Orthopaedic-implant infections by Escherichia coli: molecular and phenotypic analysis of the causative strains

Immobilization of KR-12 on a Titanium Alloy Surface Using Linking Arms Improves Antimicrobial Activity and Supports Osteoblast Cytocompatibility

Implant-associated infections pose significant challenges due to bacterial resistance to antibiotics. Recent research highlights the potential of immobilizing antimicrobial peptides (AMPs) onto implants as an alternative to conventional antibiotics for the prevention of bacterial infection. While various AMP immobilization methodologies have been investigated, they lack responsiveness to biological cues. This study proposes an enzyme-responsive antimicrobial coating for orthopedic devices using KR-12, an AMP derived from Cathelicidin LL-37, coupled with the Human Elastin-Like Polypeptide (HELP) as a biomimetic and stimuli-responsive linker, while mimicking the extracellular matrix (ECM). During implantation, these customized interfaces encounter the innate immune response triggering elastase release, which degrades HELP biopolymers, enabling the controlled release of KR-12. After coupling KR-12 with HELP to titanium surfaces, the antimicrobial activity against four pathogenic bacterial strains (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa) was assessed, revealing an inhibition ratio of bacterial adhesion and colonization exceeding 92% for all tested strains, compared with surfaces functionalized with KR-12 only. It is thought that the enhanced antimicrobial activity was due to the improved mobility of KR-12 when coupled with HELP. Furthermore, the prepared coatings boosted the adhesion and proliferation of human osteoblasts, confirming the cytocompatibility. These findings suggest the potential for smart coatings that combine the antimicrobial functions of AMPs with HELP's biological properties for use in a variety of settings, including medical devices.

Antimicrobial effect of blue light on antibiotic-sensitive and drug-resistant Escherichia coli: a novel isotropic optical fibre

Background. Orthopaedic oncological pelvic reconstructions have an elevated risk of infection with Gram-negative bacteria. This study evaluates the bactericidal ability of a novel antimicrobial blue light (ABL)-emitting optical fibre on antibiotic-sensitive Escherichi coli (AS-Ec) and ESBL-producing E. coli (ESBL-Ec). Methods. Time-to-kill assays used a 10 ml NaCl solution with a starting inoculum of 1×105 c.f.u. ml-1 for AS-Ec or ESBL-Ec; assays were repeated at least three times per strain. Experimental tubes had either one optical fibre [20.1 mW mm-1; low power (LP)] or two optical fibres [40.3 mW mm-1; high power (HP)], which delivered five wavelengths of ABL over 60 min. Control tubes had no optical fibres. Fifty microlitres of samples taken from each tube at 0, 10, 20, 30 and 60 min were streaked onto agar plates and incubated. c.f.u. ml-1 was determined. Bactericidal reduction was defined as a 99.9% (≥3 log10) reduction in c.f.u. ml-1. One-way ANOVA was conducted. Results. Bactericidal effects were seen for AS-Ec under both LP-ABL and HP-ABL with a log10c.f.u. ml-1±sd difference of 3.44±0.35 (P=0.043) and 3.74±0.21 (P=0.048) at 30 and 20 min, respectively. For ESBL-Ec, while there was a significant reduction in bacterial colony formation, the bactericidal threshold was not reached with a log10c.f.u. ml-1±sd difference of only 1.02±0.41 (P=0.034) and 2.53±0.22 (P=0.037) at 60 min for LP-ABL and HP-ABL, respectively. Conclusions. A novel ABL-emitting optical fibre exhibited bactericidal effects in AS-Ec and a clinically meaningful reduction of ESBL-Ec, providing a promising avenue for the use of ABL as a potential therapy for Gram-negative infections.

Cu-doped calcium phosphate supraparticles for bone tissue regeneration

Calcium phosphate (CaP) minerals have shown great promise as bone replacement materials due to their similarity to the mineral phase of natural bone. In addition to biocompatibility and osseointegration, the prevention of infection is crucial, especially due to the high concern of antibiotic resistance. In this context, a controlled drug release as well as biodegradation are important features which depend on the porosity of CaP. An increase in porosity can be achieved by using nanoparticles (NPs), which can be processed to supraparticles, combining the properties of nano- and micromaterials. In this study, Cu-doped CaP supraparticles were prepared to improve the bone substitute properties while providing antibacterial effects. In this context, a modified sol-gel process was used for the synthesis of CaP NPs, where a Ca/P molar ratio of 1.10 resulted in the formation of crystalline β-tricalcium phosphate (β-TCP) after calcination at 1000 °C. In the next step, CaP NPs with Cu2+ (0.5-15.0 wt%) were processed into supraparticles by a spray drying method. Cu release experiments of the different Cu-doped CaP supraparticles demonstrated a long-term sustained release over 14 days. The antibacterial properties of the supraparticles were determined against Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria, where complete antibacterial inhibition was achieved using a Cu concentration of 5.0 wt%. In addition, cell viability assays of the different CaP supraparticles with human telomerase-immortalized mesenchymal stromal cells (hMSC-TERT) exhibited high biocompatibility with particle concentrations of 0.01 mg mL-1 over 72 hours.

Development of Biocompatible Coatings with PVA/Gelatin Hydrogel Films on Vancomycin-Loaded Titania Nanotubes for Controllable Drug Release

This study investigates the utilization of poly(vinyl alcohol) (PVA)/gelatin hydrogel films cross-linked with glutaraldehyde as a novel material to coat the surface of vancomycin-loaded titania nanotubes (TNTs), with a focus on enhancing biocompatibility and achieving controlled vancomycin release. Hydrogel films have emerged as promising candidates in tissue engineering and drug-delivery systems due to their versatile properties. The development of these hydrogel films involved varying the proportions of PVA, gelatin, and glutaraldehyde to achieve the desired properties, including the gel fraction, swelling behavior, biocompatibility, and biodegradation. Among the formulations tested, the hydrogel with a PVA-to-gelatin ratio of 25:75 and 0.2% glutaraldehyde was selected to coat vancomycin-loaded TNTs. The coated TNTs demonstrated slower release of vancomycin compared with the uncoated TNTs. In addition, the coated TNTs demonstrated the ability to promote osteogenesis, as evidenced by increased alkaline phosphatase activity and calcium accumulation. The vancomycin-loaded TNTs coated with hydrogel film demonstrated effectiveness against both E. coli and S. aureus. These findings highlight the potential benefits and therapeutic applications of using hydrogel films to coat implant materials, offering efficient drug delivery and controlled release. This study contributes valuable insights into the development of alternative materials for medical applications, thereby advancing the field of biomaterials and drug delivery systems.

