Inactivation of Escherichia coli and Staphylococcus aureus by ultrasound

Effective treatment using a single-stage revision with non-contact low frequency ultrasonic debridement in the treatment of periprosthetic joint infection : a prospective single-arm study

Aims

In the surgical treatment of a periprosthetic joint infection (PJI), traditional mechanical debridement can only remove visibly infected tissue; not all of the biofilms can be removed. The aim of this study was to report the results of a single-stage revision using non-contact low-frequency ultrasonic debridement (NLFUD) in the treatment of chronic PJIs.

Methods

This was a prospective study of patients undergoing single-stage revision for chronic PJI, between August 2021 and June 2022. After mechanical debridement, an 8 mm handheld non-contact low-frequency ultrasound probe was used for debridement at a frequency of 25 ± 5 kHz and power of 90%, for five minutes. Each debridement lasted for ten seconds, with three-second intervals. The probe repeatedly sonicated all soft-tissue and bony surfaces. Before and after NLFUD, 25 ml of fluid was extracted from the surgical field for bacterial culture and counting. Chemical debridement was then used to irrigate the whole field. The bacteriological findings, recurrence of infection, and complications were recorded.

Results

A total of 45 patients (25 infected total hip arthroplasties (THAs) and 20 infected total knee arthroplasties (TKAs)) were included. Overall, 43 patients (95.6%) were free of infection at a mean follow-up of 29 months (24 to 33). There were no complications relating to the ultrasonic debridement, with no neurovascular or muscle injury, no poor wound healing, and no fat liquefaction. The rate of positive culture in the fluid from the surgical field before ultrasonic debridement was 40.0% (18/45), and it significantly increased to 75.6% (34/45) after ultrasonic debridement (p = 0.001). The median number of colony-forming units (CFUs) before debridement was 307 CFU/ml (IQR 225 to 585) significantly improved to 2,372 CFUs/ml (IQR 2,045 to 2,685; p < 0.001) after debridement.

Conclusion

We found that a favourable short-term control of infection can be achieved in these patients by a single-stage revision using NLFUD, without associated complications. However, further robust evidence is required to confirm the clinical benefits of using NLFUD under these circumstances.

Sonodynamic inactivation of gram-negative and gram-positive bacteria in the presence of phenothiazine compounds toluidine blue and azurin A

BACKGROUND

Sonodynamic antimicrobial chemotherapy (SACT) is an effective antimicrobial treatment that can avoid the production of drug-resistant bacteria. Design and development of new high-efficiency sonosensitizers play a key role in the practical application of SACT.

METHODS

The bacteriostatic effects of two phenothiazine compounds, toluidine blue (TB) and azure A (AA) combined with ultrasonic (US) on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) were studied, and the sonodynamic antibacterial activities of TB and AA were compared. The reactive oxygen species (ROS) and the types of ROS produced in the sonodynamic system were detected and the sonodynamic mechanisms of TB and AA were proposed.

RESULTS

The sonodynamic bacteriostasis mediated by TB and AA increased with the increasing concentration of sonosensitizer, the extension of sonication time and the increase of reaction temperature. The production of ROS was the main reason that TB and AA had excellent sonodynamic antibacterial performance. Singlet oxygen (1O2) and hydroxyl radical (•OH) were the main ROS types in the sonodynamic antibacterial system. The ROS produced by the combined action of AA and US was higher than that of TB.

CONCLUSION

Both TB and AA displayed excellent sonodynamic antibacterial activities. Moreover, AA had a higher sonodynamic activity than TB. The electron donation effect and steric hindrance effect of the methyl group of phenothiazine parent nucleus of TB might be the cause of the decrease of its sonodynamic activity. These results would provide a valuable reference for the further study of phenothiazines sonosensitizers and their clinical application in SACT.

