The Erlanger silver catheter: in vitro results for antimicrobial activity

Role of Nanoparticles in Enhancing Crop Tolerance to Abiotic Stress: A Comprehensive Review

Plants are subjected to a wide range of abiotic stresses, such as heat, cold, drought, salinity, flooding, and heavy metals. Generally, abiotic stresses have adverse impacts on plant growth and development which affects agricultural productivity, causing food security problems, and resulting in economic losses. To reduce the negative effects of environmental stress on crop plants, novel technologies, such as nanotechnology, have emerged. Implementing nanotechnology in modern agriculture can also help improve the efficiency of water usage, prevent plant diseases, ensure food security, reduce environmental pollution, and enhance sustainability. In this regard, nanoparticles (NPs) can help combat nutrient deficiencies, promote stress tolerance, and improve the yield and quality of crops. This can be achieved by stimulating the activity of certain enzymes, increasing the contents (e.g., chlorophyll) and efficiency of photosynthesis, and controlling plant pathogens. The use of nanoscale agrochemicals, including nanopesticides, nanoherbicides, and nanofertilizers, has recently acquired increasing interest as potential plant-enhancing technologies. This review acknowledges the positive impacts of NPs in sustainable agriculture, and highlights their adverse effects on the environment, health, and food chain. Here, the role and scope of NPs as a practical tool to enhance yield and mitigate the detrimental effects of abiotic stresses in crops are described. The future perspective of nanoparticles in agriculture has also been discussed.

Photoactive Silver Nanoagents for Backgroundless Monitoring and Precision Killing of Multidrug-Resistant Bacteria

Purpose: The growing prevalence of multidrug-resistant (MDR) bacteria makes it clinically urgent to develop an agent able to detect and treat infections simultaneously. Silver has served as a broad-spectrum antimicrobial since ancient times but suffers from major challenges such as moderate antimicrobial activity, nonspecific toxicity, and difficulty to be visualized in situ. Here, we propose a new photoactive silver nanoagent that relies on a photosensitizer-triggered cascade reaction to liberate Ag⁺ on bacterial surfaces exclusively, allowing the precise killing of MDR bacteria. Additionally, the AgNP core acts as a backgroundless surface-enhanced Raman scattering (SERS) substrate for imaging the distribution of the nanoagents on bacterial surfaces and monitoring their metabolic dynamics in the infection sites. Methods: In this strategy, the photoactive antibacterial AgNP was decorated with photosensitizers (Chlorin e6, Ce6) and Raman reporter (4-Mercaptobenzonitrile, 4-MB) to provide new opportunities for clinically monitoring and fighting MDR bacterial infections. Upon 655 nm laser activation, the Ce6 molecules produce ROS efficiently, triggering the rapid release of Ag⁺ from the AgNP core to kill bacteria. Poly[4-O-(α-D-glucopyranosyl)-D-glucopyranose] (GP) was introduced as bacteria-specific targeting ligands. SERS spectra of the prepared GP-Ce6/MB-AgNPs were recorded after injecting for 0.5, 4, 8, 12, 24, and 48 h to track the dynamic metabolism of the nanoagents and thus guiding the antibacterial therapy. Results: This new antimicrobial strategy exerts a dramatically enhanced antibacterial activity. The in vitro antibacterial efficiencies of this non-antibiotic technique were up to 99.6% against Methicillin-resistant Staphylococcus aureus (MRSA) and 98.8% against Escherichia coli (EC), while the in vivo antibacterial efficiencies for MRSA- and Carbapenem-resistant Pseudomonas aeruginosa (CRPA)-infected mice models were 96.8% and 93.6%, respectively. Besides, backgroundless SERS signal intensity of the wound declined to the level of normal tissue until 24 h, indicating that the nanoagents had been completely metabolized from the infected area. Conclusion: Given the backgroundless monitoring ability, high antibacterial efficacy, and low toxicity, the photoactive cascading agents would hold great potential for MDR-bacterial detection and elimination in diverse clinical settings.

