into the affected area or using antimicrobial agents that can penetrate biofilms.

Research is ongoing to develop new strategies for preventing and treating DRIs caused by bacterial biofilms. These efforts aim to improve patient outcomes while reducing healthcare costs associated with these infections. In this Special Issue, we encourage researchers and clinicians to submit research articles, review articles, and short communications that address the various aspects of biofilm formation and persistence in association with DRIs.

Dr. María Guembe
Guest Editor

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Keywords

  • biofilm
  • catheter-related infections
  • device-related infections
  • prosthesis
  • joint infections
  • implants

Published Papers (6 papers)

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Research

14 pages, 5347 KiB  
Article
Impact of Perioperative Dexamethasone Administration on Infection and Implant Osseointegration in a Preclinical Model of Orthopedic Device-Related Infection
by Marc-Antoine Burch, Aron Keshishian, Charlotte Wittmann, Dirk Nehrbass, Keith Thompson, Daniel Arens, R. Geoff Richards, Vuysa Mdingi, Marco Chitto, Mario Morgenstern, T. Fintan Moriarty and Henk Eijer
Microorganisms 2024, 12(6), 1134; https://doi.org/10.3390/microorganisms12061134 - 1 Jun 2024
Viewed by 492
Abstract
Glucocorticoids may be given prior to major orthopedic surgery to decrease postoperative nausea, vomiting, and pain. Additionally, many orthopedic patients may be on chronic glucocorticoid therapy. The aim of our study was to investigate whether glucocorticoid administration influences Orthopedic-Device-Related Infection (ODRI) in a [...] Read more.
Glucocorticoids may be given prior to major orthopedic surgery to decrease postoperative nausea, vomiting, and pain. Additionally, many orthopedic patients may be on chronic glucocorticoid therapy. The aim of our study was to investigate whether glucocorticoid administration influences Orthopedic-Device-Related Infection (ODRI) in a rat model. Screws colonized with Staphylococcus epidermidis were implanted in the tibia of skeletally mature female Wistar rats. The treated groups received either a single shot of dexamethasone in a short-term risk study, or a daily dose of dexamethasone in a longer-term interference study. In both phases, bone changes in the vicinity of the implant were monitored with microCT. There were no statistically significant differences in bacteriological outcome with or without dexamethasone. In the interference study, new bone formation was statistically higher in the dexamethasone-treated group (p = 0.0005) as revealed by CT and histopathological analysis, although with relatively low direct osseointegration of the implant. In conclusion, dexamethasone does not increase the risk of developing periprosthetic osteolysis or infection in a pre-clinical model of ODRI. Long-term administration of dexamethasone seemed to offer a benefit in terms of new bone formation around the implant, but with low osseointegration. Full article
(This article belongs to the Special Issue Device-Related Infections and Bacterial Biofilms)
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11 pages, 1006 KiB  
Article
Time to Positivity in Blood Culture Bottles Inoculated with Sonication Fluid from Fracture-Related Infections
by Leopold Henssler, Lena Schellenberger, Susanne Baertl, Lisa Klute, Robert Heyd, Maximilian Kerschbaum, Volker Alt and Daniel Popp
Microorganisms 2024, 12(5), 862; https://doi.org/10.3390/microorganisms12050862 - 26 Apr 2024
Viewed by 737
Abstract
The timely and accurate identification of causative agents is crucial for effectively managing fracture-related infections (FRIs). Among various diagnostic methods, the “time to positivity” (TTP) of cultures has emerged as a valuable predictive factor in infectious diseases. While sonication of implants and inoculation [...] Read more.
The timely and accurate identification of causative agents is crucial for effectively managing fracture-related infections (FRIs). Among various diagnostic methods, the “time to positivity” (TTP) of cultures has emerged as a valuable predictive factor in infectious diseases. While sonication of implants and inoculation of blood culture bottles with sonication fluid have enhanced sensitivity, data on the TTP of this microbiological technique remain limited. Therefore, patients with ICM criteria for confirmed FRI treated at our institution between March 2019 and March 2023 were retrospectively identified and their microbiological records were analyzed. The primary outcome parameter was TTP for different microorganism species cultured in a liquid culture collected from patients with confirmed FRI. A total of 155 sonication fluid samples from 126 patients (average age 57.0 ± 17.4 years, 68.3% males) was analyzed. Positive bacterial detection was observed in 78.7% (122/155) of the liquid culture pairs infused with sonication fluid. Staphylococcus aureus was the most prevalent organism (42.6%). Streptococcus species exhibited the fastest TTP (median 11.9 h), followed by Staphylococcus aureus (median 12.1 h) and Gram-negative bacteria (median 12.5 h), all of which had a 100% detection rate within 48 h after inoculation. Since all Gram-negative pathogens yielded positive culture results within 24 h, it could be discussed if empirical antibiotic therapy could be de-escalated early and limited towards the Gram-positive germ spectrum if no Gram-negative pathogens are detected up to this time point in the context of antibiotic stewardship. Full article
