Search Results (66)

Biofilms are structured communities of microorganisms encased in a self-produced extracellular matrix, and they represent one of the most widespread forms of microbial life on Earth. Their presence poses serious challenges in both environmental and clinical settings. In natural and industrial systems, biofilms contribute to water contamination, pipeline corrosion, and biofouling. Clinically, biofilm-associated infections are responsible for approximately 80% of all microbial infections, including endocarditis, osteomyelitis, cystic fibrosis, and chronic sinusitis. A particularly critical concern is their colonization of medical devices, where biofilms can lead to chronic infections, implant failure, and increased mortality. Implantable devices, such as orthopedic implants, cardiac pacemakers, cochlear implants, urinary catheters, and hernia meshes, are highly susceptible to microbial attachment and biofilm development. These infections are often recalcitrant to conventional antibiotics and frequently necessitate surgical revision. In the United States, over 500,000 biofilm-related implant infections occur annually, with prosthetic joint infections alone projected to incur revision surgery costs exceeding USD 500 million per year—a figure expected to rise to USD 1.62 billion by 2030. To address these challenges, surface modification of medical devices has emerged as a promising strategy to prevent bacterial adhesion and biofilm formation. This review focuses on recent advances in chemical surface functionalization using non-antibiotic agents, such as enzymes, chelating agents, quorum sensing quenching factors, biosurfactants, oxidizing compounds and nanoparticles, designed to enhance antifouling and mature biofilm eradication properties. These approaches aim not only to prevent device-associated infections but also to reduce dependence on antibiotics and mitigate the development of antimicrobial resistance. Full article

Background/Objectives: Antimicrobial resistance is a major global health threat. Among the most problematic pathogens are carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae, which are significant causes of mortality in humans, particularly in the context of nosocomial infections. In companion animals, these bacteria have been reported mainly as colonizers of healthy animals or, less frequently, in community-acquired infections. However, no confirmed cases of healthcare-associated infections caused by these species have been documented in this population. This study reports the first confirmed fatal cases of infection with carbapenem-resistant A. baumannii and KPC-producing K. pneumoniae in dogs. Methods: Three hospitalized dogs developed infections associated with distinct anatomical devices, including a venous catheter, an endotracheal tube, and a Penrose drain. Bacterial isolation followed by antimicrobial susceptibility testing identified carbapenem-resistant A. baumannii and K. pneumoniae. The isolates were subsequently subjected to additional antimicrobial resistance tests and whole-genome sequencing (WGS). Results: WGS confirmed the presence of the OXA-23 carbapenemase gene in both A. baumannii isolates and the KPC-2 carbapenemase gene was detected in the K. pneumoniae strain. All three strains exhibited resistance to multiple antimicrobial classes, including β-lactams (amoxicillin-clavulanic acid, ampicillin, cephalotin, piperacillin-tazobactam, cefoxitin, ceftiofur, cefotaxime, ertapenem, imipenem and meropenem), aminoglycosides (gentamicin, neomycin), tetracyclines (doxycycline, tetracycline and oxytetracycline), fluoroquinolones (ciprofloxacin, enrofloxacin), and folate pathway antagonists (trimethoprim-sulfamethoxazole). Multilocus sequence typing identified two high-risk clones: K. pneumoniae ST340 (CC258) and A. baumannii ST15 (CC15). Single nucleotide polymorphism analysis confirmed a high degree of genetic similarity between these isolates and strains previously associated with human infections in Brazil. Conclusions: These findings provide the first evidence of fatal, healthcare-associated infections caused by these multidrug-resistant pathogens in dogs and underscore the need to strengthen surveillance and infection control practices in veterinary hospitals. Furthermore, the results raise concerns about the potential of companion animals to act as reservoirs for multidrug-resistant organisms of public health relevance. Full article