Promising Therapeutic Strategies Against Microbial Biofilm Challenges

Biofilms are communities of microorganisms that are attached to a biological or abiotic surface and are surrounded by a self-produced extracellular matrix. Cells within a biofilm have intrinsic characteristics that are different from those of planktonic cells. Biofilm resistance to antimicrobial agents has drawn increasing attention. It is well-known that medical device- and tissue-associated biofilms may be the leading cause for the failure of antibiotic treatments and can cause many chronic infections. The eradication of biofilms is very challenging. Many researchers are working to address biofilm-related infections, and some novel strategies have been developed and identified as being effective and promising. Nevertheless, more preclinical studies and well-designed multicenter clinical trials are critically needed to evaluate the prospects of these strategies. Here, we review information about the mechanisms underlying the drug resistance of biofilms and discuss recent progress in alternative therapies and promising strategies against microbial biofilms. We also summarize the strengths and weaknesses of these strategies in detail.

Bactericidal and Biocompatible Properties of Plasma Chemical Oxidized Titanium (TiOB®) with Antimicrobial Surface Functionalization

Coating of plasma chemical oxidized titanium (TiOB^®) with gentamicin-tannic acid (TiOB^® gta) has proven to be efficient in preventing bacterial colonization of implants. However, in times of increasing antibiotic resistance, the development of alternative antimicrobial functionalization strategies is of major interest. Therefore, the aim of the present study is to evaluate the antibacterial and biocompatible properties of TiOB^® functionalized with silver nanoparticles (TiOB^® SiOx Ag) and ionic zinc (TiOB^® Zn). Antibacterial efficiency was determined by agar diffusion and proliferation test on Staphylocuccus aureus. Cytocompatibility was analyzed by direct cultivation of MC3T3-E1 cells on top of the functionalized surfaces for 2 and 4 d. All functionalized surfaces showed significant bactericidal effects expressed by extended lag phases (TiOB^® gta for 5 h, TiOB^® SiOx Ag for 8 h, TiOB^® Zn for 10 h). While TiOB^® gta (positive control) and TiOB^® Zn remained bactericidal for 48 h, TiOB^® SiOx Ag was active for only 4 h. After direct cultivation for 4 d, viable MC3T3-E1 cells were found on all surfaces tested with the highest biocompatibility recorded for TiOB^® SiOx Ag. The present study revealed that functionalization of TiOB^® with ionic zinc shows bactericidal properties that are comparable to those of a gentamicin-containing coating.

Silver nanoparticle deposited implants to treat osteomyelitis

In this study, electrolytically deposited strongly adherent silver nanoparticles on stainless-steel (SS) implants were used for in situ osteomyelitis treatment. Samples were heat treated to enhance adhesion of silver on 316 L SS. Ex vivo studies were performed to measure silver-release profiles from the 316 L SS screws inserted in equine cadaver bones. No change in the release profiles of silver ions were observed in vitro between the implanted screws and the control. In vivo studies were performed using osteomyelitic rabbit model with 3 mm diameter silver-deposited 316 L SS pins at two different doses of silver: high and low. Infection control ability of the pins for treating osteomyelitis in a rabbit model was measured using bacteriologic, radiographic, histological, and scanning electron microscopic studies. Silver-coated pins, especially high dose, offered a promising result to treat infection in animal osteomyelitis model without any toxicity to major organs. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1073-1083, 2018.

Gene Expression, Protein Function and Pathways of Arabidopsis thaliana Responding to Silver Nanoparticles in Comparison to Silver Ions, Cold, Salt, Drought, and Heat

Silver nanoparticles (AgNPs) have been widely used in industry due to their unique physical and chemical properties. However, AgNPs have caused environmental concerns. To understand the risks of AgNPs, Arabidopsis microarray data for AgNP, Ag⁺, cold, salt, heat and drought stresses were analyzed. Up- and down-regulated genes of more than two-fold expression change were compared, while the encoded proteins of shared and unique genes between stresses were subjected to differential enrichment analyses. AgNPs affected the fewest genes (575) in the Arabidopsis genome, followed by Ag⁺ (1010), heat (1374), drought (1435), salt (4133) and cold (6536). More genes were up-regulated than down-regulated in AgNPs and Ag⁺ (438 and 780, respectively) while cold down-regulated the most genes (4022). Responses to AgNPs were more similar to those of Ag⁺ (464 shared genes), cold (202), and salt (163) than to drought (50) or heat (30); the genes in the first four stresses were enriched with 32 PFAM domains and 44 InterPro protein classes. Moreover, 111 genes were unique in AgNPs and they were enriched in three biological functions: response to fungal infection, anion transport, and cell wall/plasma membrane related. Despite shared similarity to Ag⁺, cold and salt stresses, AgNPs are a new stressor to Arabidopsis.