Electrostatic and Covalent Binding of an Antibacterial Polymer to Hydroxyapatite for Protection against Escherichia coli Colonization

Orthopedic-device-related infections are notorious for causing physical and psychological trauma to patients suffering from them. Traditional methods of treating these infections have relied heavily on antibiotics and are becoming ineffectual due to the rise of antibiotic-resistant bacteria. Mimics of antimicrobial peptides have emerged as exciting alternatives due to their favorable antibacterial properties and lack of propensity for generating resistant bacteria. In this study, the efficacy of an antibacterial polymer as a coating material for hydroxyapatite and glass surfaces, two materials with wide ranging application in orthopedics and the biomedical sciences, is demonstrated. Both physical and covalent modes of attachment of the polymer to these materials were explored. Polymer attachment to the material surfaces was confirmed via X-ray photoelectron spectroscopy and contact angle measurements. The modified surfaces exhibited significant antibacterial activity against the Gram-negative bacterium E. coli, and the activity was retained for a prolonged period on the surfaces of the covalently modified materials.

Fabrication and Characterisation of the Cytotoxic and Antibacterial Properties of Chitosan-Cerium Oxide Porous Scaffolds

Bone damage arising from fractures or trauma frequently results in infection, impeding the healing process and leading to complications. To overcome this challenge, we engineered highly porous chitosan scaffolds (S1, S2, and S3) by incorporating 30 (wt)% iron-doped dicalcium phosphate dihydrate (Fe-DCPD) minerals and different concentrations of cerium oxide nanoparticles (CeO₂) (10 (wt)%, 20 (wt)%, and 30 (wt)%) using the lyophilisation technique. The scaffolds were specifically designed for the controlled release of antibacterial agents and were systematically characterised by utilising Raman spectroscopy, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy methodologies. Alterations in the physicochemical properties, encompassing pore size, swelling behaviour, degradation kinetics, and antibacterial characteristics, were observed with the escalating CeO₂ concentrations. Scaffold cytotoxicity and its impact on human bone marrow mesenchymal stem cell (BM-MSCs) proliferation were assessed employing the 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay. The synthesised scaffolds represent a promising approach for addressing complications associated with bone damage by fostering tissue regeneration and mitigating infection risks. All scaffold variants exhibited inhibitory effects on bacterial growth against Staphylococcus aureus and Escherichia coli strains. The scaffolds manifested negligible cytotoxic effects while enhancing antibacterial properties, indicating their potential for reducing infection risks in the context of bone injuries.

A smart coating with integrated physical antimicrobial and strain-mapping functionalities for orthopedic implants

The prevalence of orthopedic implants is increasing with an aging population. These patients are vulnerable to risks from periprosthetic infections and instrument failures. Here, we present a dual-functional smart polymer foil coating compatible with commercial orthopedic implants to address both septic and aseptic failures. Its outer surface features optimum bioinspired mechano-bactericidal nanostructures, capable of killing a wide spectrum of attached pathogens through a physical process to reduce the risk of bacterial infection, without directly releasing any chemicals or harming mammalian cells. On its inner surface in contact with the implant, an array of strain gauges with multiplexing transistors, built on single-crystalline silicon nanomembranes, is incorporated to map the strain experienced by the implant with high sensitivity and spatial resolution, providing information about bone-implant biomechanics for early diagnosis to minimize the probability of catastrophic instrument failures. Their multimodal functionalities, performance, biocompatibility, and stability are authenticated in sheep posterolateral fusion model and rodent implant infection model.

Characterization and investigation of biological properties of silver nanoparticle-doped hydroxyapatite-based surfaces on zirconium

The infections leading to failed implants can be controlled mainly by metal and metal oxide-based nanoparticles. In this work, the randomly distributed AgNPs-doped onto hydroxyapatite-based surfaces were produced on zirconium by micro arc oxidation (MAO) and electrochemical deposition processes. The surfaces were characterized by XRD, SEM, EDX mapping and EDX area and contact angle goniometer. AgNPs-doped MAO surfaces, which is beneficial for bone tissue growth exhibited hydrophilic behaviors. The bioactivity of the AgNPs-doped MAO surfaces is improved compared to bare Zr substrate under SBF conditions. Importantly, the AgNPs-doped MAO surfaces exhibited antimicrobial activity for E. coli and S. aureus compared to control samples.

ZnO nanoparticle modified chitosan/borosilicate bioglass composite scaffold for inhibiting bacterial infection and promoting bone regeneration

The treatment of implant-associated bone infection remains a significant clinical challenge. However, bone scaffolds with antimicrobial activity and osteoinductive properties can prevent these infections and improve clinical outcomes. In this study, borosilicate bioglass and chitosan composite scaffolds were prepared, and then the surface was modified with nano-zinc oxide. In vitro and in vivo experiments showed that the chitosan/borosilicate bioglass scaffolds have good degradation and osteogenic properties, while the oxidized Zinc scaffolds have better antibacterial properties.

Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria

Gram-negative bacilli can be responsible for prosthetic joint infection (PJI) even if staphylococci are the main involved pathogens. Gram-negative PJIs (GN-PJI) are considered difficult-to-treat infections due to the increase in antimicrobial resistance and biofilm formation. To minimize the risk of infection in cases of arthroplasties with cemented prosthesis, bone cement can be loaded with antibiotics, especially gentamicin. In this study, we aimed to compare the prophylactic antibiofilm activity of ready-to-use antibiotic-loaded bone cements (ALBC), already commercialized or new prototypes. We compared ALBCs containing gentamicin alone, gentamicin plus vancomycin, gentamicin plus clindamycin, gentamicin plus Fosfomycin, and fosfomycin alone, to plain cement (no antibiotic); these comparisons were conducted to investigate the biofilm formation of three strains of Escherichia coli, three strains of Pseudomonas aeruginosa and two strains of Klebsiella pneumoniae, with or without specific resistance to gentamicin or fosfomycin. We reported that ALBC containing gentamicin and clindamycin (COPAL G+C) seems to be the most interesting ALBC of our tested panel for the prevention of biofilm formation by gentamicin-susceptible strains, even if clindamycin is not effective against Gram-negative bacteria. However, gentamicin-resistant strains are still a problem, and further studies are needed to identify an antibiotic to associate with gentamicin for an efficient dual ALBC against Gram-negative bacteria.

