Search Results (386)

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

The aim of this work is to evaluate the effectiveness of antimicrobial photodynamic therapy (aPDT) against oral MDR (multi-drug-resistant) Candida spp. infections related to orthodontic treatment with palatal expanders through in vitro study. Methods: PDT protocol: Curcumin + H₂O₂ was used as a photosensitizer activated by a 460 nm diode LED lamp, with an 8 mm blunt tip for 2 min in each spot of interest. In vitro simulation: A palatal expander sterile device was inserted into a custom-designed orthodontic bioreactor, realized with 10 mL of Sabouraud dextrose broth plus 10% human saliva and infected with an MDR C. albicans clinical isolate CA95 strain to reproduce an oral palatal expander infection. After 48 h of incubation at 37 °C, the device was treated with the PDT protocol. Two samples before and 5 min after the PDT process were taken and used to contaminate a Petri dish with a Sabouraud field to evaluate Candida spp. CFUs (colony-forming units). Results: A nearly 99% reduction in C. albicans colonies in the palatal expander biofilm was found after PDT. Conclusion: The data showed the effectiveness of using aPDT to treat palatal infection; however, specific patient oral micro-environment reproduction (Ph values, salivary flow, mucosal adhesion of photosensitizer) must be further analyzed. Full article

Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods: This prospective, multi-center, post-market study (NCT05101993) evaluated the long-term safety and performance of the epicardial V-shape AtriClip device. Patients ≥18 years who had received V-shape AtriClip devices during non-emergent cardiac surgery consented to a prospective 12-month follow-up visit and LAA imaging. The primary performance was LAAE without residual left atrium-LAA communication, assessed by imaging at the last follow-up visit. The primary safety was device- or implant procedure-related serious adverse events (SAEs) (death, major bleeding, surgical site infection, pericardial effusion requiring intervention, myocardial infarction) within 30 days. Results: Of 155 patients from 11 U.S. centers, 151 patients had evaluable imaging. Complete LAAE was obtained in all patients. Primary performance in the intent-to-treat population was met, with 97% (95% CI 93.52%, 99.29%; p = 0.0001) complete LAAE. Primary safety was met, with 100% (95% CI 97.75%, 100%; p < 0.0001) of patients free from pre-defined SAEs within 30 days. One device-related SAE was reported, which resolved intraprocedurally. Conclusions: AtriClip V-Clip showed safe and successful LAAE through 12 months of follow-up. Full article

Biofilms, structured communities of microorganisms encased in an extracellular matrix, are a major cause of persistent infections, particularly when formed on medical devices. This study investigated the kinetics of biofilm formation by Escherichia coli and Pseudomonas aeruginosa, two clinically significant pathogens, on two medical-grade polymers: polyether ether ketone (PEEK) and polyamide 12 (PA12). Using a modified crystal violet staining method and spectrophotometric quantification, we evaluated biofilm development over time on polymer granules and catheter segments composed of these materials. Results revealed that PEEK surfaces supported significantly more biofilm formation than PA12, with peak accumulation observed at 24 h for both pathogens. Conversely, PA12 demonstrated reduced bacterial adhesion and lower biofilm biomass, suggesting surface characteristics less conducive to microbial colonization. Additionally, the study validated a reproducible protocol for assessing biofilm formation, providing a foundation for evaluating anti-biofilm strategies. While the assays were performed under static in vitro conditions, the findings highlight the importance of material selection and early prevention strategies in the design of infection-resistant medical devices. This work contributes to the understanding of how surface properties affect microbial adhesion and underscores the critical need for innovative surface modifications or coatings to mitigate biofilm-related healthcare risks. Full article

