Microfluidic Shear Assay to Distinguish between Bacterial Adhesion and Attachment Strength on Stiffness-Tunable Silicone Substrates

Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections

SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.

Microfluidics for Biofilm Studies

Biofilms are multicellular communities held together by a self-produced extracellular matrix and exhibit a set of properties that distinguish them from free-living bacteria. Biofilms are exposed to a variety of mechanical and chemical cues resulting from fluid motion and mass transport. Microfluidics provides the precise control of hydrodynamic and physicochemical microenvironments to study biofilms in general. In this review, we summarize the recent progress made in microfluidics-based biofilm research, including understanding the mechanism of bacterial adhesion and biofilm development, assessment of antifouling and antimicrobial properties, development of advanced in vitro infection models, and advancement in methods to characterize biofilms. Finally, we provide a perspective on the future direction of microfluidics-assisted biofilm research.

Antibacterial features of material surface: strong enough to serve as antibiotics?

Bacteria are small but need big efforts to control. The use of antibiotics not only produces superbugs that are increasingly difficult to inactivate, but also raises environmental concerns with the growing consumption. It is now believed that the antibacterial task can count on some physiochemical features of material surfaces, which can be anti-adhesive or bactericidal without releasing toxicants. It is necessary to evaluate to what extent can we rely on the surface design since the actual application scenarios will need the antibacterial performance to be sharp, robust, environmentally friendly, and long-lasting. Herein, we review the recent laboratory advances that have been classified based on the specific surface features, including hydrophobicity, charge potential, micromorphology, stiffness and viscosity, and photoactivity, and the antibacterial mechanisms of each feature are included to provide a basic rationale for future design. The significance of anti-biofilms is also introduced, given the big role of biofilms in bacteria-caused damage. A perspective on the potential wide application of antibacterial surface features as a substitute or supplement to antibiotics is then discussed. Surface design is no doubt a solution worthy to explore, and future success will be a result of further progress in multiple directions, including mechanism study and material preparation.

Effect of surface stiffness in initial adhesion of oral microorganisms under various environmental conditions

Biofilms are three-dimensional structures formed as a result of microorganism's adhesion on a biotic or abiotic surface. Once a biofilm is established, it is onerous to eradicate it or kill the pathogens therein. Thus, targeting the microbial adhesion process, the initial stage of biofilm formation, is a reasonable approach to avoid challenges associated with subsequently formed biofilms. While many properties of interacting material that play significant roles in initial bacterial adhesion have been widely studied, the effect of surface stiffness on bacterial adhesion was relatively underexplored. In this study, we aimed to investigate the effect of surface stiffness on the adhesion of microbial species found in the oral cavity by employing representative oral bacteria, Streptococcus mutans and Streptococcus oralis, and the fungus, Candida albicans. We compared the adhesion behavior of these species alone or in combination toward various surface stiffness (0.06 - 3.01 MPa) by assessing the adhered and planktonic cell numbers at an early (4 h) adhesion stage under various carbon sources and the presence of conditioning film. Our data revealed that in general, a higher amount of microbial cells adhered to softer PDMS surfaces than stiffer ones, which indicates that surface stiffness plays a role in the adhesion of tested species (either single or co-cultured). This pattern was more obvious under sucrose conditions than glucose + fructose conditions. Interestingly, in monospecies, saliva coating did not alter the effect of surface stiffness on S. mutans adhesion while it diminished S. oralis and C. albicans adhesion. However, in the multispecies model, saliva coating rendered the percentage of all adhered microbes to varied PDMS not distinct. The data provide new insights into the role of surface stiffness on microbial mechanosensing and their initial adhesion behavior which may set a scientific foundation for future anti-adhesion strategies.