Interrelationships between the structural, spectroscopic, and antibacterial properties of nanoscale (< 50 nm) cerium oxides

Bone healing is a complex process, and if not managed successfully, it can lead to non-union, metal-work failure, bacterial infections, physical and psychological patient impairment. Due to the growing urgency to minimise antibiotic dependency, alternative treatment strategies, including the use of nanoparticles, have attracted significant attention. In the present study, cerium oxide nanoparticles (Ce4+, Ce3+) have been selected due to their unique antibacterial redox capability. We found the processing routes affected the agglomeration tendency, particle size distribution, antibacterial potential, and ratio of Ce3+:Ce4+ valence states of the cerium oxide nanoparticles. The antibacterial efficacy of the nanoparticles in the concentration range of 50-200 µg/ml is demonstrated against Escherichia coli, Staphylococcus epidermis, and Pseudomonas aeruginosa by determining the half-maximal inhibitory concentration (IC50). Cerium oxide nanoparticles containing a more significant amount of Ce3+ ions, i.e., FRNP, exhibited 8.5 ± 1.2%, 10.5 ± 4.4%, and 13.8 ± 5.8% increased antibacterial efficacy compared with nanoparticles consisting mainly of Ce4+ ions, i.e., nanoparticles calcined at 815 °C.

Multifunctionality of Nanosized Calcium Apatite Dual-Doped with Li+/Eu3+ Ions Related to Cell Culture Studies and Cytotoxicity Evaluation In Vitro

Li⁺/Eu³⁺ dual-doped calcium apatite analogues were fabricated using a microwave stimulated hydrothermal technique. XRPD, FT-IR, micro-Raman spectroscopy, TEM and SAED measurements indicated that obtained apatites are single-phased, crystallize with a hexagonal structure, have similar morphology and nanometric size as well as show red luminescence. Lithium effectively modifies the local symmetry of optical active sites and, thus, affects the emission efficiency. Moreover, the hydrodynamic size and surface charge of the nanoparticles have been extensively studied. The protein adsorption (lysozyme, LSZ; bovine serum albumin, BSA) on the nanoparticle surface depended on the type of cationic dopant (Li⁺, Eu³⁺) and anionic group (OH⁻, Cl⁻, F⁻) of the apatite matrix. Interaction with LSZ resulted in a positive zeta potential, and the nanoparticles had the lowest hydrodynamic size in this protein medium. The cytotoxicity assessment was carried out on the human osteosarcoma cell line (U2OS), murine macrophages (J774.E), as well as human red blood cells (RBCs). The studied apatites were not cytotoxic to RBCs and J774.E cells; however, at higher concentrations of nanoparticles, cytotoxicity was observed against the U2OS cell line. No antimicrobial activity was detected against Gram-negative bacteria with one exception for P. aeruginosa treated with Li⁺-doped fluorapatite.

Surface bioengineering of diverse orthopaedic implants with optional functions via bioinspired molecular adhesion and bioorthogonal conjugations

In this work, we reported an upgraded mussel-inspired strategy for surface bioengineering of osteoimplants by combination of mussel adhesion and bioorthogonal click chemistry. The main idea of this strategy is a mussel-inspired synthetic peptide containing multiple 3,4-dihydroxy-L-phenylalanine (DOPA) units and a dibenzocyclooctyne (DBCO) terminal (DOPA-DBCO). According to the mussel adhesion mechanism, the DOPA-DBCO peptide could stably adhere onto a variety of material surface, leaving the residual DBCO groups on the surface. Then, the DBCO residues could be employed for a second-step bioorthogonal conjugation with azide-capping biomolecules through bioorthogonal click chemistry, finally leading to the biomodified surfaces. To demonstrate the generality of our strategy for surface biomodification of diversified orthopaedic materials including metallic and polymeric substrates, we here conceptually conjugated some typical azide-capping biomolecules on both metal and polymeric surfaces. The results definitely verified the feasibility for engineering of functional surfaces with some essential requirements of osteoimplants, for example, the ability to facilitate cell adhesion, suppress bacterial infection, and promote osteogenesis. In a word, this study indicated that our novel surface strategy would show broad applicability for diverse osteoimplants and in different biological scenarios. We can also image that the molecular specificity of bioorthogonal conjugation and the universality of mussel adhesion mechanism may jointly provide a versatile surface bioengineering method for a wider range of biomedical implants.

Silk Fibroin-Based Hybrid Nanostructured Coatings for Titanium Implantable Surfaces Modification

This study proposes the development of new architectures that combine nanostructured titanium surface and biodegradable polymers as a promising approach to achieve a better performance after bioactive agent incorporation. The silk fibroin protein that was extracted from silkworm Bombyx mori cocoons is important due to the remarkable characteristics, such as biocompatibility, good mechanical properties, adjustable degradation and drug stabilizing capabilities. The titanium substrate was firstly nanostructurated with TiO2 nanotubes and then coated with silk fibroin using electrospinning and electrochemical deposition. The deposited silk film ability to become a bioactive implant coating with antibacterial properties after the encapsulation of the active agents such as CeO2 was investigated. Important features of the new implant coating were analysed: surface properties, electrochemical stability in physiological simulated electrolytes, and antibacterial action against Escherichia coli. The obtained results indicate that silk fibroin bioactive layers are a potential candidate for regenerative medicine.

Genome Sequence of Escherichia coli KI683, Isolated from a Urosepsis Patient

Escherichia coli KI683 was isolated from blood of a patient who developed septicemia as a complication of a urinary tract infection. Genome sequencing resulted in three contigs with a total genome size of 5,243,173 bp encoding 5,143 genes.

Escherichia coli KI683 was isolated from blood of a patient who developed septicemia as a complication of a urinary tract infection. Genome sequencing resulted in three contigs with a total genome size of 5,243,173 bp encoding 5,143 genes.