Infective endocarditis (IE) of the tricuspid and pulmonary valve accounts for 5 to 10% of all IE cases and, compared with left-sided IE, is often associated with intravenous (i.v.) drug use, presence of intracardiac devices, and central venous catheters (CVCs), including permanent—Hickman catheter (HC). We report a case of a 71-year-old female patient on a chronic hemodialysis (HD) program who had developed IE. Her first symptoms were fever and malaise. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) examinations were performed, revealing vegetations on the tip of HC and the anterior and posterior leaflets of the tricuspid valve (TV). Three blood culture bottles were positive for Enterococcus spp. The HC was replaced with a new CVC to continue HD. After a six-week antibiotic treatment, most clinical symptoms were resolved, and there was a decrease in vegetation size with normalization of inflammatory markers and negative follow-up blood cultures. After this initial improvement in the patient’s condition, the clinical course was complicated by the development of Citrobacter koseri bacteremia and sepsis. Despite adequate antibiotic therapy, the condition progressed to septic shock, which was soon followed by a fatal outcome. IE treatment in HD patients requires long-term broad-spectrum antibiotic therapy, and also, in patients without arteriovenous fistula (AVF), the CVC should be replaced after each HD during IE and sepsis treatment to minimize the patient’s exposure to a foreign body that is susceptible to bacterial colonization. A colonized foreign body is a focus for sustained and spreading infection, and its presence prevents adequate antibiotic treatment until the focus of infection is removed. Full article

Introduction: Candida auris (now Candidozyma auris) and multidrug-resistant (MDR) bacterial infections pose significant therapeutic challenges due to high antimicrobial resistance, increased mortality, and persistence in healthcare settings. In Greece, their rising prevalence is raising concerns regarding co-infection, yet comprehensive data remain limited. This study aims to investigate the epidemiology, risk factors, and clinical outcomes of MDR bacterial co-infection in patients with C. auris candidemia. Methods: This single-center, retrospective observational cohort study was conducted at a Greek tertiary university hospital and included adult patients with C. auris bloodstream infections from January 2019 to June 2024. The data were analyzed using appropriate statistical methodologies. Results: Among 96 patients, those with C. auris candidemia and MDR bacterial co-infection exhibited a significantly higher mortality rate (87.23% vs. 61.22%, p = 0.007). The presence of a central venous catheter was the only factor significantly associated with MDR co-infection (p = 0.030). In univariate analysis, MDR co-infection, a higher Charlson Comorbidity Index, and mechanical ventilation correlated with increased mortality. Multivariate analysis identified MDR co-infection (OR = 3.19, p = 0.045) and mechanical ventilation (OR = 7.07, p = 0.002) as independent mortality predictors. Conclusions: These findings underscore the need for enhanced surveillance, precise identification, and stringent infection control measures to prevent C. auris and MDR bacterial outbreaks in healthcare settings. Full article

Proteus mirabilis has been identified as the third most frequent reason for catheter-associated urinary tract infections. The production of urease significantly enhances the force of catheter blockage caused by biofilm formation. Because biofilms are important virulence factors that make antibiotics less potent, it is becoming increasingly important to develop novel alternative antibiotics. In addition to the unique properties they possess, nanoparticles made from metal oxide are currently attracting considerable attention as possible antibacterials. This research aims to explore the potential anti-biofilm properties of green manufactured ZnO-CuO nanoparticles generated by P. mirabilis. By synthesizing reductive enzymes, bacterial cells can participate in the biosynthesis process. This study explores whether green synthesized ZnO-CuO nanoparticles can work as an anti-biofilm agent formed by P. mirabilis. These nanoparticles were generated using Bacteriocins to determine their effectiveness against bacteria, which were partially purified and showed antimicrobial activity against Gram-negative bacteria of P. mirabilis. AFM, TEM, FESEM, XRD, and ultraviolet (UV)–visible spectroscopy were used to analyze the biosynthesized nanoparticles to ascertain their chemical and physical characteristics. XRD verified the hexagonal structure, TEM demonstrated a size range of 96.00 nm, and FESEM verified the surface morphology. The dispersion and roughness of the nanoparticles are shown through AFM examination. The produced nanoparticles’ UV-visible spectra displayed a maximum peak at 287 and 232 nm. When applied to strains (wild-type) of Proteus mirabilis (multidrug-resistant), copper and zinc nanoparticles had notable biofilm inhibitory effects. Weak biofilm production has been demonstrated by bacteria that effectively generate biofilms, following incubation with 128 μg/mL subminimum inhibitory concentrations (MICs) of CuO nanoparticles for 24 and 48 h at 37 °C. Following treatment with the ZnO-CuO nanocomposite of these strains, downregulation alterations in LuxS expression were detected by utilizing a real-time PCR process. After this, isolates were treated with the nanocomposite, and downregulated shifts in LuxS expression were found by utilizing the real-time PCR technique in contrast with the isolates that were not treated. Zinc oxide (ZnO) nanoparticles can be utilized as antibacterial agents in a concentration-dependent manner, aligning with all observed findings. The present research demonstrates that green synthesized copper oxide–zinc oxide nanocomposites are effective anti-biofilm agents against P. mirabilis. Their noteworthy downregulation of LuxS gene expression successfully prevents biofilm formation and swarming motility. Full article