Designs and methodologies to recreate in vitro human gut microbiota models

The human gut microbiota is widely considered to be a metabolic organ hidden within our bodies, playing a crucial role in the host’s physiology. Several factors affect its composition, so a wide variety of microbes residing in the gut are present in the world population. Individual excessive imbalances in microbial composition are often associated with human disorders and pathologies, and new investigative strategies to gain insight into these pathologies and define pharmaceutical therapies for their treatment are needed. In vitro models of the human gut microbiota are commonly used to study microbial fermentation patterns, community composition, and host-microbe interactions. Bioreactors and microfluidic devices have been designed to culture microorganisms from the human gut microbiota in a dynamic environment in the presence or absence of eukaryotic cells to interact with. In this review, we will describe the overall elements required to create a functioning, reproducible, and accurate in vitro culture of the human gut microbiota. In addition, we will analyze some of the devices currently used to study fermentation processes and relationships between the human gut microbiota and host eukaryotic cells.

Graphic abstract

Escherichia coli Biofilm Formation, Motion and Protein Patterns on Hyaluronic Acid and Polydimethylsiloxane Depend on Surface Stiffness

The surface stiffness of the microenvironment is a mechanical signal regulating biofilm growth without the risks associated with the use of bioactive agents. However, the mechanisms determining the expansion or prevention of biofilm growth on soft and stiff substrates are largely unknown. To answer this question, we used PDMS (polydimethylsiloxane, 9-574 kPa) and HA (hyaluronic acid gels, 44 Pa-2 kPa) differing in their hydration. We showed that the softest HA inhibited Escherichia coli biofilm growth, while the stiffest PDMS activated it. The bacterial mechanical environment significantly regulated the MscS mechanosensitive channel in higher abundance on the least colonized HA-44Pa, while Type-1 pili (FimA) showed regulation in higher abundance on the most colonized PDMS-9kPa. Type-1 pili regulated the free motion (the capacity of bacteria to move far from their initial position) necessary for biofilm growth independent of the substrate surface stiffness. In contrast, the total length travelled by the bacteria (diffusion coefficient) varied positively with the surface stiffness but not with the biofilm growth. The softest, hydrated HA, the least colonized surface, revealed the least diffusive and the least free-moving bacteria. Finally, this shows that customizing the surface elasticity and hydration, together, is an efficient means of affecting the bacteria's mobility and attachment to the surface and thus designing biomedical surfaces to prevent biofilm growth.

A high-throughput integrated biofilm-on-a-chip platform for the investigation of combinatory physicochemical responses to chemical and fluid shear stress

Physicochemical conditions play a key role in the development of biofilm removal strategies. This study presents an integrated, double-layer, high-throughput microfluidic chip for real-time screening of the combined effect of antibiotic concentration and fluid shear stress (FSS) on biofilms. Biofilms of Escherichia coli LF82 and Pseudomonas aeruginosa were tested against gentamicin and streptomycin to examine the time dependent effects of concentration and FSS on the integrity of the biofilm. A MatLab image analysis method was developed to measure the bacterial surface coverage and total fluorescent intensity of the biofilms before and after each treatment. The chip consists of two layers. The top layer contains the concentration gradient generator (CGG) capable of diluting the input drug linearly into four concentrations. The bottom layer contains four expanding FSS chambers imposing three different FSSs on cultured biofilms. As a result, 12 combinatorial states of concentration and FSS can be investigated on the biofilm simultaneously. Our proof-of-concept study revealed that the reduction of E. coli biofilms was directly dependent upon both antibacterial dose and shear intensity, whereas the P. aeruginosa biofilms were not impacted as significantly. This confirmed that the effectiveness of biofilm removal is dependent on bacterial species and the environment. Our experimental system could be used to investigate the physicochemical responses of other biofilms or to assess the effectiveness of biofilm removal methods.