(This article belongs to the Special Issue Device-Related Infections and Bacterial Biofilms)
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11 pages, 246 KiB  
Article
Prosthetic Joint Infections Caused by Mycobacterium tuberculosis Complex—An ESGIAI–ESGMYC Multicenter, Retrospective Study and Literature Review
by Alvaro Auñon, Llanos Salar-Vidal, Ignacio Mahillo-Fernandez, Francisco Almeida, Pedro Pereira, Jaime Lora-Tamayo, Tristan Ferry, Sarah Souèges, Aurélien Dinh, Rosa Escudero, Candela Menéndez Fernández-Miranda, Alicia Rico, Nicolo Rossi and Jaime Esteban
Microorganisms 2024, 12(5), 849; https://doi.org/10.3390/microorganisms12050849 - 24 Apr 2024
Viewed by 836
Abstract
Purpose: While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available [...] Read more.
Purpose: While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available in the literature of tuberculous PJIs, aiming to detect factors that may influence patient outcomes. Methods: The ESGIAI and ESGMYC study groups were used to collect information on non-published cases of tuberculous prosthetic joint infections (PJIs). Additionally, a literature review of all published cases of tuberculous PJIs was conducted. All identified cases in the retrospective study and in the literature review were merged and included in the statistical analysis, involving both univariate and multivariate analyses. Results: Fifteen previously unreported cases of tuberculous prosthetic joint infections (PJIs) from four countries were detailed. Among them, ten patients were female, with a median age of 76 years. The hip was affected in 13 cases. Seven patients experienced co-infection with another microorganism. Treatment approaches varied, with 13 patients undergoing implant removal, one treated with DAIR (debridement, antibiotics, and implant retention), and one case was treated with an unknown treatment method. All patients received antibiotic therapy and achieved a cure. The literature review that was conducted detected 155 published cases. Univariate analysis revealed a statistical significance for previous tuberculosis, joint, and no importance of surgery for cure. Conclusions: Tuberculous prosthetic joint infection (PJI) is a rare condition, typically presenting as a localized chronic infection. Antibiotic treatment is essential for the management of these patients, but neither surgical treatment nor duration of treatment seems to have importance in the outcome. Full article
(This article belongs to the Special Issue Device-Related Infections and Bacterial Biofilms)
12 pages, 2362 KiB  
Article
Evaluation of Biofilm Production and Antifungal Susceptibility to Fluconazole in Clinical Isolates of Candida spp. in Both Planktonic and Biofilm Form
by Anna Marzucco, Giulia Gatti, Maria Sofia Montanari, Michela Fantini, Claudia Colosimo, Maria Vittoria Tamburini, Valentina Arfilli, Manuela Morotti, Pasqualina Schiavone, Francesco Congestrì, Martina Manera, Agnese Denicolò, Martina Brandolini, Francesca Taddei, Laura Grumiro, Silvia Zannoli, Giorgio Dirani, Alessandra Mistral De Pascali, Vittorio Sambri and Monica Cricca
Microorganisms 2024, 12(1), 153; https://doi.org/10.3390/microorganisms12010153 - 12 Jan 2024
Cited by 1 | Viewed by 1118
Abstract
Candida spp. are an important opportunistic pathogen that can represent a possible cause of severe infections, especially in immunocompromised individuals. The clinical impact of Candida spp. depends, in part, on the ability to form biofilms, communities of nestled cells into the extracellular matrix. [...] Read more.
Candida spp. are an important opportunistic pathogen that can represent a possible cause of severe infections, especially in immunocompromised individuals. The clinical impact of Candida spp. depends, in part, on the ability to form biofilms, communities of nestled cells into the extracellular matrix. In this study, we compared the biofilm formation ability of 83 strains of Candida spp. isolated from blood cultures and other materials, such as respiratory samples, urine, and exudate, and their sensitivity to fluconazole (FLZ). Strains were divided into tertiles to establish cut-offs to classify isolates as low, moderate, or high biofilm producers (<0.26, 0.266–0.839, >0.839) and biofilms with low, moderate, or high metabolic activity (<0.053, 0.053–0.183, >0.183). A non-linear relationship between biofilm production and metabolic activity was found in C. glabrata and C. tropicalis. In addition, the increase in minimum biofilm eradication concentrations (MBEC50) compared to the Minor Inhibitory Concentration (PMIC) of the planktonic form in Candida spp. confirms the role of biofilm in the induction of resistance to FLZ. Full article