Silicone urinary catheters are broadly employed in medical practice. However, they are susceptible to inducing catheter-associated urinary tract infections (CAUTIs) due to bacterial adherence to the catheter’s surface, and they exhibit a high friction coefficient, which can greatly affect their effectiveness and functionality. Thus, the development of a silicone urinary catheter with antibacterial properties and lubricity is in strong demand. We hereby developed a poly(vinyl acetate) carrier coating to load chlorhexidine acetate and applied a hydrogel coating primarily composed of polyvinylpyrrolidone (PVP) and poly(ethylene glycol) diacrylate (PEGDA), which was then coated onto the silicone urinary catheters and cured through a thermal curing process and could provide lubricity. Subsequently, we analyzed its surface characteristics and assessed the antibacterial property, lubricity, cytotoxicity, and potential for vaginal irritation. The findings from the Fourier transform infrared spectrometer (FTIR), scanning electron microscope (SEM), water contact angle (WCA), inhibition zone measurements, and friction coefficient analysis confirmed the successful modification of the silicone urinary catheter. Additionally, the outcomes from the cytotoxicity and vaginal irritation assessments demonstrated that the dual-function hydrogel coating-coated silicone urinary catheters exhibit outstanding biocompatibility. This study illustrates that the prepared silicone urinary catheters possess durable antibacterial properties and lubricity, which thus gives them broad clinical application prospects. Full article

Introduction: Healthcare-associated infections (HAIs) pose a significant global challenge, resulting in prolonged hospital stays, higher healthcare costs, and increased morbidity and mortality rates. Reusable medical equipment, such as tourniquets, represents a potential vector for infection transmission. Despite frequent use and close contact with patients’ skin, infection control protocols often overlook these devices. This study examines microbial contamination on the surface of reusable tourniquets in both emergency department and operating theatre settings. Methods: A cross-sectional study was conducted between March and September 2024 in Gdansk, Poland. Samples from tourniquets used in the emergency department and the operating theatre were collected after an indefinite period, 14 days, and 28 days. Bacterial contamination on the surfaces of the tourniquets was measured using Columbia agar blood medium and expressed as colony-forming units (CFUs) per cm². Results: Significant bacterial loads were detected on reusable tourniquets, with contamination levels varying by location and duration of use. The average number of CFU/cm² across all stages of this study was 545 CFU/cm² for the emergency department and 101 CFU/cm² for the operating theatre. Tourniquets used in the emergency department exhibited higher bacterial counts compared to those from the operating theatre, which showed a greater diversity of bacterial species. These findings underscore the need to revise infection control protocols for reusable tourniquets. Conclusion: This study provides critical data that may influence future policy changes aimed at reducing the risk of HAIs through the improved management of reusable medical devices. Full article