Mussel‐Inspired Biomaterials: From Chemistry to Clinic

After several billions of years, nature still makes decisions on its own to identify, develop, and direct the most effective material for phenomena/challenges faced. Likewise, and inspired by the nature, we learned how to take steps in developing new technologies and materials innovations. Wet and strong adhesion by Mytilidae mussels (among which Mytilus edulis—blue mussel and Mytilus californianus—California mussel are the most well‐known species) has been an inspiration in developing advanced adhesives for the moist condition. The wet adhesion phenomenon is significant in designing tissue adhesives and surgical sealants. However, a deep understanding of engaged chemical moieties, microenvironmental conditions of secreted proteins, and other contributing mechanisms for outstanding wet adhesion mussels are essential for the optimal design of wet glues. In this review, all aspects of wet adhesion of Mytilidae mussels, as well as different strategies needed for designing and fabricating wet adhesives are discussed from a chemistry point of view. Developed muscle‐inspired chemistry is a versatile technique when designing not only wet adhesive, but also, in several more applications, especially in the bioengineering area. The applications of muscle‐inspired biomaterials in various medical applications are summarized for future developments in the field.

Fluid Flow Induces Differential Detachment of Live and Dead Bacterial Cells from Nanostructured Surfaces

Nanotopographic surfaces are proven to be successful in killing bacterial cells upon contact. This non-chemical bactericidal property has paved an alternative way of fighting bacterial colonization and associated problems, especially the issue of bacteria evolving resistance against antibiotic and antiseptic agents. Recent advancements in nanotopographic bactericidal surfaces have made them suitable for many applications in medical and industrial sectors. The bactericidal effect of nanotopographic surfaces is classically studied under static conditions, but the actual potential applications do have fluid flow in them. In this study, we have studied how fluid flow can affect the adherence of bacterial cells on nanotopographic surfaces. Gram-positive and Gram-negative bacterial species were tested under varying fluid flow rates for their retention and viability after flow exposure. The total number of adherent cells for both species was reduced in the presence of flow, but there was no flowrate dependency. There was a significant reduction in the number of live cells remaining on nanotopographic surfaces with an increasing flowrate for both species. Conversely, we observed a flowrate-independent increase in the number of adherent dead cells. Our results indicated that the presence of flow differentially affected the adherent live and dead bacterial cells on nanotopographic surfaces. This could be because dead bacterial cells were physically pierced by the nano-features, whereas live cells adhered via physiochemical interactions with the surface. Therefore, fluid shear was insufficient to overcome adhesion forces between the surface and dead cells. Furthermore, hydrodynamic forces due to the flow can cause more planktonic and detached live cells to collide with nano-features on the surface, causing more cells to lyse. These results show that nanotopographic surfaces do not have self-cleaning ability as opposed to natural bactericidal nanotopographic surfaces, and nanotopographic surfaces tend to perform better under flow conditions. These findings are highly useful for developing and optimizing nanotopographic surfaces for medical and industrial applications.

Manipulating Bacterial Biofilms Using Materiobiology and Synthetic Biology Approaches

Bacteria form biofilms on material surfaces within hours. Biofilms are often considered problematic substances in the fields such as biomedical devices and the food industry; however, they are beneficial in other fields such as fermentation, water remediation, and civil engineering. Biofilm properties depend on their genome and the extracellular environment, including pH, shear stress, and matrices topography, stiffness, wettability, and charges during biofilm formation. These surface properties have feedback effects on biofilm formation at different stages. Due to emerging technology such as synthetic biology and genome editing, many studies have focused on functionalizing biofilm for specific applications. Nevertheless, few studies combine these two approaches to produce or modify biofilms. This review summarizes up-to-date materials science and synthetic biology approaches to controlling biofilms. The review proposed a potential research direction in the future that can gain better control of bacteria and biofilms.