Evaluation of antibacterial properties of hydroxyapatite/bioactive glass and fluorapatite/bioactive glass nanocomposite foams as a cellular scaffold of bone tissue

AIMS AND OBJECTIVES:

Infection is a serious problem for patients after implantation surgery, which is difficult to treat with antibiotic therapy. The present study was developed to evaluate and compare the antibacterial properties of hydroxyapatite/bioactive glass (HA/BG) and fluorapatite/bioactive glass (FA/BG) nanocomposite foams as a cellular scaffold for use in bone defects by two macrodilution and disk diffusion methods.

MATERIALS AND METHODS:

Staphylococcus aureus, Enterococcus faecalis, and Streptococcus mutans were cultured in brain heart infusion broth medium with nanocomposite powder for 5 days, and their bioactivity levels were evaluated by daily culturing on solid agar medium plates. To carry out the disk diffusion test, a disc form of nanocomposite foams was used on agar medium with 48 h incubation.

RESULTS:

None of two nanocomposites even at their highest concentration (200 mg/mL) did not prevent the growth of two Staphylococcus aureus and Enterococcus faecalis microorganisms. However, HA/BG nanocomposite on the 3^rd day at a concentration of 200 mg/mL and on 4^th and 5^th day at a concentration of 100 mg/mL and FA/BG nanocomposite on the 4^th day at a concentration of 100 mg/mL and on the 5^th day at a concentration of 50 mg/mL could be able to kill Streptococcus mutans microorganism. In the disc diffusion test, none of the nanocomposites could create a nongrowth zone. Both tested biomaterials showed increased antibacterial properties over time and concentration increase.

CONCLUSION:

HA/BG and FA/BG nanocomposites, due to their biocompatibility and antimicrobial properties, are good choices for implantation instead of damaged bone tissue in tissue engineering.

Antibacterial activity of AgNPs–TiO2 nanotubes: influence of different nanoparticle stabilizers

Enhanced antibacterial properties of nanomaterials such as TiO₂ nanotubes (TNTs) and silver nanoparticles (AgNPs) have attracted much attention in biomedicine and industry. The antibacterial properties of nanoparticles depend, among others, on the functionalization layer of the nanoparticles. However, the more complex information about the influence of different functionalization layers on antibacterial properties of nanoparticle decorated surfaces is still missing. Here we show the array of ∼50 nm diameter TNTs decorated with ∼50 nm AgNPs having different functionalization layers such as polyvinylpyrrolidone, branched polyethyleneimine, citrate, lipoic acid, and polyethylene glycol. To assess the antibacterial properties, the viability of Gram-positive (Staphylococcus aureus) and Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) has been assessed. Our results showed that the functional layer of nanoparticles plays an important role in antibacterial properties and the synergistic effect such nanoparticles and TiO₂ nanotubes have had different effects on adhesion and viability of G⁻ and G⁺ bacteria. These findings could help researchers to optimally design any surfaces to be used as an antibacterial including the implantable titanium biomaterials.

Synergictic antibacterial effect of AgNPs–TiO₂ nanotubes is influenced by different nanoparticle stabilizers.

Complete zwitterionic double network hydrogels with great toughness and resistance against foreign body reaction and thrombus

A new methodology for developing biocompatible double network hydrogels by using a responsive amphoteric polymer as a first framework.

Silver Doping Mechanism in Bioceramics—From Ag+: Doped HAp to Ag°/BCP Nanocomposite

The results presented in this paper, based on the powder X-ray diffraction technique followed by Rietveld analyses, are devoted to the mechanism of silver incorporation in biphasic calcium phosphates. Results were confirmed by SEM observation. Samples were synthesized via the sol-gel route, followed by heat treatments. Two incorporation sites were highlighted: Ca2+ replacement by Ag+ into the calcium phosphates (HAp: hydroxyapatite and β-TCP: tricalcium phosphate), and the other as metallic silver Ag° nanoparticles (formed by autogenous reduction). The samples obtained were thus nanocomposites, written Ag°/BCP, composed of closely-mixed Ag° particles of about 100 nm at 400 °C (which became micrometric upon heating) and calcium phosphates, themselves substituted by Ag+ cations. Between 400 °C and 700 °C the cationic silver part was mainly located in the HAp phase of the composition Ca10-xAgx(PO4)6(OH)2-x (written Ag+: HAp). From 600 °C silver cations migrated to β-TCP to form the definite compound Ca10Ag(PO4)7 (written Ag+: TCP). Due to the melting point of Ag°, the doping element completely left our sample at temperatures above 1000 °C. In order to correctly understand the biological behavior of such material, which is potentially interesting for biomaterial applications, its complex doping mechanism should be taken into consideration for subsequent cytotoxic and bacteriologic studies.

Lytic bacteriophages against multidrug-resistant Staphylococcus aureus, Enterococcus faecalis and Escherichia coli isolates from orthopaedic implant-associated infections

Orthopaedic implant-associated infections are a devastating complication of orthopaedic surgery with a significant impact on patients and healthcare systems. The aims of this work were to describe the patterns of antimicrobial resistance, pathogenicity and virulence of clinical bacterial isolates from orthopaedic implant-associated infections and to further isolate and characterise bacteriophages that are efficient in controlling these bacteria. Staphylococcus aureus, Enterococcus faecalis and Escherichia coli isolated from orthopaedic infections showed multiresistance patterns to the most frequently used antibiotics in clinical settings. The presence of mobile genetic elements (mecA, Tn916/Tn1545 and intl1) and virulence determinants (icaB, cna, hlb, cylLs, cylM, agg, gelE, fsr and fimA) highlighted the pathogenicity of these isolates. Moreover, the isolates belonged to clonal complexes associated with the acquisition of pathogenicity islands and antimicrobial resistance genes by recombination and horizontal gene transfer. Bacteriophages vB_SauM_LM12, vB_EfaS_LM99 and vB_EcoM_JB75 were characterised and their ability to infect clinical isolates of S. aureus, E. faecalis and E. coli, respectively, was assessed. Morphological and genomic analyses revealed that vB_EfaS_LM99 and vB_EcoM_JB75 belong to the Siphoviridae and Myoviridae families, respectively, and no genes associated with lysogeny were found. The bacteriophages showed low latent periods, high burst sizes, broad host ranges and tolerance to several environmental conditions. Moreover, they showed high efficiency and specificity to infect and reduce clinical bacteria, including methicillin-resistant S. aureus and vancomycin-resistant enterococci. Therefore, the results obtained suggest that the bacteriophages used in this work are a promising approach to control these pathogens involved in orthopaedic implant-associated infections.