A review and perspective of existing research on the release of nanomaterials from solid nanocomposites

Advances in adding nanomaterials to various matrices have occurred in tandem with the identification of potential hazards associated with exposure to pure forms of nanomaterials. We searched multiple research publication databases and found that, relative to data generated on potential nanomaterial hazards or exposures, very little attention has focused on understanding the potential and conditions for release of nanomaterials from nanocomposites. However, as a prerequisite to exposure studying release is necessary to inform risk assessments. We identified fifty-four studies that specifically investigated the release of nanomaterials, and review them in the following release scenario groupings: machining, weathering, washing, contact and incineration. While all of the identified studies provided useful information, only half were controlled experiments. Based on these data, the debris released from solid, non-food nanocomposites contains in varying frequencies, a mixture of four types of debris. Most frequently identified are (1) particles of matrix alone, and slightly less often, the (2) matrix particles exhibit the nanomaterial partially or fully embedded; far less frequently is (3) the added nanomaterial entirely dissociated from the matrix identified: and most rare are (4) dissolved ionic forms of the added nanomaterial. The occurrence of specific debris types appeared to be dependent on the specific release scenario and environment. These data highlight that release from nanocomposites can take multiple forms and that additional research and guidance would be beneficial, allowing for more consistent characterization of the release potential of nanomaterials. In addition, these data support calls for method validation and standardization, as well as understanding how laboratory release scenarios relate to real-world conditions. Importantly, as risk is considered to be a function of the inherent hazards of a substance and the actual potential for exposure, data on nanomaterial release dynamics and debris composition from commercially relevant nanocomposites are a valuable starting point for consideration in fate and transport modeling, exposure assessment, and risk assessment frameworks for nanomaterials.

Proteomic analysis of the proteins released from Staphylococcus aureus following exposure to Ag(I)

The silver ion (Ag(I)) has well established antimicrobial properties and is widely used in a variety of anti-bacterial ointments and plasters for the control of wound infections. Wounds are frequently colonised by the bacterium Staphylococcus aureus and the aim of the work presented here was to establish how S. aureus responded following exposure to Ag(I). Exposure of S. aureus to Ag(I) resulted in the release of a range of proteins from cells. Analysis of proteins released revealed a number of proteins associated with the stress response (e.g. alkaline shock protein, methionine sulfoxide reductase), virulence (e.g. signal transduction protein) and metabolism (e.g. lipase, acetate kinase, phosphoglycerate mutase). The release of toxins (e.g. α-hemolysin, bifunctional autolysin, leucocidin F) was decreased. These results indicated that, while silver is a potent antimicrobial agent, exposure of S. aureus to this metal results in the release of a variety of proteins from the cell. Many of the proteins showing increased release were antigenic and would have the potential to induce an inflammatory response at the site of infection and thus delay healing.

Hard implant coatings with antimicrobial properties

Infection of orthopaedic implants often leads to inflammation immediately after surgery and increases patient morbidity due to repetitive operations. Silver ions have been shown to combine good biocompatibility with a low risk of inducing bacterial resistance. In this study a physical vapour deposition system using both arc deposition and magnetron sputtering has been utilized to produce silver ion doped TiN coatings on Ti substrates. This biphasic system combines the advantages of silver induced bactericidity with the good mechanical properties of TiN. Crystallographic analysis by X-ray diffraction showed that silver was deposited as well in its elementary form as it was incorporated into the crystal lattice of TiN, which resulted in increasing hardness of the TiN-coatings. Elution experiments revealed a continuous release of Ag ions in phosphate buffered saline. The coatings showed significant inhibitory effects on the growth of Staphylococcus epidermidis and Staphylococcus aureus and practically no cell-toxicity in cytocompatibility tests.