Microfluidic Study of Bacterial Attachment on and Detachment from Zinc Oxide Nanopillars

Nanopillars can influence how bacterial cells attach to a surface. Herein, we investigated whether self-assembled zinc oxide (ZnO) nanopillars synthesized on glass substrates via the conventional hydrothermal route possess anti-biofouling properties either by reducing the amount of initially attached cells or promoting the detachment of cells from the surface or both. To avoid complications associated with manual intervention methods of assessing bacterial attachment on nanopillar surfaces, we implemented a microfluidic approach. In our study, we synthesized two nanopillar topographies: a low surface density of ZnO nanopillars and a high surface density of ZnO nanopillars. Next, we mounted microfluidic channels to each of these substrates. This microfluidic approach allowed us to gently flow Pseudomonas aeruginosa, Staphylococcus aureus, or Bacillus subtilis cells onto the nanopillars for initial attachment before systematically increasing the flowrate to attempt to detach remaining attached cells without introducing air-liquid interface artefacts during the assay. Generally, initial bacterial attachment was similar across all substrates. However, cells consistently detached more readily from high-surface-density nanopillars compared to low-surface-density nanopillars. Electron microscopy revealed that cells that attached to high-surface-density nanopillars rested atop the nanopillars, fully exposed to microfluidic shear, whereas many cells became trapped in the void space between neighboring low-surface-density nanopillars, shielding these cells from detachment. Our findings indicate that self-assembled ZnO nanopillars can provide anti-biofouling properties under submerged flow but only if synthesized at high surface density.

Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices

The spread of biofilms on medical implants represents one of the principal triggers of persistent and chronic infections in clinical settings, and it has been the subject of many studies in the past few years, with most of them focused on prosthetic joint infections. We review here recent works on biofilm formation and microbial colonization on a large variety of indwelling devices, ranging from heart valves and pacemakers to urological and breast implants and from biliary stents and endoscopic tubes to contact lenses and neurosurgical implants. We focus on bacterial abundance and distribution across different devices and body sites and on the role of environmental features, such as the presence of fluid flow and properties of the implant surface, as well as on the interplay between bacterial colonization and the response of the human immune system.

Chips for Biomaterials and Biomaterials for Chips: Recent Advances at the Interface between Microfabrication and Biomaterials Research

In recent years, the use of microfabrication techniques has allowed biomaterials studies which were originally carried out at larger length scales to be miniaturized as so-called "on-chip" experiments. These miniaturized experiments have a range of advantages which have led to an increase in their popularity. A range of biomaterial shapes and compositions are synthesized or manufactured on chip. Moreover, chips are developed to investigate specific aspects of interactions between biomaterials and biological systems. Finally, biomaterials are used in microfabricated devices to replicate the physiological microenvironment in studies using so-called "organ-on-chip," "tissue-on-chip" or "disease-on-chip" models, which can reduce the use of animal models with their inherent high cost and ethical issues, and due to the possible use of human cells can increase the translation of research from lab to clinic. This review gives an overview of recent developments at the interface between microfabrication and biomaterials science, and indicates potential future directions that the field may take. In particular, a trend toward increased scale and automation is apparent, allowing both industrial production of micron-scale biomaterials and high-throughput screening of the interaction of diverse materials libraries with cells and bioengineered tissues and organs.

Elastic-Modulus-Dependent Macroscopic Supramolecular Assembly of Poly(dimethylsiloxane) for Understanding Fast Interfacial Adhesion