Catheter-associated urinary tract infection (CAUTI) induced by rapid bacterial colonization and biofilm formation on urinary catheters is a key issue that urgently needs to be addressed. To prevent CAUTI, many contact-killing, non-leaching coatings have been developed for the surfaces of silicone catheters. However, due to the chemical inertness of the silicone substrate, most current coatings lack adhesion and are unstable under external forces. Thus, the aim of this study was to develop a surface coating that has both good antibacterial ability and a high affinity toward silicone substrates. To achieve high affinity, a pre-coating layer with abundant surface vinyl groups, named SI-vinyl, was prepared on the silicone substrate by moisture curing using a mixture of α,ω-dihydroxy polydimethylsiloxane and vinyltrimethoxysilane as the painting agent. To endow the surface with contact-killing ability, a series of polyurethanes with different contents of quaternary ammonium salt groups in their main chain and two vinyl end groups were synthesized and covalently grafted onto the surface of SI-vinyl, resulting in corresponding bactericidal coatings with different surface contents of quaternary ammonium salt groups (SI-QAS). Of these bactericidal coatings, SI-QAS-2, with a surface QAS content of 2.1 × 10¹⁶ N⁺ cm⁻², was selected as the best coating based on the consideration of stability, compatibility, and antibacterial ability. The SI-QAS-2 coating demonstrated high contact-killing performance, rapidly inactivating 72.8%, 99.9%, and 98.9% of Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa within 30 min. Furthermore, even after being exposed to a high concentration of bacteria (10⁶ CFU/mL) for 4 days, the SI-QAS-2 coating still maintained a high bactericidal ratio of over 80%. In summary, we developed a novel contact-killing coating that reduces the risk of bacterial infections caused by catheter implantation, demonstrating that it has high affinity toward silicone substrates, excellent contact-killing efficiency, a facile preparation method, and potential for further application. Full article

Catheter-associated urinary tract infections (CAUTIs) cause serious complications among hospitalized patients due to biofilm-forming microorganisms which make treatment ineffective by forming antibiotic-resistant strains. As most CAUTI-causing bacterial pathogens have already developed multidrug resistance, there is an urgent need for alternative antibacterial agents to prevent biofilms on catheter surfaces. As a trial to find out such a potential agent of natural origin, the bark of Tamarix ericoides Rottl., a little-known plant from the Tamaricaceae family, was examined for its antibacterial and antibiofilm activities against one of the major, virulent, CAUTI-causing bacterial pathogens: Enterococcus faecalis. The methanolic T. ericoides bark extract was analyzed for its antibacterial activity using the well diffusion method and microdilution method. Killing kinetics were calculated using time–kill assay, and the ability of biofilm formation and its eradication upon treatment with the T. ericoides bark extract was studied by crystal violet assay. GC-MS analysis was performed to understand the phytochemical presence in the extract. A in vitro bladder model study was performed using extract-coated catheters against E. faecalis, and the effect was visualized using CLSM. The changes in the cell morphology of the bacterium after treatment with the T. ericoides bark extract were observed using SEM. The biocompatibility of the extract towards L₉₂₉ cells was studied by MTT assay. The anti-E. faecalis activity of the extract-coated catheter tube was quantified by viable cell count method, which exposed 20% of growth after five days of contact with E. faecalis. The anti-adhesive property of the T. ericoides bark extract was studied using CLSM. The extract showed potential antibacterial activity, and the lowest inhibitory concentration needed to inhibit the growth of E. faecalis was found to be 2 mg/mL. The GC-MS analysis of the methanolic fractions of the T. ericoides bark extract revealed the presence of major phytochemicals, such as diethyl phthalate, pentadecanoic acid, methyl 6,11-octadecadienoate, cyclopropaneoctanoic acid, 2-[(2-pentylcyclopropyl) methyl]-, methyl ester, erythro-7,8-bromochlorodisparlure, etc., that could be responsible for the antibacterial activity against E. faecalis. The killing kinetics of the extract against E. faecalis was calculated and the extract showed promising antibiofilm activity on polystyrene surfaces. The T. ericoides bark extract effectively reduced the E. faecalis mature biofilms by 75%, 82%, and 83% after treatment with 1X MIC (2 mg/mL), 2X MIC (4 mg/mL), and 3X MIC (6 mg/mL) concentrations, respectively, which was further confirmed by SEM analysis. The anti-adhesive property of the T. ericoides bark extract studied using CLSM revealed a reduction in the biofilm thickness, and the FDA and PI combination revealed the death of 80% of the cells on the extract-coated catheter tube. In addition, SEM analysis showed extensive damage to the E. faecalis cells after the T. ericoides bark extract treatment, and it was not cytotoxic. Hence, after further studies, T. ericoides bark extract with potential antibacterial, antibiofilm, and anti-adhesive activities can be developed as an alternative agent for treating CAUTIs. Full article