Multifunctional biophotonic nanostructures inspired by the longtail glasswing butterfly for medical devices

Numerous living organisms possess biophotonic nanostructures that provide colouration and other diverse functions for survival. While such structures have been actively studied and replicated in the laboratory, it remains unclear whether they can be used for biomedical applications. Here, we show a transparent photonic nanostructure inspired by the longtail glasswing butterfly (Chorinea faunus) and demonstrate its use in intraocular pressure (IOP) sensors in vivo. We exploit the phase separation between two immiscible polymers (poly(methyl methacrylate) and polystyrene) to form nanostructured features on top of a Si3N4 substrate. The membrane thus formed shows good angle-independent white-light transmission, strong hydrophilicity and anti-biofouling properties, which prevent adhesion of proteins, bacteria and eukaryotic cells. We then developed a microscale implantable IOP sensor using our photonic membrane as an optomechanical sensing element. Finally, we performed in vivo testing on New Zealand white rabbits, which showed that our device reduces the mean IOP measurement variation compared with conventional rebound tonometry without signs of inflammation.

Poultry hatcheries as potential reservoirs for antimicrobial-resistant Escherichia coli: A risk to public health and food safety

Hatcheries have the power to spread antimicrobial resistant (AMR) pathogens through the poultry value chain because of their central position in the poultry production chain. Currently, no information is available about the presence of AMR Escherichia coli strains and the antibiotic resistance genes (ARGs) they harbor within hatchezries. Therefore, this study aimed to investigate the possible involvement of hatcheries in harboring hemolytic AMR E. coli. Serotyping of the 65 isolated hemolytic E. coli revealed 15 serotypes with the ability to produce moderate biofilms, and shared susceptibility to cephradine and fosfomycin and resistance to spectinomycin. The most common β-lactam resistance gene was bla_TEM, followed by bla_OXA-1, bla_MOX-like_,bla_CIT-like_,bla_SHV and bla_FOX. Hierarchical clustering of E. coli isolates based on their phenotypic and genotypic profiles revealed separation of the majority of isolates from hatchlings and the hatchery environments, suggesting that hatchling and environmental isolates may have different origins. The high frequency of β-lactam resistance genes in AMR E. coli from chick hatchlings indicates that hatcheries may be a reservoir of AMR E. coli and can be a major contributor to the increased environmental burden of ARGs posing an eminent threat to poultry and human health.

Antibacterial forsterite (Mg2SiO4) scaffold: A promising bioceramic for load bearing applications

In the current work, forsterite samples with different surface area were investigated for its antibacterial activity. Dissolution studies show that the lower degradation of forsterite compared to other silicate bioceramics, which is a desirable property for repairing bone defects. Forsterite scaffold shows superior compressive strength than the cortical bone after immersion in simulated body fluid. Bactericidal tests indicate that the forsterite had inhibition effect on the growth of clinical bacterial isolates. Forsterite may be a suitable candidate material for load bearing applications with enhanced mechanical properties and lower degradation rate.

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Forsterite with higher surface area shows better degradation, mechanical stability and antibacterial activity.

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The compressive strength of forsterite is similar to that of cortical bone.

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The dissolution of Mg²⁺ ion and change in pH are responsible for antibacterial activity of forsterite.

Synthesis of silver nanoparticle-decorated hydroxyapatite (HA@Ag) poriferous nanocomposites and the study of their antibacterial activities

Herein, we demonstrate a facile and green rapid approach for the synthesis of uniform poriferous hydroxylapatite [Ca₁₀(PO₄)₆(OH)₂, HA] and poriferous silver nanoparticle (Ag NPs)-decorated hydroxylapatite (HA@Ag) nanocomposites with excellent antibacterial properties. All the nanocomposites were fully characterized in the solid state via various techniques such as X-ray powder diffraction (XRD), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), automatic specific surface area and porosity analysis (BET) and field emission scanning electron microscopy (FESEM). The results show that HA has a porous rod-like structure, which the HA@Ag nanocomposites retained, and the surface of HA was loaded with globular-like Ag NPs with an average diameter of about 5.8 nm, which exhibit a well-crystalline state. The experimental parameters such as pH, the molar ratio of HA and Tollens' reagent, and reductant have a significant effect on the size and distribution of the Ag NPs. Moreover, the antimicrobial activities of HA and HA@Ag against Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) were evaluated via broth dilution, filter paper diffusion, optical density (OD₆₀₀) and electron microscopy observation. The as-prepared HA@Ag nanocomposites exhibit excellent antibacterial activities, especially for S. aureus. The minimum inhibition concentration (MIC) of HA@Ag is only 3.9 μg mL⁻¹.

We demonstrate a facile and green rapid approach for the synthesis of uniform poriferous hydroxylapatite (HA) and poriferous silver nanoparticles (Ag NPs)-decorated hydroxylapatite (HA@Ag) nanocomposites with excellent antibacterial properties.

Bacteriostatic behavior of surface modulated silicon nitride in comparison to polyetheretherketone and titanium

Perioperative and latent infections are leading causes of revision surgery for orthopaedic devices resulting in significant increased patient care, comorbidities, and attendant costs. Identifying biomaterial surfaces that inherently resist biofilm adhesion and bacterial expression is an important emerging strategy in addressing implant-related infections. This in vitro study was designed to compare biofilm formation on three biomaterials commonly employed in spinal fusion surgery-silicon nitride (Si₃ N₄ ), polyetheretherketone (PEEK), and a titanium alloy (Ti6Al4V-ELI) -using one gram-positive and one gram-negative bacterial species. Disc samples from various surface treated Si₃ N₄ , PEEK, and Ti6Al4V were inoculated with 10⁵ CFU/mm² Staphylococcus epidermidis (ATCC®14990™) or Escherichia coli (ATCC^® 25922™) and cultured in PBS, 7% glucose, and 10% human plasma for 24 and 48 h, followed by retrieval and rinsing. Vortexed solutions were diluted, plated, and incubated at 37 °C for 24 to 48 h. Colony forming units (CFU/mm² ) were determined using applicable dilution factors and surface areas. A two-tailed, heteroscedastic Student's t-test (95% confidence) was used to determine statistical significance. The various Si₃ N₄ samples showed the most favorable bacterial resistance for both bacilli tested. The mechanisms for the bacteriostatic behavior of Si₃ N₄ are likely due to multivariate surface effects including submicron-topography, negative charging, and chemical interactions which form peroxynitrite (an oxidative agent). Si₃ N₄ is a new biomaterial with the apparent potential to inhibit biofilm formation. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1521-1534, 2017.