Review on the Significant Interactions between Ultrafine Gas Bubbles and Biological Systems

Having sizes comparable with living cells and high abundance, ultrafine bubbles (UBs) are prone to inevitable interactions with different types of cells and facilitate alterations in physiological properties. The interactions of four typical cell types (e.g., bacterial, fungal, plant, and mammalian cells) with UBs have been studied over recent years. For bacterial cells, UBs have been utilized in creating the capillary force to tear down biofilms. The release of high amounts of heat, pressure, and free radicals during bubble rupture is also found to affect bacterial cell growth. Similarly, the bubble gas core identity plays an important role in the development of fungal cells. By the proposed mechanism of attachment of UBs on hydrophobin proteins in the fungal cell wall, oxygen and ozone gas-filled ultrafine bubbles can either promote or hinder the cell growth rate. On the other hand, reactive oxygen species (ROS) formation and mass transfer facilitation are two means of indirect interactions between UBs and plant cells. Likewise, the use of different gas cores in generating bubbles can produce different physical effects on these cells, for example, hydrogen gas for antioxidation against infections and oxygen for oxidation of toxic metal ions. For mammalian cells, the importance of investigating their interactions with UBs lies in the bubbles' action on cell viability as membrane poration for drug delivery can greatly affect cells' survival. UBs have been utilized and tested in forming the pores by different methods, ranging from bubble oscillation and microstream generation through acoustic cavitation to bubble implosion.

Proteomics-based analysis of the stress response of Bacillus cereus spores under ultrasound and electrolyzed water treatment

Ultrasound is a green nonthermal technology with promising applications in microbial inactivation. Electrolyzed water has been investigated and found to have a synergistic inactivation effect of ultrasound on spores. This study used a data-independent-acquisition method to analyze the stress response of Bacillus cereus spores following ultrasound combined with electrolyzed water treatment. We identified 197 differentially expressed proteins under ultrasound combined with an electrolyzed water treatment for which the ratio in the metabolic pathway was the highest. Spores downregulated key proteins in energy metabolic and transportation pathways, in particular in phosphotransferase systems and ATP synthase under ultrasound, electrolyzed water, and combined stress. The results of this study revealed that the key proteins in intracellular metabolism decreased after ultrasound treatment, and the expression of small acid-soluble spore protein and cell wall biosynthesis protein increased. Meanwhile, DNA integration, recombination, and inversion protein and small acid-soluble spore protein were upregulated after electrolyzed water treatment. In general, the spores exhibited stress resistance under external stress. The inactivation of spores by further stress was reduced, which we called "cross-protection."

Ultrasound Technology as Inactivation Method for Foodborne Pathogens: A Review

An efficient microbiological decontamination protocol is required to guarantee safe food products for the final consumer to avoid foodborne illnesses. Ultrasound and non-thermal technology combinations represent innovative methods adopted by the food industry for food preservation and safety. Ultrasound power is commonly used with a frequency between 20 and 100 kHz to obtain an “exploit cavitation effect”. Microbial inactivation via ultrasound derives from cell wall damage, the oxidation of intracellular amino acids and DNA changing material. As an inactivation method, it is evaluated alone and combined with other non-thermal technologies. The evidence shows that ultrasound is an important green technology that has a good decontamination effect and can improve the shelf-life of products. This review aims to describe the applicability of ultrasound in the food industry focusing on microbiological decontamination, reducing bacterial alterations caused by food spoilage strains and relative foodborne intoxication/infection.

Recent trends in the applications of sonochemical reactors as an advanced oxidation process for the remediation of microbial hazards associated with water and wastewater: A critical review

Water is one of the major sources that spread human diseases through contamination with bacteria and other pathogenic microorganisms. This review focuses on microbial hazards as they are often present in water and wastewater and cause various human diseases. Among the currently used disinfection methods, sonochemical reactors (SCRs) that produce free radicals combined with advanced oxidation processes (AOPs) have received significant attention from the scientific community. Also, this review discussed various types of cavitation reactors, such as acoustic cavitation reactors (ACRs) utilizing ultrasonic energy (UE), which had been widely employed, involving AOPs for treating contaminated waters. Besides ACRs, hydrodynamic cavitation reactors (HCRs) also effectively destroy and deactivate microorganisms to varying degrees. Cavitation is the fundamental phenomenon responsible for initiating many sonochemical reactions in liquids. Bacterial degradation occurs mainly due to the thinning of microbial membranes, local warming, and the generation of free radicals due to cavitation. Over the years, although extensive investigations have focused on the antimicrobial effects of UE (ultrasonic energy), the primary mechanism underlying the cavitation effects in the disinfection process, inactivation of microbes, and chemical reactions involved are still poorly understood. Therefore, studies under different conditions often lead to inconsistent results. This review investigates and compares other mechanisms and performances from greener and environmentally friendly sonochemical techniques to the remediation of microbial hazards associated with water and wastewater. Finally, the energy aspects, challenges, and recommendations for future perspectives have been provided.