Ag/SiO(x)C(y) plasma polymer coating for antimicrobial protection of fracture fixation devices

Implant-related infections are often devastating situations in orthopaedic trauma surgery particularly if multiresistant bacteria are involved. Protection of the implant surface by an antimicrobial coating exhibiting activity against multiresistant bacterial strains is of high interest. Aim of this study was to investigate the antimicrobial effects of an Ag/SiO(x)C(y) plasma polymer coating for fracture fixation devices, such as nails, plates, and external fixators, including tests against methicillin-resistant Staphylococcus aureus (MRSA) and its biocompatibility. The antimicrobial activity of the coating deposited onto 12 x 3 mm(2) stainless steel implants was tested in vitro against Staphylococcus aureus, Staphylococcus epidermidis, and MRSA using different testing methods (ASTM E-2810, JIS Z 2801, proliferation assay). Additionally, the coated devices were implanted into the paravertebral muscle of rabbits and explanted after 2, 7, 14, and 28 days to test the remaining ex vivo antimicrobial activity. For biocompatibility assessment the Ag/SiO(x)C(y) plasma polymer coating was tested in vitro according to ISO 10993-5. The Ag/SiO(x)C(y) coating exhibited excellent antimicrobial activity against all tested bacterial strains in all three in vitro tests. Ex vivo testing proved suppression of more than 99.9 % of bacterial proliferation by the coating compared to non-coated samples even after 28 days. ISO 10993-5 showed good biocompatibility of the coating without any indications of cytotoxic effects. In summary, Ag/SiO(x)C(y) plasma polymer coating showed excellent antimicrobial activity including effectiveness against MRSA and good in vitro biocompatibility. Therefore, it possesses high potential as a prophylactic agent in orthopaedic trauma surgery.

The effects of copper additives on the quantity and cell viability of adherent Staphylococcus epidermidis in silicone implants

This in vitro study evaluated the antibacterial effect of copper additives in silicone implants. Specimens of a standard silicone material used in breast augmentation and modified copper-loaded silicone specimens were prepared and incubated in a Staphylococcus epidermidis suspension (2 h, 37 degrees C). After the quantification of adhering staphylococci using a biofluorescence assay (Resazurin), the viability of the adhering bacterial cells was quantified by live or dead cell labeling in combination with fluorescence microscopy. In the Resazurin fluorometric quantification, a higher amount of adhering S. epidermidis cells was detected on pure silicone (4612 [2319/7540] relative fluorescence units [rfu]) than on silicone with copper additives (2701 [2158/4153] rfu). Additionally, a significantly higher amount of adhering bacterial cells (5.07% [2.03%/8.93%]) was found for pure silicone than for silicone with copper additives (1.72% [1.26%/2.32%]); (p < 0.001). Calculations from live or dead staining showed that the percentage of dead S. epidermidis cells adhered on pure silicone (52.1%) was significantly lower than on silicone with copper additives (79.7%); (p < 0.001). In vitro, silicone material with copper additives showed antibacterial effects against S. epidermidis. Copper-loaded silicone may prevent bacterial colonization, resulting in lower infection rates of silicone implants.

Adhesion forces between Staphylococcus epidermidis and surfaces bearing self-assembled monolayers in the presence of model proteins