Combinatorial MAPLE deposition of antimicrobial orthopedic maps fabricated from chitosan and biomimetic apatite powders

Chitosan/biomimetic apatite thin films were grown in mild conditions of temperature and pressure by Combinatorial Matrix-Assisted Pulsed Laser Evaporation on Ti, Si or glass substrates. Compositional gradients were obtained by simultaneous laser vaporization of the two distinct material targets. A KrF* excimer (λ=248nm, τFWHM=25ns) laser source was used in all experiments. The nature and surface composition of deposited materials and the spatial distribution of constituents were studied by SEM, EDS, AFM, GIXRD, FTIR, micro-Raman, and XPS. The antimicrobial efficiency of the chitosan/biomimetic apatite layers against Staphylococcus aureus and Escherichia coli strains was interrogated by viable cell count assay. The obtained thin films were XRD amorphous and exhibited a morphology characteristic to the laser deposited structures composed of nanometric round shaped grains. The surface roughness has progressively increased with chitosan concentration. FTIR, EDS and XPS analyses indicated that the composition of the BmAp-CHT C-MAPLE composite films gradually modified from pure apatite to chitosan. The bioevaluation tests indicated that S. aureus biofilm is more susceptible to the action of chitosan-rich areas of the films, whilst the E. coli biofilm proved more sensible to areas containing less chitosan. The best compromise should therefore go, in our opinion, to zones with intermediate-to-high chitosan concentration which can assure a large spectrum of antimicrobial protection concomitantly with a significant enhancement of osseointegration, favored by the presence of biomimetic hydroxyapatite.

Concentration-dependent behaviors of bone marrow derived mesenchymal stem cells and infectious bacteria toward magnesium oxide nanoparticles

This article reports the quantitative relationship between the concentration of magnesium oxide (MgO) nanoparticles and its distinct biological activities towards mammalian cells and infectious bacteria for the first time. The effects of MgO nanoparticles on the viability of bone marrow derived mesenchymal stem cells (BMSCs) and infectious bacteria (both gram-negative Escherichia coli and gram-positive Staphylococcus epidermidis) showed a concentration-dependent behavior in vitro. The critical concentrations of MgO nanoparticles identified in this study provided valuable guidelines for biomaterial design toward potential clinical translation. BMSCs density increased significantly when cultured in 200μg/mL of MgO in comparison to the Cells Only control without MgO. The density of BMSCs decreased significantly after culture in the media with 500μg/mL or more of MgO. Concentrations at or above 1000μg/mL of MgO resulted in complete BMSCs death. Quantification of colony forming units (CFU) revealed that the minimum bactericidal concentration (MBC) of MgO for E. coli and S. epidermidis was 1200μg/mL. The addition of MgO nanoparticles into the cultures increased the pH and Mg(2+) ion concentration in the respective culture media, which might have played a role in the observed cell responses but not the main factors. E. coli and S. epidermidis still proliferated significantly at alkaline pH up to 10 or with supplemental Mg(2+) dosages up to 50mM, indicating bactericidal properties of MgO are beyond the effects of increased media pH and Mg(2+) ion concentrations. MgO nanoparticles at a concentration of 200μg/mL provided dual benefits of promoting BMSC proliferation while reducing bacterial adhesion, which should be further studied for potential medical implant applications. The use of free MgO nanoparticles yielded detrimental effects to BMSCs in concentrations above 300μg/mL. We recommend further study into MgO nanoparticle as a coating material or as a part of a composite.

STATEMENT OF SIGNIFICANCE

This article reports the quantitative relationship between the concentration of magnesium oxide (MgO) nanoparticles and its distinct biological activities towards mammalian cells and infectious bacteria for the first time. The effects of MgO nanoparticles on the viability of bone marrow derived mesenchymal stem cells (BMSCs) and infectious bacteria (both gram-negative Escherichia coli and gram-positive Staphylococcus epidermidis) showed a concentration-dependent behavior in vitro. The critical concentrations of MgO nanoparticles identified in this study provided valuable guidelines for biomaterial design toward potential clinical translation.

Innate immune evasion of Escherichia coli clinical strains from orthopedic implant infections

Escherichia coli is one of the first causes of Gram-negative orthopedic implant infections (OII). Those infections, usually hematogenous, mostly originate from the urinary tract. We investigated the strategies developed by E. coli in this context to evade host innate immune responses, i.e. complement and polymorphonuclear neutrophils (PMN). Twenty strains from OII were compared with 20 strains from bacteremia in patients with non-infected orthopedic implant. In both groups, 6/20 (30 %) strains lysed PMNs, due to the production of the pore-forming toxin α-hemolysin (HlyA). For the others, resistance to phagocytic killing by PMN was not significantly different between both groups. In contrast, resistance to complement-mediated serum killing was significantly higher in OII strains than in the others (65 % vs 10 %; P <0.001). In E. coli, different mechanisms have been involved in complement resistance. Here, serum resistance was not linked to a group 2 capsule, or a loss of outer membrane permeability, or the recruitment of the complement inhibitor C4bp, but was significantly associated with the synthesis of long-chain LPS, regardless of the O-antigen. Thus, serum resistance could promote seeding of peri-implant tissues by helping E. coli to either persist in blood and reach the site of infection or overcome localized complement activation.

Preparation and characterization of novel Ag doped hydroxyapatite–Fe3O4–chitosan hybrid composites and in vitro biological evaluations for orthopaedic applications

Graphical abstract of novel 5%@Ag:HAP–Fe₃O₄–CS hybrid composites and biological investigations.