Background and Objectives: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no liver-focused quantitative synthesis exists. We aimed to evaluate the effectiveness and safety of prophylactic ciNPWT after hepatopancreatobiliary (HPB) surgery. Methods: MEDLINE, Embase, and PubMed were searched from inception to 30 April 2025. Randomized and comparative observational studies that compared ciNPWT with conventional dressings after elective liver transplantation, hepatectomy, pancreatoduodenectomy, and liver resections were eligible. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB-2/ROBINS-I). A random-effects Mantel–Haenszel model generated pooled risk ratios (RRs) for superficial SSI; secondary outcomes were reported descriptively. Results: Twelve studies (seven RCTs, five cohorts) encompassing 15,212 patients (3561 ciNPWT; 11,651 control) met the inclusion criteria. Device application lasted three to seven days in all trials. The pooled analysis demonstrated a 29% relative reduction in superficial SSI with ciNPWT (RR 0.71, 95% CI 0.63–0.79; p < 0.001) with negligible heterogeneity (I² 0%). Absolute risk reduction ranged from 0% to 13%, correlating positively with the baseline control-group SSI rate. Deep/organ-space SSI (RR 0.93, 95% CI 0.79–1.09) and 90-day mortality (RR 0.94, 95% CI 0.69–1.28) were unaffected. Seven studies documented a 1- to 3-day shorter median length of stay; only two reached statistical significance. Device-related adverse events were rare (one seroma, no skin necrosis). Conclusions: Prophylactic ciNPWT safely reduces superficial SSI after high-risk HPB surgery, with the greatest absolute benefit when baseline SSI risk exceeds ≈10%. Its influence on deep infection and mortality is negligible. Full article

Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial. Objective: To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases. Patients and Methods: A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications. Results: A total of 40 patients met the screening criteria. In the sampling group (n = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group (n = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2–11.6 years). Discussion: TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling. Full article

Background/Objectives: Personalized 3D-printed (3DP) metallic implants delivery systems are being explored to repair bone fractures, allowing the customization of medical implants that respond to individual patient needs, making it potentially more effective and of greater quality than mass-produced devices. However, challenges associated with postsurgical infections caused by bacterial adhesion remain a clinical issue. To address this, local antibiotic therapies are receiving extensive attention to minimize the risk of implant-related infections. This study investigated the use of amikacin (AMK), a broad-spectrum aminoglycoside antibiotic, incorporated onto 3D-printed 316L stainless steel implants using biodegradable polymer coatings of chitosan and poly lactic-co-glycolic acid (PLGA). Methods: This research examined different approaches to coat 3DP implants with amikacin. Various polymer-based coatings were studied to determine the optimal formulation based on the characteristics and release profile. The optimal formulation was performed on the antibacterial activity studies. Results: AMK-chitosan with PLGA coating implants controlled the rate of drug release for up to one month. The 3DP drug-loaded substrates demonstrated effective, concentration-dependent antibacterial activity against common infective pathogens. AMK-loaded substrates showed antimicrobial effectiveness for one week and inhibited bacteria significantly compared to the uncoated controls. Conclusions: This study demonstrated that 3DP metal surfaces coated with amikacin can provide customizable drug release profiles while effectively inhibiting bacterial growth. These findings highlight the potential of combining 3D printing with localized delivery strategies to prevent implant-associated infections and advance the development of personalized therapies. Full article

This review aims to summarize the global prevalence of healthcare-associated infections in patients with acute heart failure who have been admitted to coronary care units, highlighting the underrepresented burden of infection in this high-risk population. Coronary care units (CCUs) play a pivotal role in the care of patients experiencing acute or decompensated heart failure, offering a highly monitored environment with immediate access to advanced cardiac interventions. The management of heart failure in CCUs involves a multidisciplinary approach that includes hemodynamic monitoring, pharmacologic therapy, respiratory support, and, in selected cases, mechanical circulatory assistance. The early identification of deterioration, rapid therapeutic escalation, and close monitoring of cardiac function are hallmarks of CCU care. However, the complexity and severity of illness in this population are compounded by a high risk of infections, including hospital-acquired pneumonia, bloodstream infections, and device-related infections. These infections not only increase morbidity and prolong hospitalization but also significantly impact mortality and healthcare costs. The immunocompromised state of many heart failure patients—due to poor perfusion, malnutrition, and the use of invasive devices—further elevates their vulnerability. Effective infection prevention, early diagnosis, and targeted antimicrobial therapy are, therefore, critical components of heart failure management within CCUs. This intersection of advanced cardiac care and infection control highlights the need for integrated, multidisciplinary strategies to improve outcomes in this high-risk population. Full article

