Interactions of vancomycin resistant enterococci with biomaterial surfaces

Design of antimicrobial peptides conjugated biodegradable citric acid derived hydrogels for wound healing

Wound healing is usually facilitated by the use of a wound dressing that can be easily applied to cover the wound bed, maintain moisture, and avoid bacterial infection. In order to meet all of these requirements, we developed an in situ forming biodegradable hydrogel (iFBH) system composed of a newly developed combination of biodegradable poly(ethylene glycol) maleate citrate (PEGMC) and poly(ethylene glycol) diacrylate (PEGDA). The in situ forming hydrogel systems are able to conform to the wound shape in order to cover the wound completely and prevent bacterial invasion. A 2(k) factorial analysis was performed to examine the effects of polymer composition on specific properties, including the curing time, Young's modulus, swelling ratio, and degradation rate. An optimized iFBH formulation was achieved from the systematic factorial analysis. Further, in vitro biocompatibility studies using adult human dermal fibroblasts (HDFs) confirmed that the hydrogels and degradation products are not cytotoxic. The iFBH wound dressing was conjugated and functionalized with antimicrobial peptides as well. Evaluation against bacteria both in vitro and in vivo in rats demonstrated that the peptide-incorporated iFBH wound dressing offered excellent bacteria inhibition and promoted wound healing. These studies indicated that our in situ forming antimicrobial biodegradable hydrogel system is a promising candidate for wound treatment.

Cell-wall glycolipid mutations and their effects on virulence of E. faecalis in a rat model of infective endocarditis

Enterococci are among the major pathogens implicated in cardiac infections and biofilm formation. E. faecalis has been shown to play an important role in infectious endocarditis. Several distinct mechanisms for biofilm formation have been identified in E. faecalis. Our group has previously characterized two distinct bacterial glucosyltransferases playing key roles in the production of the major cell wall glycolipids and leading to reduced biofilm production. To assess if this mechanism is involved in the pathogenesis of enterococcal endocarditis we compared the wild-type strain of E. faecalis 12030 with two mutants in gene EF2891 and EF2890 respectively in a rat model of infective endocarditis. The results showed less endocarditic lesions and reduced colony counts per vegetation in the two mutants. indicating that the modification of bacterial surface lipids results in significantly reduced virulence in infective endocarditis. These results underscore the important role of biofilm formation in the pathogenicity of enterococcal endocarditis and may indicate an interesting target for novel therapeutic strategies.

Alanine esters of enterococcal lipoteichoic acid play a role in biofilm formation and resistance to antimicrobial peptides

Enterococcus faecalis is among the predominant causes of nosocomial infections. Surface molecules like d-alanine lipoteichoic acid (LTA) perform several functions in gram-positive bacteria, such as maintenance of cationic homeostasis and modulation of autolytic activities. The aim of the present study was to evaluate the effect of d-alanine esters of teichoic acids on biofilm production and adhesion, autolysis, antimicrobial peptide sensitivity, and opsonic killing. A deletion mutant of the dltA gene was created in a clinical E. faecalis isolate. The absence of d-alanine in the LTA of the dltA deletion mutant was confirmed by nuclear magnetic resonance spectroscopy. The wild-type strain and the deletion mutant did not show any significant differences in growth curve, morphology, or autolysis. However, the mutant produced significantly less biofilm when grown in the presence of 1% glucose (51.1% compared to that of the wild type); adhesion to eukaryotic cells was diminished. The mutant absorbed 71.1% of the opsonic antibodies, while absorption with the wild type resulted in a 93.2% reduction in killing. Sensitivity to several cationic antimicrobial peptides (polymyxin B, colistin, and nisin) was considerably increased in the mutant strain, confirming similar results from other studies of gram-positive bacteria. Our data suggest that the absence of d-alanine in LTA plays a role in environmental interactions, probably by modulating the net negative charge of the bacterial cell surface, and therefore it may be involved in the pathogenesis of this organism.