Pathogenic potential of Escherichia coli clinical strains from orthopedic implant infections towards human osteoblastic cells

Escherichia coli is one of the first causes of Gram-negative orthopedic implant infections (OII), but little is known about the pathogenicity of this species in such infections that are increasing due to the ageing of the population. We report how this pathogen interacts with human osteoblastic MG-63 cells in vitro, by comparing 20 OII E. coli strains to two Staphylococcus aureus and two Pseudomonas aeruginosa strains. LDH release assay revealed that 6/20 (30%) OII E. coli induced MG-63 cell lysis whereas none of the four control strains was cytotoxic after 4 h of coculture. This high cytotoxicity was associated with hemolytic properties and linked to hlyA gene expression. We further showed by gentamicin protection assay and confocal microscopy that the non-cytotoxic E. coli were not able to invade MG-63 cells unlike S. aureus strains (internalization rate <0.01% for the non-cytotoxic E. coli versus 8.88 ± 2.31% and 4.60 ± 0.42% for both S. aureus). The non-cytotoxic E. coli also demonstrated low adherence rates (<7%), the most adherent E. coli eliciting higher IL-6 and TNF-α mRNA expression in the osteoblastic cells. Either highly cytotoxic or slightly invasive OII E. coli do not show the same infection strategies as S. aureus towards osteoblasts.

Biofilm formation by clinical isolates and its relevance to clinical infections

Reports of biofilms have increased exponentially in the scientific literature over the past two decades, yet the vast majority of these are basic science investigations with limited clinical relevance. Biofilm studies involving clinical isolates are most often surveys of isolate collections, but suffer from lack of standardization in methodologies for producing and assessing biofilms. In contrast, more informative clinical studies correlating biofilm formation to patient data have infrequently been reported. In this chapter, biofilm surveys of clinical isolates of aerobic and anaerobic bacteria, mycobacteria, and Candida are reviewed, as well as those pertaining to the unique situation of cystic fibrosis. In addition, the influence of host components on in vitro biofilm formation, as well as published studies documenting the clinical impact of biofilms in human infections, are presented.

Potentially pathogenic Escherichia coli can form a biofilm under conditions relevant to the food production chain

The biofilm-producing abilities of potentially human-pathogenic serotypes of Escherichia coli from the ovine reservoir were studied at different temperatures and on different surfaces. A possible influence of the hydrophobicity of the bacterial cells, as well as the presence of two virulence factors, the Shiga toxin-encoding (Stx) bacteriophage and the eae gene, was also studied. A total of 99 E. coli isolates of serotypes O26:H11, O103:H2, and O103:H25 isolated from sheep feces were included. The results show that isolates of all three E. coli serotypes investigated can produce biofilm on stainless steel, glass, and polystyrene at 12, 20, and 37°C. There was a good general correlation between the results obtained on the different surfaces. E. coli O103:H2 isolates produced much more biofilm than those of the other two serotypes at all three temperatures. In addition, isolates of serotype O26:H11 produced more biofilm than those of O103:H25 at 37°C. The hydrophobicity of the isolates varied between serotypes and was also influenced by temperature. The results strongly indicated that hydrophobicity influenced the attachment of the bacteria rather than their ability to form biofilm once attached. Isolates with the eae gene produced less biofilm at 37°C than isolates without this gene. The presence of a Stx bacteriophage did not influence biofilm production. In conclusion, our results show that potentially human-pathogenic E. coli from the ovine reservoir can form biofilm on various surfaces and at several temperatures relevant for food production and handling.

Propionibacterium acnes: an underestimated pathogen in implant-associated infections

The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.

Activities of fosfomycin, tigecycline, colistin, and gentamicin against extended-spectrum-β-lactamase-producing Escherichia coli in a foreign-body infection model

Limited antimicrobial agents are available for the treatment of implant-associated infections caused by fluoroquinolone-resistant Gram-negative bacilli. We compared the activities of fosfomycin, tigecycline, colistin, and gentamicin (alone and in combination) against a CTX-M15-producing strain of Escherichia coli (Bj HDE-1) in vitro and in a foreign-body infection model. The MIC and the minimal bactericidal concentration in logarithmic phase (MBC(log)) and stationary phase (MBC(stat)) were 0.12, 0.12, and 8 μg/ml for fosfomycin, 0.25, 32, and 32 μg/ml for tigecycline, 0.25, 0.5, and 2 μg/ml for colistin, and 2, 8, and 16 μg/ml for gentamicin, respectively. In time-kill studies, colistin showed concentration-dependent activity, but regrowth occurred after 24 h. Fosfomycin demonstrated rapid bactericidal activity at the MIC, and no regrowth occurred. Synergistic activity between fosfomycin and colistin in vitro was observed, with no detectable bacterial counts after 6 h. In animal studies, fosfomycin reduced planktonic counts by 4 log(10) CFU/ml, whereas in combination with colistin, tigecycline, or gentamicin, it reduced counts by >6 log(10) CFU/ml. Fosfomycin was the only single agent which was able to eradicate E. coli biofilms (cure rate, 17% of implanted, infected cages). In combination, colistin plus tigecycline (50%) and fosfomycin plus gentamicin (42%) cured significantly more infected cages than colistin plus gentamicin (33%) or fosfomycin plus tigecycline (25%) (P < 0.05). The combination of fosfomycin plus colistin showed the highest cure rate (67%), which was significantly better than that of fosfomycin alone (P < 0.05). In conclusion, the combination of fosfomycin plus colistin is a promising treatment option for implant-associated infections caused by fluoroquinolone-resistant Gram-negative bacilli.

Biofilm formation by clinical isolates and the implications in chronic infections

Background

Biofilm formation is a major virulence factor contributing to the chronicity of infections. To date few studies have evaluated biofilm formation in infecting isolates of patients including both Gram-positive and Gram-negative multidrug-resistant (MDR) species in the context of numerous types of infectious syndromes. Herein, we investigated the biofilm forming capacity in a large collection of single patient infecting isolates and compared the relationship between biofilm formation to various strain characteristics.