Macroscopic supramolecular assembly (MSA) is a new concept of supramolecular science with an emphasis on noncovalent interactions between macroscopic building blocks with sizes exceeding 10 μm. Owing to a similar noncovalently interactive nature with the phenomena of bioadhesion, self-healing, etc. and flexible features in tailoring and designing modular building blocks, MSA has been developed as a simplified model to interpret interfacial phenomena and a facile method to fabricate supramolecular materials. However, at this early stage, MSA has always been limited to hydrogel materials, which provide flowability for high molecular mobility to the interfacial binding. The extension to a wide range of materials for MSA is desired. Herein, we have developed a strategy of adjusting intrinsic properties (e.g., elastic modulus) of nonhydrogel materials to realize MSA, which could broaden the material choices of MSA. Using the widely used elastomer of poly(dimethylsiloxane) (PDMS) as building blocks, we have demonstrated the elastic-modulus-dependent MSA of PDMS based on the host/guest molecular recognition between supramolecular groups of β-cyclodextrin and adamantane. In the varied elastic modulus range of 0.38 to 3.84 MPa, we obtained the trend of the MSA probability decreasing from 100% at 0.38 MPa to 0% at 3.84 MPa. Meanwhile, in situ measurements of interactive forces between PDMS building blocks have supported the observed assembly phenomena. The underlying reasons are interpreted with the low-modulus flexible surfaces favoring for high molecular mobility to achieve interactions between multiple sites at the interface based on the theory of multivalency. Taken together, we have demonstrated the feasibility of directly adjusting the modulus of bulk materials to realize MSA of nonhydrogel materials, which may provide clues to the fast wet adhesion and new solutions to the additive manufacture of elastomer materials.

Implication of Surface Properties, Bacterial Motility, and Hydrodynamic Conditions on Bacterial Surface Sensing and Their Initial Adhesion

Biofilms are structured microbial communities attached to surfaces, which play a significant role in the persistence of biofoulings in both medical and industrial settings. Bacteria in biofilms are mostly embedded in a complex matrix comprised of extracellular polymeric substances that provide mechanical stability and protection against environmental adversities. Once the biofilm is matured, it becomes extremely difficult to kill bacteria or mechanically remove biofilms from solid surfaces. Therefore, interrupting the bacterial surface sensing mechanism and subsequent initial binding process of bacteria to surfaces is essential to effectively prevent biofilm-associated problems. Noting that the process of bacterial adhesion is influenced by many factors, including material surface properties, this review summarizes recent works dedicated to understanding the influences of surface charge, surface wettability, roughness, topography, stiffness, and combination of properties on bacterial adhesion. This review also highlights other factors that are often neglected in bacterial adhesion studies such as bacterial motility and the effect of hydrodynamic flow. Lastly, the present review features recent innovations in nanotechnology-based antifouling systems to engineer new concepts of antibiofilm surfaces.

Development of Polythiourethane/ZnO-Based Anti-Fouling Materials and Evaluation of the Adhesion of Staphylococcus aureus and Candida glabrata Using Single-Cell Force Spectroscopy

The attachment of bacteria and other microbes to natural and artificial surfaces leads to the development of biofilms, which can further cause nosocomial infections. Thus, an important field of research is the development of new materials capable of preventing the initial adhesion of pathogenic microorganisms. In this work, novel polymer/particle composite materials, based on a polythiourethane (PTU) matrix and either spherical (s-ZnO) or tetrapodal (t-ZnO) shaped ZnO fillers, were developed and characterized with respect to their mechanical, chemical and surface properties. To then evaluate their potential as anti-fouling surfaces, the adhesion of two different pathogenic microorganism species, Staphylococcus aureus and Candida glabrata, was studied using atomic force microscopy (AFM). Our results show that the adhesion of both S. aureus and C. glabrata to PTU and PTU/ZnO is decreased compared to a model surface polydimethylsiloxane (PDMS). It was furthermore found that the amount of both s-ZnO and t-ZnO filler had a direct influence on the adhesion of S. aureus, as increasing amounts of ZnO particles resulted in reduced adhesion of the cells. For both microorganisms, material composites with 5 wt.% of t-ZnO particles showed the greatest potential for anti-fouling with significantly decreased adhesion of cells. Altogether, both pathogens exhibit a reduced capacity to adhere to the newly developed nanomaterials used in this study, thus showing their potential for bio-medical applications.