Self-assembled monolayers (SAMs) are being developed into coatings to reduce microbial biofilm formation on biomaterials. To test anti-adhesion properties, SAMs can be easily constructed on gold, and used to represent a coated biomaterial. However, coatings that prevent bacterial adhesion must also resist protein adsorption. We explored the competitive effects of bacteria and protein for adsorption to SAMs, choosing fetal bovine serum (FBS) to represent protein non-specific binding, and fibronectin (FN) to evaluate ligand/receptor binding. Staphylococcus epidermidis were immobilized on an atomic force microscope (AFM) tip and used as a force probe to detect the interaction forces between bacteria and gold-coated SAMs. The SAMs tested were alkanethiol molecules terminating in isophthalic acid (IPA) or isophthalic acid with silver (IAG). While S. epidermidis showed weak interactions with FBS, the bacteria showed strong adhesion with FN, due to ligand/receptor binding. Bacterial retention and viability experiments were correlated with the force measurements. S. epidermidis interacting with IAG SAMs showed a loss of viability, due to the mobility of silver ions. For most substrata, there was a link between high adhesion forces with bacteria and a high percentage of dead cells being retained on that substratum (even in the absence of a specific biocidal effect, such as silver). This may suggest that high adhesion forces can cause stress to the bacteria which contributed to their death. The relationship between highly adhesive SAMs and bacterial inactivation may be useful in future biomaterial design. When evaluating coatings for biomaterials, it is important to consider the interplay between bacteria, proteins, and the coating material.

Formation of colloidal silver nanoparticles stabilized by Na+–poly(γ-glutamic acid)–silver nitrate complex via chemical reduction process

Macromolecular and polyanionic Na(+)-poly(gamma-glutamic acid) (PGA) silver nitrate complex acted as both a metal ion provider and a particle protector to fabricate nanosized silver colloids under chemical reduction by dextrose. The formation and size of particles have been characterized from transmission electron microscopy (TEM), dynamic light scattering analysis and UV-vis spectrophotometer. The results showed that the average particle size was 17.2+/-3.4 to 37.3+/-5.5 nm, apparently depending on the complex concentration. It was found that the rate constant and conversion of silver nanoparticles were proportional to the concentration of PGA. The growth mechanism of nanosized silver colloid was fully discussed. In addition, the in vitro cytotoxicity evaluated by L929 fibroblasts proliferation and antibacterial activity against Gram-positive strain (methicillin-resistant S. aureus (MRSA)) and Gram-negative strain (P. aeruginosa) bacteria have been assessed.

Antibacterial and osteogenic properties of silver-containing hydroxyapatite coatings produced using a sol gel process

Since bacterial infection is a rising complication following the wide use of implant, there is considerable attention on the effect of implant surface properties on bacterial adhesion. In this study, the effect of silver (Ag) doped hydroxyapatite (HA) coatings on initial antibacterial adhesion and osteoblast cell proliferation and differentiation was investigated. Using a sol-gel process, HA coatings doped with 1 wt % AgNO(3) (AgHA1.0) and 1.5 wt % Ag (AgHA1.5) were prepared. Coated surfaces were characterized using X-ray diffraction (XRD) and contact angles measurements. The initial bacteria adhesion was evaluated using a RP12 strain of Staphylococcus epidermidis (ATCC 35984) and the Cowan I strain of Staphylococcus aureus, whereas osteoblast proliferation and differentiation were evaluated using human embryonic palatal mesenchyme cells (HEPM), an osteoblast precursor cell line. In this study, XRD analysis of all surfaces indicated peaks corresponding to HA. Contact angles for AgHA surfaces were observed to be significantly lower when compared to HA surfaces. In vitro initial bacterial adhesion study indicated a significantly reduced number of S. epidermidis and S. aureus on AgHA surfaces when compared to HA surface. The use of HEPM cells indicated no significant difference in double-stranded DNA (dsDNA) production between all surfaces. Additionally, no differences in alkaline phosphatase specific activity were observed between HA and AgHA1.0 surfaces. Overall, it was concluded that AgHA1.0 has the similar biological activity as HA, with respect to bone cell proliferation and differentiation. In addition, the AgHA1.0 was also concluded to have the ability to minimize the initial bacteria adhesion. (c) 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2007.

Comparison of silver-impregnated with standard multi-lumen central venous catheters in critically ill patients*

OBJECTIVES

To evaluate a new silver-impregnated multi-lumen central venous catheter for reducing catheter-related colonization in intensive care patients.

DESIGN

Multicenter, prospective, randomized, controlled clinical study.

SETTING

Ten adult intensive care units (multidisciplinary, medical and surgical, university and nonuniversity hospitals) in eight institutions.

PATIENTS

A total of 577 patients who required 617 multi-lumen central venous catheters between November 2002 and April 2004 were studied.