Conventional antibiotics are limited by drug resistance, poor penetration, and inadequate targeting in the treatment of bacterial biofilm-associated infections. Microbubble-based ultrasound (US)-responsive drug delivery systems can disrupt biofilm structures and enhance antibiotic penetration through cavitation effects. However, currently developed US-responsive microbubbles still depend on antibiotics and lack targeting capability. In this work, magnetic field/ultrasound (MF/US)-responsive Fe₃O₄ microbubbles (FMB) were constructed based on Fe₃O₄ nanoparticles (NPs) with superparamagnetic and peroxidase-like catalytic properties. In vitro experiments demonstrated that FMB can be targeted to methicillin-resistant Staphylococcus aureus (MRSA) biofilms by the direction of MF. Upon US irradiation, FMB collapse due to inertial cavitation and generate mechanical forces to disrupt the structure of MRSA biofilms and releases Fe₃O₄ NPs, which catalyze the generation of reactive oxygen species (ROS) from H₂O₂ in the biofilm microenvironment and kill the bacteria within the biofilm. In a mouse biofilm infection model, FMB efficiently destroyed MRSA biofilms grown in subcutaneous catheters with the MF and US. Magnetic-targeted mechanical/catalytic therapy based on FMB provides a promising strategy for effectively combating bacterial biofilm infection. Full article

Catheter-associated urinary tract infections (CAUTIs) present significant health risks in medical settings, necessitating innovative solutions to prevent bacterial colonization on catheter surfaces. This study introduces a novel polymeric coating with dual antifouling and light-activated bactericidal properties to enhance the bactericidal efficacy of urinary catheters. The coatings were synthesized using a one-step process involving pyrogallol chemistry to deposit a copolymer composed of zwitterionic sulfobetaine for antifouling and sodium copper chlorophyllin, a photosensitizer that generates reactive oxygen species under light exposure to effectively kill bacteria. We evaluated the antifouling properties, cytocompatibility, and bactericidal performance of the coatings under various light conditions. The results showed significant reductions in bacterial adhesion, with light activation further endowing the catheter with bactericidal effects. Additionally, light could be delivered through an optical fiber within the catheter lumen to target and kill bacteria. The innovative coating using light-activated bactericidal action offers a promising approach to preventing CAUTIs, representing a potential breakthrough in developing safer and more effective urinary catheters. Full article

Microbial biofilm formation on medical devices paves the way for device-associated infections. Staphylococcus epidermidis is one of the most common strains involved in such infections as it is able to colonize numerous devices, such as intravenous catheters, prosthetic joints, and heart valves. We previously reported the antibiofilm activity against S. epidermidis of pentadecanoic acid (PDA) deposited by drop-casting on the silicon-based polymer poly(dimethyl)siloxane (PDMS). This material exerted an antibiofilm activity by releasing PDA; however, a toxic effect on bacterial cells was observed, which could potentially favor the emergence of resistant strains. To develop a PDA-functionalized material for medical use and overcome the problem of toxicity, we produced PDA-doped PDMS by either spray-coating or PDA incorporation during PDMS polymerization. Furthermore, we created a strategy to assess the kinetics of PDA release using ADIFAB, a very sensitive free fatty acids fluorescent probe. Spray-coating resulted in the most promising strategy as the concentration of released PDA was in the range 0.8–1.5 μM over 21 days, ensuring long-term effectiveness of the antibiofilm molecule. Moreover, the new coated material resulted biocompatible when tested on immortalized human keratinocytes. Our results indicate that PDA spray-coated PDMS is a promising material for the production of medical devices endowed with antibiofilm activity. Full article