Bactericidal efficiency of micro- and nanostructured surfaces: a critical perspective

Micro/nanostructured surfaces (MNSS) have shown the ability to inactivate bacterial cells by physical means. An enormous amount of research has been conducted in this area over the past decade. Here, we review the various surface factors that affect the bactericidal efficiency. For example, surface hydrophobicity of the substrate has been accepted to be influential on the bactericidal effect of the surface, but a review of the literature suggests that the influence of hydrophobicity differs with the bacterial species. Also, various bacterial viability quantification methods on MNSS are critically reviewed for their suitability for the purpose, and limitations of currently used protocols are discussed. Presently used static bacterial viability assays do not represent the conditions of which those surfaces could be applied. Such application conditions do have overlaying fluid flow, and bacterial behaviours are drastically different under flow conditions compared to under static conditions. Hence, it is proposed that the bactericidal effect should be assessed under relevant fluid flow conditions with factors such as shear stress and flowrate given due significance. This review will provide a range of opportunities for future research in design and engineering of micro/nanostructured surfaces with varying experimental conditions.

Evaluation of bacterial adhesion strength on phospholipid copolymer films with antibacterial ability using microfluidic shear devices

Biomimetic phospholipid copolymer films are known to possess antifouling properties against protein adsorption and biofilm formation. However, the interactions between bacterial cells and material surfaces are not fully understood. This work investigated the bacterial adhesion strength of phospholipid copolymer films using a shear stress-tunable microfluidic device. The copolymer, comprising 2-methacryloyloxyethyl phosphorylcholine (MPC), 3-methacryloxypropyl trimethoxysilane (MPTMSi), and 3-(methacryloyloxy) propyl-tris(trimethylsilyloxy) silane (MPTSSi), formed crosslinked films on glass substrates; the thickness of the coating film was controlled by the polymer concentration during dip-coating. Polymer films with two typical thicknesses, 20 and 40 nm (denoted as C-20 and C-40, respectively), were prepared on the bottom wall of the microfluidic device. After seeding S. aureus in the microfluidic device, several shear stresses were applied to evaluate the adhesion strength of the polymer films. S. aureus was found to have weaker adhesion strength on the C-40 surface than on the C-20 surface; numerous bacterial cells detached from the C-40 surface on application of identical shear stress. To mimic the presence of plasma protein, fibrinogen (Fg) was introduced into the device before performing the bacterial adhesion assay. The results showed that the adsorption of Fg promoted S. aureus adhesion and strong interactions under shear stress. However, the adhesion strength of S. aureus did not affect the Fg adsorption for both the C-20 and C-40 surfaces. Using the shear stress-tunable microfluidic device, we found that the adhesion of S. aureus on the thicker and softer phospholipid copolymer was weak, and the cells easily detached under high shear stress.

Effect of localized hydrodynamics on biofilm attachment and growth in a cross-flow filtration channel

Biofilm attachment and growth in membrane filtration systems are considerably influenced by the localized flow inside the feed channel. The present work aims to map the biofilm attachment/growth mechanism under varying flow conditions. Effect of varying clearance region (space between the spacer filament and membrane surface) on biofouling pattern is investigated by using three 3D-printed pillar spacers having different filament diameters of 340, 500, and 1000 µm while maintaining the same pillar orientation, diameter and height. Direct Numerical Simulations (DNS) and Optical Coherence Tomography (OCT) were carried out to accurately predict the local hydrodynamics behavior and in-situ monitor the biofilm formation. On spacer filaments, biofouling attachment is primarily observed in the regions where low and non-fluctuating shear stresses are present. Conversely, on membrane surface, highest biofouling attachment was observed under spacer filaments where high shear stresses are prevalent along with low clearance height. Furthermore, as filtration time progresses, the biofilm grows faster on the membrane in the center of spacer cells where low shear stress with steady hydrodynamics conditions are prevalent. The proposed hydrodynamics approach envisages a full spectrum of spacer design constraints that can lead to intrinsic biofilm mitigation while improving filtration performance of membranes based water treatment.