INTERVENTIONS

Intensive care adult patients requiring multi-lumen central venous catheters expected to remain in place for >or=3 days were randomly assigned to undergo insertion of silver-impregnated catheters (silver group) or standard catheters (standard group). Catheter colonization was defined as the growth of >or=1,000 colony-forming units in culture of the intravascular tip of the catheter by the vortexing method. Diagnosis of catheter-related infection was performed by an independent and blinded expert committee.

RESULTS

A total of 320 catheters were studied in the silver group and 297 in the standard group. Characteristics of the patients, insertion site, duration of catheterization (median, 11 vs. 10 days), and other risk factors for infection were similar in the two groups. Colonization of the catheter occurred in 47 (14.7%) vs. 36 (12.1%) catheters in the silver and the standard groups (p = .35), for an incidence of 11.2 and 9.4 per 1,000 catheter days, respectively. Catheter-related bloodstream infection was recorded in eight (2.5%) vs. eight (2.7%) catheters in the silver and the standard groups (p = .88), for an incidence of 1.9 and 2.1 per 1,000 catheter days, respectively.

CONCLUSION

The use of silver-impregnated multi-lumen catheters in adult intensive care patients is not associated with a lower rate of colonization than the use of standard multi-lumen catheters.

In vitro anti-bacterial and biological properties of magnetron co-sputtered silver-containing hydroxyapatite coating

Bacterial infection after implant placement is a significant rising complication. In order to reduce the incidence of implant-associated infections, several biomaterial surface treatments have been proposed. In this study, the effect of in vitro antibacterial activity and in vitro cytotoxicity of co-sputtered silver (Ag)-containing hydroxyapatite (HA) coating was evaluated. Deposition was achieved by a concurrent supply of 10 W to the Ag target and 300 W to the HA target. Heat treatment at 400 degrees C for 4 h was performed after 3 h deposition. X-ray diffraction, contact angles measurements, and surface roughness were used to characterize the coating surfaces. The RP12 strain of Staphylococcus epidermidis (ATCC 35984) and the Cowan I strain of Staphylococcus aureus were used to evaluate the antibacterial activity of the Ag-HA coatings, whereas human embryonic palatal mesenchyme cells, an osteoblast precursor cell line, were used to evaluate the in vitro cytotoxicity of the coatings. X-ray diffraction analysis performed in this study indicated peaks corresponding to Ag and HA on the co-sputtered Ag-HA surfaces. The contact angles for HA and Ag-HA surfaces were observed to be significantly lower when compared to Ti surfaces, whereas no significant difference in surface roughness was observed for all groups. In vitro bacterial adhesion study indicated a significantly reduced number of S. epidermidis and S. aureus on Ag-HA surface when compared to titanium (Ti) and HA surfaces. In addition, no significant difference in the in vitro cytotoxicty was observed between HA and Ag-HA surfaces. Overall, it was concluded that the creation of a multifunctional surface can be achieved by co-sputtering the osteoconductive HA with antibacterial Ag.

Antimicrobial titanium/silver PVD coatings on titanium

BACKGROUND

Biofilm formation and deep infection of endoprostheses is a recurrent complication in implant surgery. Post-operative infections may be overcome by adjusting antimicrobial properties of the implant surface prior to implantation. In this work we described the development of an antimicrobial titanium/silver hard coating via the physical vapor deposition (PVD) process.

METHODS

Coatings with a thickness of approximately 2 mum were deposited on titanium surfaces by simultaneous vaporisation of both metals in an inert argon atmosphere with a silver content of approximately 0.7-9% as indicated by energy dispersive X-ray analysis. On these surfaces microorganisms and eukaryotic culture cells were grown.

RESULTS

The coatings released sufficient silver ions (0.5-2.3 ppb) when immersed in PBS and showed significant antimicrobial potency against Staphylococcus epidermis and Klebsiella pneumoniae strains. At the same time, no cytotoxic effects of the coatings on osteoblast and epithelial cells were found.

CONCLUSION

Due to similar mechanical performance when compared to pure titanium, the TiAg coatings should be suitable to provide antimicrobial activity on load-bearing implant surfaces.

A prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters*

OBJECTIVE

Central venous catheters are the predominant cause of nosocomial bacteremia; however, the effectiveness of different antimicrobial central venous catheters remains uncertain. We compared the infection rate of silver-platinum-carbon (SPC)-impregnated catheters with rifampicin-minocycline (RM)-coated catheters.

DESIGN

A large, single-center, prospective randomized study.

SETTING

Twenty-two-bed adult general intensive care unit in a large tertiary metropolitan hospital in Brisbane, Australia (2000-2001).

PATIENTS

Consecutive series of all central venous catheterizations in intensive care unit patients.

INTERVENTIONS

Randomization, concealment, and blinding were carefully performed. Catheter insertion and care were performed according to published guidelines. Blood cultures were taken at central venous catheter removal, and catheter-tip cultures were performed by both roll-plate and sonication techniques. Pulsed field gel electrophoresis was used to establish shared clonal origin for matched isolates.

MEASUREMENTS AND MAIN RESULTS

Central venous catheter colonization and catheter-related bloodstream infection were determined with a blinded technique using the evaluation of the extensive microbiological and clinical data collected and a rigorous classification system. Six hundred forty-six central venous catheters (RM 319, SPC 327) were inserted, and 574 (89%) were microbiologically evaluable. Colonization rates were lower for the RM catheters than SPC catheters (25 of 280, 8.9%; 43 of 294, 14.6%; p=.039). A Kaplan-Meier analysis that included catheter time in situ did not quite achieve statistical significance (p=.055). Catheter-related bloodstream infection was infrequent for both catheter-types (RM 4, 1.4%; SPC 5, 1.7%).

CONCLUSIONS

The SPC catheter is a clinically effective antimicrobial catheter; however, the RM catheter had a lower colonization rate. Both catheter types had low rates of catheter-related bloodstream infection. These results indicate that future studies will require similar rigorous methodology and thousands of central venous catheters to demonstrate differences in catheter-related bloodstream infection rates.

[Nanoparticulate silver. A new antimicrobial substance for bone cement]

BACKGROUND

Multiresistant bacteria have become an important problem in prosthetic joint infections. Their frequent resistance against gentamicin, which is commonly used in antibiotic-loaded bone cements, makes a new prophylaxis necessary.

METHODS

PMMA-cement was loaded with 1% nanoparticulate silver and its antibacterial activity tested in vitro against gentamicin-resistant MRSE and MRSA strains as well as being compared to the activity of plain and gentamicin-loaded bone cements. A quantitative elution testing was also done to study the potentially cytotoxic effects of NanoSilver cement.

RESULTS

Unloaded and PMMA-cement loaded with 2% gentamicin did not exhibit any antibacterial activity against MRSE and MRSA. At 1%, NanoSilver cement completely inhibited the proliferation of MRSA and MRSE. NanoSilver bone cement did not show any significant differences compared to the non-toxic control group.

CONCLUSIONS

If these promising in vitro results can be confirmed in vivo, NanoSilver bone cement may be of considerable value in total joint arthroplasty.

In vitro testing of antimicrobial activity of bone cement

The purpose of this study was to establish a reliable and cost-effective microplate proliferation assay for in vitro antimicrobial testing of bone cement samples. Cement samples devoid of antimicrobial agents, loaded with 2% gentamicin or with different concentrations of high-porosity silver, were incubated in a 96-well microplate with several staphylococcal, Pseudomonas aeruginosa, and Enterococcus faecium isolates exhibiting different susceptibilities to gentamicin. After being rinsed, the samples were brought into a soy medium in which adherent cells on the cement surface either were killed by the antimicrobial surface or started to release clonal counterparts. The medium was monitored in real time by recording a time proliferation curve for each well. Microplate testing revealed no antibacterial effect of plain bone cement. The antibacterial activity of gentamicin-loaded bone cement was shown by the microplate test to depend on the gentamicin susceptibilities of the strains. The effect of high-porosity silver was dose dependent. Bactericidal activity against all tested strains was found for bone cement loaded with 1% high-porosity silver. The accuracy of this new proliferation assay was shown by the high correlation between the types of proliferation curves and antibiotic susceptibility. In contrast to routine agar diffusion testing, it assesses the dynamic response of microorganisms to antimicrobial agents in biomaterials and allows high-throughput screening and detection of antimicrobial properties of poorly water-soluble compounds like silver.