Methods

The biofilm-forming capacity of 205 randomly sampled clinical isolates from patients, collected from various anatomical sites, admitted for treatment at Brooke Army Medical Center (BAMC) from 2004–2011, including methicillin-resistant/methicillin susceptible Staphylococcus aureus (MRSA/MSSA) (n=23), Acinetobacter baumannii (n=53), Pseudomonas aeruginosa (n=36), Klebsiella pneumoniae (n=54), and Escherichia coli (n=39), were evaluated for biofilm formation using the high-throughput microtiter plate assay and scanning electron microscopy (SEM). Relationships between biofilm formation to clonal type, site of isolate collection, and MDR phenotype were evaluated. Furthermore, in patients with relapsing infections, serial strains were assessed for their ability to form biofilms in vitro.

Results

Of the 205 clinical isolates tested, 126 strains (61.4%) were observed to form biofilms in vitro at levels greater than or equal to the Staphylococcus epidermidis, positive biofilm producing strain, with P. aeruginosa and S. aureus having the greatest number of biofilm producing strains. Biofilm formation was significantly associated with specific clonal types, the site of isolate collection, and strains positive for biofilm formation were more frequently observed to be MDR. In patients with relapsing infections, the majority of serial isolates recovered from these individuals were observed to be strong biofilm producers in vitro.

Conclusions

This study is the first to evaluate biofilm formation in a large collection of infecting clinical isolates representing diverse types of infections. Our results demonstrate: (1) biofilm formation is a heterogeneous property amongst clinical strains which is associated with certain clonal types, (2) biofilm forming strains are more frequently isolated from non-fluid tissues, in particular bone and soft tissues, (3) MDR pathogens are more often biofilm formers, and (4) strains from patients with persistent infections are positive for biofilm formation.

Detection of clonally related Escherichia coli isolates producing different CMY β-lactamases from a cystic fibrosis patient

OBJECTIVES

This study reports details on Escherichia coli isolates recovered from a cystic fibrosis (CF) patient in order to understand how this pathogen adapts to and resists broad-spectrum antipseudomonal therapy in this context.

METHODS

Five E. coli isolates were obtained from various clinical samples (airways, urine or dialysis catheter) over a 7 month period covering a double-lung transplantation. All isolates were analysed in terms of clonality [enterobacterial repetitive intergenic consensus (ERIC)-PCR and multilocus sequence typing], virulence profiles (phylogroup and search for 15 virulence genes), growth patterns (morphotype, biofilm-forming ability and growth rate), hypermutability and antimicrobial susceptibility, with molecular characterization of β-lactamases and porins.

RESULTS

The five isolates shared similar ERIC-PCR profiles and sequence types (ST1193) and exhibited the same virulence profile. The respiratory isolates were strong mutators, exhibited mucoid or small-colony morphotypes, exhibited strong biofilm-forming ability and grew slowly compared with the others. All isolates were highly resistant to ceftazidime. The respiratory isolates showed reduced susceptibility to cefepime and high resistance to aztreonam. The patient had received a 31 day course of ceftazidime/aztreonam until transplantation. All isolates harboured the same wild-type chromosomal AmpC. A CMY-2 enzyme was detected in the non-respiratory isolates. The respiratory isolates harboured L293S and V211A/L293S new CMY-2 variants, which were designated CMY-94 and CMY-95, respectively. OmpF porin loss was observed in the non-respiratory isolates.

CONCLUSIONS

Our study shows that, similarly to Pseudomonas aeruginosa, E. coli can undergo phenotypic and genomic changes in the CF context. For the first time, we identified an in vivo expanded-spectrum evolution of the CMY-2 β-lactamase, during bacterial persistence in the CF lung.

Ocorrência e fatores de risco para infecção de sítio cirúrgico em cirurgias ortopédicas

OBJETIVO: Analisar a ocorrência e os fatores de risco para infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas. MÉTODOS: Estudo transversal prospectivo com 93 pacientes submetidos a cirurgias ortopédicas eletivas e limpas. RESULTADOS: A infecção de sítio cirúrgico foi diagnosticada em 16 pacientes (17,2%). Na análise dos dados, após ajuste do modelo de regressão logística binária, apenas a variável tempo total de internação mostrou-se com relação estatisticamente significativa com a presença ou não de infecção. CONCLUSÃO: A ocorrência de infecção de sítio cirúrgico em cirurgia ortopédica foi mais elevada, sendo 75% dos casos diagnosticados após a alta hospitalar, resultado que reforça a necessidade da vigilância pós-alta.

Enhanced adhesion of Campylobacter jejuni to abiotic surfaces is mediated by membrane proteins in oxygen-enriched conditions

Campylobacter jejuni is responsible for the major foodborne bacterial enteritis in humans. In contradiction with its fastidious growth requirements, this microaerobic pathogen can survive in aerobic food environments, suggesting that it must employ a variety of protection mechanisms to resist oxidative stress. For the first time, C. jejuni 81-176 inner and outer membrane subproteomes were analyzed separately using two-dimensional protein electrophoresis (2-DE) of oxygen-acclimated cells and microaerobically grown cells. LC-MS/MS analyses successfully identified 42 and 25 spots which exhibited a significantly altered abundance in the IMP-enriched fraction and in the OMP-enriched fraction, respectively, in response to oxidative conditions. These spots corresponded to 38 membrane proteins that could be grouped into different functional classes: (i) transporters, (ii) chaperones, (iii) fatty acid metabolism, (iv) adhesion/virulence and (v) other metabolisms. Some of these proteins were up-regulated at the transcriptional level in oxygen-acclimated cells as confirmed by qRT-PCR. Downstream analyses revealed that adhesion of C. jejuni to inert surfaces and swarming motility were enhanced in oxygen-acclimated cells or paraquat-stressed cells, which could be explained by the higher abundance of membrane proteins involved in adhesion and biofilm formation. The virulence factor CadF, over-expressed in the outer membrane of oxygen-acclimated cells, contributes to the complex process of C. jejuni adhesion to inert surfaces as revealed by a reduction in the capability of C. jejuni 81-176 ΔCadF cells compared to the isogenic strain.Taken together, these data demonstrate that oxygen-enriched conditions promote the over-expression of membrane proteins involved in both the biofilm initiation and virulence of C. jejuni.