Implant infections due to enterococci: role of capsular polysaccharides and biofilm

Enterococci are natural inhabitants of the gastrointestinal tract and of the female genital tract of humans and many animals. In recent years, enterococci have been increasingly recognized as important human pathogens causing infections associated with medical devices. Their resistance to most antimicrobial agents and their ability to form biofilm has contributed to the increasing incidence of nosocomial enterococcal infections. Enterococci possess a capsular polysaccharide composed of a glycerol-teichoic acid-like molecule consisting of repeating units of 6-alfa-D-glucose-1-2-glycerol-3-PO4 , substituted on carbon 2 with a alfa-2,1-linked molecule of glucose. Using both immunologic and genetic data E. faecalis can be assigned to specific serotypes based on capsular polysaccharides. Clinical examples of foreign-body infections due to enterococci are described, comprising infections of artificial joints, implanted intravascular catheters, artificial hearts and artificial valves, stents, liquor shunt devices, and intraocular infections. Methods to prevent and/or treat enterococcal infections are presented.

Pathogenesis of implant infections by enterococci

Enterococci are commensals of human and animal intestinal tract that have emerged in the last decades as a major cause of nosocomial infections of bloodstream, urinary tract and in infected surgical sites. Enterococcus faecalis is responsible for ca. 80% of all enterococcal infections while Enterococcus faecium accounts for most of the others; among the most relevant risk factors for development of enterococcal infections is the presence of implanted devices. The pathogenesis of such infections is poorly understood, but several virulence factors have been proposed. Among them, the ability to form biofilm has recently been shown to be one of the most prominent features of this microorganism, allowing colonization of inert and biological surfaces, while protecting against antimicrobial substances, and mediating adhesion and invasion of host cells and survival within professional phagocytes. Biofilm formation has been shown to be particularly important in the development of prosthetic valve enterococcal endocarditis and stent occlusion. Enterococci are also able to express other surface factors that may support colonization of both inert and biological surfaces, and that may be involved in the invasion of, and survival within, the host cell.

Treatment and prevention of enterococcal infections--alternative and experimental approaches

Enterococci are one of the leading types of organisms isolated from infections of hospitalised patients and the third most common cause of nosocomial bloodstream infections. They contribute significantly to patient mortality and morbidity, as well as healthcare costs. The emergence of resistance against virtually all clinically available antibiotics and the ability to transfer these resistance determinants to other pathogens demonstrates the urgency for an improved understanding of enterococcal virulence mechanisms, and the development of alternative treatment and prevention options. This article reviews new antimicrobials, vaccine targets, bacteriophage therapy, as well as treatments targeting virulence factors and biofilm, for their potential to treat and/or prevent enterococcal infections. Although clinical isolates often cause serious infections, so-called 'non-pathogenic' strains are used as therapeutics in the form of probiotics. Understanding the differences between true pathogens and beneficial commensals may help to evaluate future treatment and prophylactic options.

Infection and chemotherapy: recent experiences, proposed strategies and perspectives in plastic and reconstructive surgery

In plastic surgery the necessity of avoiding as much septic complication as possible is caused by major technical peculiarities. On the one hand the use of autologous grafts (skin, cartilage, bone, microsurgical flaps, etc.) makes the surgical act prone to infection, even in the case of "clean surgery" with almost total failure. On the other hand, reconstruction is performed in "unclean" and immunodepressed patients such as burned and polytraumatized patients. Finally, there are recent and extensive uses of normal and "smart" and biodegradable biomaterials (from silicon to hyaluronic acid esters, etc.) and particularly the recent possibility of applying the products of tissue engineering (cultured fibroblasts, cheratinocyte, chondrocytes grown and expanded in vitro on various scaffolds) with the known increase in infectious risks, has made mandatory the prevention and treatment of infections and also the identification of the "local" environmental increase in resistant strains. A brief review is presented together with the results of the Italian Multicenter Burns Antibiotic Protocol on more than 300 patients and the data on 284 patients treated with auto-semi-artificial skin expanded in vitro at the Institute of Plastic Surgery of the University of Milan Medical School.