An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement

Infections with multiresistant bacteria have become a serious problem in joint arthroplasty. This study reports about in vitro antibacterial activity against multiresistant bacteria and in vitro cytotoxicity of polymethylmetacrylate bone cement loaded with metallic silver particles with a size of 5-50 nm called NanoSilver. In vitro antibacterial activity against S. epidermidis, methicillin-resistant S. epidermidis (MRSE), and methicillin-resistant S. aureus (MRSA) was studied by microplate proliferation tests. Quantitative elution testing and qualitative ongrowth of human osteoblasts was done to study in vitro cytotoxicity. Only NanoSilver cement showed high-antibacterial activity against all strains, including MRSE and MRSA. Gentamicin cement was not effective against MRSA and MRSE due to the high-level gentamicin resistance of the tested strains. Plain cement did not inhibit proliferation of any strains. There was no significant difference regarding in vitro cytotoxicity between NanoSilver and the non-toxic control. Cytotoxicity of cement loaded with silver salts made this kind of silver unsuitable for all day clinical use in the past. This new form of silver called NanoSilver was free of in vitro cytotoxicity and showed high effectiveness against multiresistant bacteria. If the results can be confirmed in vivo NanoSilver may have a high interest in joint arthroplasty.

The inhibitory activity of serum to prevent bacterial adhesion is mainly due to apo-transferrin

A marked, up to 5-fold, reduction in bacterial adhesion to Tecoflex polyurethane (PU) surfaces was observed in the presence of bovine/human serum or plasma at 0.5% or higher concentrations in the medium. Further investigation of the phenomenon resulted in identification, isolation, and characterization of the serum component with the ability to significantly reduce bacterial adhesion. Upon fractionation of bovine serum by an anion exchange chromatography, protein pools were made and analyzed by immunoelectrophoresis and by polyacrylamide gel electrophoresis in the presence of SDS and were examined for their effect on the adhesion of Staphylococcus epidermidis to PU surfaces. The pool exhibiting a significant inhibitory effect was subjected to further biochemical tests, which resulted in the identification of transferrin (Tf) as its predominant protein. Bacterial adhesion studies in the presence of purified Tf revealed that holo-Tf (iron-containing form) had no influence on bacterial adhesion at any concentration. Only apo-Tf (iron-lacking form) exerted the inhibitory effect, in a dose responsive manner at concentrations of 10 microg/mL or higher. Bacteria remained viable when suspended at the low apo-Tf concentrations, sufficient to prevent bacterial adhesion.

Staphylococcus and biofilms

The genetic and molecular basis of biofilm formation in staphylococci is multifaceted. The ability to form a biofilm affords at least two properties: the adherence of cells to a surface and accumulation to form multilayered cell clusters. A trademark is the production of the slime substance PIA, a polysaccharide composed of beta-1,6-linked N-acetylglucosamines with partly deacetylated residues, in which the cells are embedded and protected against the host's immune defence and antibiotic treatment. Mutations in the corresponding biosynthesis genes (ica operon) lead to a pleiotropic phenotype; the cells are biofilm and haemagglutination negative, less virulent and less adhesive on hydrophilic surfaces. ica expression is modulated by various environmental conditions, appears to be controlled by SigB and can be turned on and off by insertion sequence (IS) elements. A number of biofilm-negative mutants have been isolated in which polysaccharide intercellular adhesin (PIA) production appears to be unaffected. Two of the characterized mutants are affected in the major autolysin (atlE) and in D-alanine esterification of teichoic acids (dltA). Proteins have been identified that are also involved in biofilm formation, such as the accumulation-associated protein (AAP), the clumping factor A (ClfA), the staphylococcal surface protein (SSP1) and the biofilm-associated protein (Bap). Concepts for the prevention of obstinate polymer-associated infections include the search for new anti-infectives active in biofilms and new biocompatible materials that complicate biofilm formation and the development of vaccines.