(This article belongs to the Special Issue Device-Related Infections and Bacterial Biofilms)
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17 pages, 5457 KiB  
Article
Comparative Genomic Analysis of Cutibacterium spp. Isolates in Implant-Associated Infections
by Anja Erbežnik, Andraž Celar Šturm, Katja Strašek Smrdel, Tina Triglav and Polona Maver Vodičar
Microorganisms 2023, 11(12), 2971; https://doi.org/10.3390/microorganisms11122971 - 12 Dec 2023
Viewed by 1320
Abstract
Bacteria of the genus Cutibacterium are Gram-positive commensals and opportunistic pathogens that represent a major challenge in the diagnosis and treatment of implant-associated infections (IAIs). This study provides insight into the distribution of different sequence types (STs) of C. acnes, and the [...] Read more.
Bacteria of the genus Cutibacterium are Gram-positive commensals and opportunistic pathogens that represent a major challenge in the diagnosis and treatment of implant-associated infections (IAIs). This study provides insight into the distribution of different sequence types (STs) of C. acnes, and the presence of virulence factors (VFs) in 64 Cutibacterium spp. isolates from suspected or confirmed IAIs obtained during routine microbiological diagnostics. Fifty-three C. acnes, six C. avidum, four C. granulosum, and one C. namnetense isolate, collected from different anatomical sites, were included in our study. Using whole-genome sequencing and a single-locus sequencing typing scheme, we successfully characterized all C. acnes strains and revealed the substantial diversity of STs, with the discovery of six previously unidentified STs. Phylotype IA1, previously associated with both healthy skin microbiome and infections, was the most prevalent, with ST A1 being the most common. Some minor differences in STs’ distribution were observed in correlation with anatomical location and association with infection. A genomic analysis of 40 investigated VFs among 64 selected strains showed no significant differences between different STs, anatomical sites, or infection-related and infection undetermined/unlikely groups of strains. Most differences in VF distribution were found between strains of different Cutibacterium spp., subspecies, and phylotypes, with CAMP factors, biofilm-related VFs, lipases, and heat shock proteins identified in all analyzed Cutibacterium spp. Full article
(This article belongs to the Special Issue Device-Related Infections and Bacterial Biofilms)
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13 pages, 862 KiB  
Article
Infected Shoulder Arthroplasty in Patients Younger than 60 Years: Results of a Multicenter Study
by Adrien Jacquot, Ramy Samargandi, Lisa Peduzzi, Daniel Mole and Julien Berhouet
Microorganisms 2023, 11(11), 2770; https://doi.org/10.3390/microorganisms11112770 - 14 Nov 2023
Cited by 3 | Viewed by 839
Abstract
Background: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a significant complication. This study aimed to explore the epidemiology and risk factors of shoulder PJI in patients aged 60 and younger, analyze treatment options, and evaluate outcomes after 1-year follow-up. Methods: In this [...] Read more.
Background: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a significant complication. This study aimed to explore the epidemiology and risk factors of shoulder PJI in patients aged 60 and younger, analyze treatment options, and evaluate outcomes after 1-year follow-up. Methods: In this retrospective multicentric observational study, data from 1404 shoulders in patients under 60 who underwent primary shoulder arthroplasty were analyzed. Patients with PJI and at least 1-year follow-up after infection treatment were included. Results: The study identified 55 shoulders with PJI, resulting in a 2.35% infection rate after primary shoulder arthroplasty in the young population. Male gender and reverse shoulder arthroplasty were risk factors for infection, while previous surgeries did not significantly contribute. The most common causative agents were Cutibacterium acnes and Staphylococcus epidermidis. Open washout had a 52.9% success rate for acute infections, while one-stage and two-stage revisions achieved infection control rates of 91.3% and 85.7%, respectively. Resection arthroplasty had an 81.8% success rate but poorer functional outcomes. Conclusions: PJI following shoulder arthroplasty in young patients is a significant concern. Preoperative planning should be carefully considered to minimize infection risk. Treatment options such as open washout and one-stage and two-stage revisions offer effective infection control and improved functional outcomes. Resection arthroplasty should be reserved for complex cases where reimplantation is not a viable option. Full article
(This article belongs to the Special Issue Device-Related Infections and Bacterial Biofilms)
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