Orthopedic implant technology has historically seen difficulties in attaining long-term stability and biological integration, leading to complications such as implant loosening, wear debris production, and heightened infection risk. Nanotechnology provides a revolutionary method for addressing these constraints through the introduction of materials characterized by exceptional biocompatibility, durability, and integration potential. Nanomaterials (NMs), characterized by distinctive surface topographies and elevated surface area-to-volume ratios, facilitate improved osseointegration and provide regulated medication release, thereby creating a localized therapeutic milieu surrounding the implant site. To overcome the long-standing constraints of conventional implants, such as poor osseointegration, low mechanical fixation, immunological rejection, and implant-related infections, nanotechnology is causing a revolution in the field of orthopedic research. NMs are ideally suited for orthopedic applications due to their exceptional features, including increased tribology, wear resistance, prolonged drug administration, and excellent tissue regeneration. Because of their nanoscale size, they can imitate the hierarchical structure of real bone, which in turn encourages the proliferation of cells, lowers the risk of infection, and helps with the mending of bone fractures. This article will investigate the wide-ranging possibilities of nanostructured ceramics, polymers, metals, and carbon materials in bone tissue engineering, diagnostics, and the treatment of implant-related infections, bone malignancies, and bone healing. In addition, this paper will provide a basic overview of the most recent discoveries in nanotechnology driving the future of translational orthopedic research. It will also highlight safety evaluations and regulatory requirements for orthopedic devices. Full article

Background/Objectives: Breast implants are widely used in reconstructive surgeries, as well as in cosmetic procedures, to enhance or restore breast shape and volume. With advances in techniques and materials, these devices have become safer and more effective over the years. Nevertheless, complications such as capsular contracture, rupture, infections, or other types of malignancies (BIA-SCC). This study evaluated the postmarketing safety and performance of implants via technovigilance data and a review of scientific studies. Methods: The research analyzed publications from the BVS, PubMed, Embase, and ClinicalTrials databases from between 2007 and 2023 (15 years), in addition to reports registered in the Notivisa system during the same period. Results: A total of 113 studies were identified, 15 of which were selected for the final analysis, which revealed that capsular contracture, seroma, infection, and rupture were the most common complications. In the Notivisa system, 786 reports were found, including 397 technical complaints and 389 adverse events, with pain, infections, and lymphoma among the most frequently reported issues. Conclusions: These findings highlight the importance of continuous surveillance to identify risks and promote improvements in the quality and safety of breast implants, ensuring patient well-being. As a practical contribution, a clinical decision-making algorithm was proposed to support healthcare professionals in the early identification and management of implant-related complications. Full article

Background: Hemolysis during sepsis may be driven by patient-specific factors, including the intensity of the inflammatory response and the etiology of infection, as well as treatment-related factors, such as the use of extracorporeal life-support devices. Methods: We evaluated the incidence of hemolysis—reflected by decreased plasma levels of haptoglobin and hemopexin—in a cohort of septic patients with acute respiratory failure (n = 50) admitted to the intensive care unit (ICU). Results: Hemolysis was observed in 60% of patients. Its incidence was significantly higher among those with septic shock (86%) and those receiving extracorporeal membrane oxygenation (ECMO) therapy (81%). While continuous renal replacement therapy (CRRT) alone did not increase the incidence of hemolysis, its combination with ECMO was associated with hemolysis in 100% of those treated. Logistic regression analysis identified low haptoglobin levels (odds ratio [OR] 27.1), advanced age (OR 1.2), and stage 3 acute kidney injury (OR 22.2) as significant predictors of mortality. Conclusions: These findings highlight the clinical relevance of monitoring hemolysis in septic patients. Given the routine availability of haptoglobin and hemopexin assays in most hospital laboratories, these biomarkers offer practical and accessible tools for the detection and monitoring of hemolysis in critically ill patients. Full article

Urinary tract infections (UTIs) are among the most prevalent infectious diseases in older women, especially those over 65 years of age. Physiological changes related to aging, comorbidities, and frequent use of medical devices such as urinary catheters increase susceptibility. Increasing antimicrobial resistance further complicates treatment strategies. This study aims to describe the epidemiological profile of UTI in women over 65 years of age, focusing on the characterization of etiological agents, observed antimicrobial resistance patterns, and commonly reported risk factors. We conducted a retrospective analysis of microbiological and clinical data from elderly women diagnosed with UTIs. Bacterial isolates were identified and antimicrobial susceptibility profiles were evaluated over a specified period. A statistical analysis was performed to determine the prevalence of different pathogens and antibiotic resistance trends. Escherichia coli was the predominant uropathogen, consistent across different clinical scenarios and patient conditions. The four most common bacterial strains—E. coli, Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis—aligned with global epidemiological data. In Escherichia coli a significant increase in resistance to nitrofurantoin was observed, possibly indicating excessive empirical use, while resistance to other antibiotics, such as amoxicillin/clavulanic acid and ertapenem, remained stable or decreased. Institutional antibiotic stewardship programs likely contributed to this trend. The study highlights E. coli as the main etiological agent in elderly women with UTIs. The observed resistance patterns emphasize the need for localized antimicrobial surveillance and personalized therapeutic approaches. Continuous microbiological monitoring and rational use of antibiotics are crucial to optimize treatment outcomes and control the development of resistance. Full article