Pediatric chronic intestinal failure (PIF) is a rare and heterogeneous condition characterized by the inability of the patient’s intestine to adequately absorb the required fluids and/or nutrients for growth and homeostasis. As a result, patients will become dependent on home parenteral nutrition (HPN). A MEDLINE search was performed in May 2024 with keywords “intestinal failure”, “parenteral nutrition” and “pediatric”. Different underlying conditions which may result in PIF include short bowel syndrome, intestinal neuromuscular motility disorders and congenital enteropathies. Most common complications associated with HPN are catheter-related bloodstream infections, catheter-related thrombosis, intestinal failure-associated liver disease, small intestinal bacterial overgrowth, metabolic bone disease and renal impairment. Treatment for children with PIF has markedly improved with a great reduction in morbidity and mortality. Centralization of care in specialist centers and international collaboration between centers is paramount to further improve care for this vulnerable patient group. A recently promising medical therapy has become available for children with short bowel syndrome which includes glucagon-like peptide 2, a naturally occurring hormone which is known to delay gastric emptying and induce epithelial proliferation. Despite advances in curative and supportive treatment, further research is necessary to improve nutritional, pharmacological and surgical care and prevention of complications associated with parenteral nutrition use. Full article

Staphylococcus pseudintermedius, a commensal opportunistic bacterium predominantly residing in the skin of companion animals, particularly dogs, has the potential to induce skin and soft tissue infections in pets, and zoonotic infections, including catheter-related complications. This study documents four cases of S. pseudintermedius infection or colonization in patients who had close contact with dogs or cats. Identification of the bacterial species was performed using MALDI-TOF mass spectrometry, and antibiotic susceptibility was determined using microdilution assay. DNA was sequenced using Nanopore technology followed by in silico analysis. Three isolates were multidrug resistant, including resistance to methicillin, with one belonging to the prevalent European lineage ST551, and the other two were attributed to a novel multilocus sequence type, ST2672. The remaining isolate was attributed to the novel multilocus sequence type ST2673 and was methicillin susceptible. All four isolates exhibited an array of virulence factors that contributed to colonization, damage to host immune cells, and biofilm formation. All the ST551 isolates included in the comparative analysis displayed clonality within the European continent. The importance of describing zoonotic infections associated with S. pseudintermedius resides in the scarcity of available scientific literature, further accentuated by its heightened resistance profile and potential complications, particularly in the context of catheter-related infections. Full article

The aim of this study was to develop a novel biomimetic in vitro extraluminal migration model to observe the migration of bacteria along indwelling urinary catheters within the urethra and assess the efficacy of a prototype chlorhexidine diacetate (CHX) coating to prevent this migration. The in vitro urethra model utilised chromogenic agar. A catheter was inserted into each in vitro urethra. One side of the urethra was then inoculated with bacteria to replicate a contaminated urethral meatus. The models were then incubated for 30 days (d), with the migration distance recorded each day. Four indwelling catheter types were used to validate the in vitro urethra model and methodology. Using the biomimetic in vitro urethra model, E. coli and S. aureus migrated the entire length of a control catheter within 24–48 h (h). In the presence of a prototype CHX coating, full migration of the channel was prevented for 30 d. The results of this study support the hypothesis that catheter-associated urinary tract infections (CAUTIs) could be prevented by targeting catheter-mediated extraluminal microbial migration from outside of the urinary tract into the bladder. Full article