Staphylococcus aureus Aggregates on Orthopedic Materials under Varying Levels of Shear Stress

Periprosthetic joint infection (PJI) occurring after artificial joint replacement is a major clinical issue requiring multiple surgeries and antibiotic interventions. Staphylococcus aureus is the bacterium most commonly responsible for PJI. Recent in vitro research has shown that staphylococcal strains rapidly form aggregates in the presence of synovial fluid (SF). We hypothesize that these aggregates provide early protection to bacteria entering the wound site, allowing them time to attach to the implant surface, leading to biofilm formation. Thus, understanding the attachment kinetics of these aggregates is critical in understanding their adhesion to various biomaterial surfaces. In this study, the number, size, and surface area coverage of aggregates as well as of single cells of S. aureus were quantified under various conditions on different orthopedic materials relevant to orthopedic surgery: stainless steel (316L), titanium (Ti), hydroxyapatite (HA), and polyethylene (PE). It was observed that, regardless of the material type, SF-induced aggregation resulted in reduced aggregate surface attachment and greater aggregate size than the single-cell populations under various shear stresses. Additionally, the surface area coverage of bacterial aggregates on PE was relatively high compared to that on other materials, which could potentially be due to the rougher surface of PE. Furthermore, increasing shear stress to 78 mPa decreased aggregate attachment to Ti and HA while increasing the aggregates' average size. Therefore, this study demonstrates that SF induced inhibition of aggregate attachment to all materials, suggesting that biofilm formation is initiated by lodging of aggregates on the surface features of implants and host tissues.IMPORTANCE Periprosthetic joint infection occurring after artificial joint replacement is a major clinical issue that require repeated surgeries and antibiotic interventions. Unfortunately, 26% of patients die within 5 years of developing these infections. Staphylococcus aureus is the bacterium most commonly responsible for this problem and can form biofilms to provide protection from antibiotics as well as the immune system. Although biofilms are evident on the infected implants, it is unclear how these are attached to the surface in the first place. Recent in vitro investigations have shown that staphylococcal strains rapidly form aggregates in the presence of synovial fluid and provide protection to bacteria, thus allowing them time to attach to the implant surface, leading to biofilm formation. In this study, we investigated the attachment kinetics of Staphylococcus aureus aggregates on different orthopedic materials. The information presented in this article will be useful in surgical management and implant design.

New cross-linkable poly[bis(octafluoropentoxy) phosphazene] biomaterials: Synthesis, surface characterization, bacterial adhesion, and plasma coagulation responses

Biomaterial-associated microbial infection and thrombosis represent major issues to the success of long-term use of implantable blood-contacting medical devices. The development of new poly[bis(octafluoropentoxy) phosphazene (OFP) biomaterials provides new routes for combatting microbial infection and thrombosis. However, the limited mechanical properties of OFP to date render them unsuitable for application in medical devices and inhibit any attempts at subsequent surface topography modification. In this study, we synthesized cross-linkable OFPs (X-OFPs) with the different degrees of cross-linking in an effort to improve the mechanical properties. The results showed that the surface chemistry and surface topography of X-OFPs do not change significantly, but the surface mechanical stiffness increased after cross-linking. Atomic force microscopic phase images showed that the polymer phase separation structures changed due to cross-linking. Experiments with three bacterial strains: Staphylococcal epidermidis, Staphylococcal aureus, and Pseudomonas aeruginosa showed that bacterial adhesion was significantly decreased on the OFP and X-OFPs for both the pre-cross-linked and cross-linked as compared to polyurethane biomaterials. Furthermore, bacterial adhesions were lower on X-OFP surfaces than on pre-cross-linked materials, suggesting that mechanical stiffness is an important parameter influencing bacterial adhesion. Blood plasma coagulation responses revealed longer coagulation times for OFP and X-OFP materials than on polyurethanes, indicating that the new cross-linked OFPs are resistant to plasma coagulation compared to currently used polyurethane biomaterials.