CRISPRi-Mediated Gene Suppression Reveals Putative Reverse Transcriptase Gene PA0715 to Be a Global Regulator of Pseudomonas aeruginosa

Purpose

Pseudomonas aeruginosa is a common pathogen of infection in burn and trauma patients, and multi-drug resistant P. aeruginosa has become an increasingly important pathogen. Essential genes are key to the development of novel antibiotics. The PA0715 gene is a novel unidentified essential gene that has attracted our interest as a potential antibiotic target. Our study aims to determine the exact role of PA0715 in cell physiology and bacterial pathogenicity, providing important clues for antibiotic development.

Patients and Methods

The shuttle vector pHERD20T containing an arabinose inducible promoter was used to construct the CRISPRi system. Alterations in cellular physiology and bacterial pathogenicity of P. aeruginosa PAO1 after PA0715 inhibition were characterized. High-throughput RNA-seq was performed to gain more insight into the mechanisms by which PA0715 regulates the vital activity of P. aeruginosa.

Results

We found that down-regulation of PA0715 significantly reduced PAO1 growth rate, motility and chemotaxis, antibiotic resistance, pyocyanin and biofilm production. In addition, PA0715 inhibition reduced the pathogenicity of PAO1 to the greater galleria mellonella larvae. Transcriptional profiling identified 1757 genes including those related to amino acid, carbohydrate, ketone body and organic salt metabolism, whose expression was directly or indirectly controlled by PA0715. Unexpectedly, genes involved in oxidative phosphorylation also varied with PA0715 levels, and these findings support a hitherto unrecognized critical role for PA0715 in oxidative respiration in P. aeruginosa.

Conclusion

We identified PA0715 as a global regulator of the metabolic network that is indispensable for the survival and reproduction of P. aeruginosa. Our results provide a basis for future studies of potential antibiotic targets for P. aeruginosa and offer new ideas for P. aeruginosa infection control.

The effect of ultrasound treatment in combination with nisin on the inactivation of Listeria innocua and Escherichia coli

Ultrasound, alone or in combination with natural antimicrobials, is a novel food processing technology of interest to replace traditional food decontamination methods, as it is milder than classical sterilisation (heat treatment) and maintains desirable sensory characteristics. However, ultrasound efficacy can be affected by food structure/composition, as well as the order in which combined treatments are applied. More specifically, treatments which target different cell components could result in enhanced inactivation if applied in the appropriate order. The microbial properties i.e. Gram positive/Gram negative can also impact the treatment efficacy. This work presents a systematic study of the combined effect of ultrasound and nisin on the inactivation of the bacteria Listeria innocua (Gram positive) and Escherichia coli (Gram negative), at a range of cavitation conditions (44, 500, 1000 kHz). The order of treatment application was varied, and the impact of system structure was also investigated by varying the concentration of Xanthan gum used to create the food model systems (0 - 0.5% w/v). Microbial inactivation kinetics were monitored, and advanced microscopy and flow cytometry techniques were utilised to quantify the impact of treatment on a cellular level. Ultrasound was shown to be effective against E. coli at 500 kHz only, with L. innocua demonstrating resistance to all frequencies studied. Enhanced inactivation of E. coli was observed for the combination of nisin and ultrasound at 500 kHz, but only when nisin was applied before ultrasound treatment. The system structure negatively impacted the inactivation efficacy. The combined effect of ultrasound and nisin on E. coli was attributed to short-lived destabilisation of the outer membrane as a result of sonication, allowing nisin to penetrate the cytoplasmic membrane and facilitate cell inactivation.