Background: Salmonella enterica serovar Infantis (S. Infantis) is a widespread pathogen in agriculture, causing epidemics in chicken flocks. Despite being primarily an animal pathogen, it may pose significant health risks to immunocompromised individuals. Methods: This report describes the first known case of cardiac device-related infective endocarditis (CDRIE) attributed to S. Infantis, highlighting its emerging pathogenic potential. It also reviews the literature for microbiologic and epidemiologic perspectives. Results: A 61-year-old male with a history of high-grade multiple myeloma presented with nonspecific symptoms, including low-grade fever and exertional dyspnoea. Blood cultures identified a pure culture of S. Infantis, and transoesophageal echocardiography revealed vegetations on pacing leads. Following pacemaker extraction and appropriate antimicrobial therapy, the patient’s condition temporary improved, but later deteriorated due to the progression of underlying malignancy. Conclusions: This case underscores the importance of considering S. Infantis in the differential diagnosis of endocarditis in immunocompromised patients, along with the critical need for stringent food safety measures to mitigate infection risks from contaminated poultry products. Full article

Catheter-associated bloodstream infections (CABSIs) and catheter-related bloodstream infections (CRBSIs) are significant causes of morbidity and mortality worldwide. The current practice favors the removal of vascular access devices (VADs); however, the evidence on this topic remains inconclusive. This study evaluates the clinical outcomes in terms of in-hospital mortality and catheter retention vs. removal in CABSI and CRBSI cases. A retrospective, observational, single-center study was conducted at Luigi Sacco Hospital, Milan, Italy (May 2021–December 2023), and it analyzed non-ICU adult patients with VADs diagnosed with CRBSIs or CABSIs. Clinical and microbiological data were collected to assess the outcomes based on catheter management. Among 1874 patients with VADs, 147 were included, with 164 VAD infection events (92 CABSIs and 72 CRBSIs). Overall, 35 (23.8%) patients with CABSIs and CRBSIs died. Out of those who retained the catheter 19 (35.8%) patients died, while among removal patients 16 (17%) died (p = 0.018). A Candida spp. isolation was found to be significantly associated with a higher likelihood of catheter removal (p = 0.04). Our findings suggest that, in non-ICU CRBSI and CABSI cases, VAD removal may be associated with improved outcomes when feasible. Full article

In small animal practice, blood cultures (BCs) are essential for diagnosing bacterial bloodstream infections (BSIs) and guiding targeted antimicrobial therapy, particularly in relation to the rise of multidrug-resistant (MDR) pathogens. This study analyzed 96 positive BCs from dogs and cats at the Veterinary University Hospital (VUH) of Bologna (2020–2024), assessing bacterial prevalence, antimicrobial resistance, and associated risk factors. Escherichia coli was the most common isolate (29/96), followed by Streptococcus canis (11/96). MDR percentage was 29.2% (28/96), with Gram-negatives associated with higher rates (p = 0.040). Nearly half of the cases (46.9%, 45/96) were suspected healthcare-associated infections (HAIs) significantly associated with the number of invasive devices used (p = 0.008) and with the absence of co-positive samples (p = 0.012). Empirical antibiotic therapy was administered in 94.8% (91/96) of cases, with ampicillin–sulbactam and marbofloxacin as the most used drugs. In vitro empirical therapy appropriateness was 76.9% (70/91). MDR was associated with inappropriate empirical therapy (p < 0.001). Mortality within 30 days was 36.5% (35/96), significantly linked to antibiotic escalation (p = 0.006). The findings highlight the need for systematic BC surveillance in veterinary settings to optimize treatment strategies (especially in countries with restrictions on antibiotic use in animals) to mitigate MDR spread and to protect public health. Full article