Ultrasound frequency of sonication applied in microbiological diagnostics has a major impact on viability of bacteria causing PJI

OBJECTIVES

Sonication of explanted prosthesis constitutes an element of microbiological diagnostics. The aim of performing this procedure is to remove biofilm and to increase sensitivity of diagnostics. Ultrasound used in medical purposes are low-frequency and low-intensity. With this wide range of frequency which can be used in sonication process it is necessary to find the golden mean between biofilm dislodging and planktonic bacteria sparing.

MATERIALS AND METHODS

The aim of this study was to determine the least harming low-intensity ultrasound frequency (35 kHz, 40 kHz or 53 kHz) used during sonication process with other parameters constant. Four bacteria species were examined: S. aureus, E. faecalis, E. coli, K. pneumoniae. Number of microbiological studies (n) for each group (g) counted 40 specimens (based on scheme 1 bacteria type - 4 groups, 40 studies each).

RESULTS

A detailed analysis of gathered data was conducted. Based on study findings following conclusions were drawn. Sonication has a significant and negative impact on survival of sonicated planktonic bacteria. Part of bacteria in planktonic state are damaged/killed by ultrasound, which is demonstrated by lower CFU count in sonicated samples versus control group.

CONCLUSIONS

Optimal ultrasound frequencies for sonication of S. aureus, P. aeruginosa and E. coli are 35 kHz and 40 kHz. Ultrasound frequencies used in sonication process (35 kHz, 40 kHz, 53 kHz) of E. coli showed same impact on bacteria survival. It is crucial to perform further assessment of ultrasound parameters on clinical effects of sonication used in PJI diagnostics.

Rapid antibiotic susceptibility testing of bacteria from patients' blood via assaying bacterial metabolic response with surface-enhanced Raman spectroscopy

Blood stream infection is one of the major public health issues characterized with high cost and high mortality. Timely effective antibiotics usage to control infection is crucial for patients’ survival. The standard microbiological diagnosis of infection however can last days. The delay in accurate antibiotic therapy would lead to not only poor clinical outcomes, but also to a rise in antibiotic resistance due to widespread use of empirical broad-spectrum antibiotics. An important measure to tackle this problem is fast determination of bacterial antibiotic susceptibility to optimize antibiotic treatment. We show that a protocol based on surface-enhanced Raman spectroscopy can obtain consistent antibiotic susceptibility test results from clinical blood-culture samples within four hours. The characteristic spectral signatures of the obtained spectra of Staphylococcus aureus and Escherichia coli—prototypic Gram-positive and Gram-negative bacteria—became prominent after an effective pretreatment procedure removed strong interferences from blood constituents. Using them as the biomarkers of bacterial metabolic responses to antibiotics, the protocol reported the susceptibility profiles of tested drugs against these two bacteria acquired from patients’ blood with high specificity, sensitivity and speed.

Effects of Ultrafine Bubbles on Gram-Negative Bacteria: Inhibition or Selection?

Ultrafine bubbles exist in all liquids and are naturally stable. As their properties are not entirely known, it is unclear how they impact the surrounding solution and comparable-sized particles within it. It is essential to further investigate the properties of ultrafine bubbles in order to expand their industrial application. In this regard, the effect of ultrafine bubbles on bacterial development is of particular interest. Our current study, using optical density measurements and fluorescence microscopic images has demonstrated that ultrafine gas bubbles impact the morphology and phenotype of Escherichia coli and Pseudomonas aeruginosa. Specifically, Fourier transform infrared spectroscopic measurements indicated a thickening of bacterial membranes in samples exposed to ultrafine bubbles. The study also confirmed that ultrafine bubbles can inhibit bacterial cell growth. This study signifies the role of surface phenomena in bacterial culture, which is crucial in the upstream processes of recombinant DNA technology applications.

Multiple Low Frequency Ultrasound Enhances Bactericidal Activity of Vancomycin against Methicillin-Resistant Staphylococcus aureus Biofilms

Methicillin-resistant Staphylococcus aureus (MRSA) biofilm infections are difficult to treat due to the high antimicrobial resistance of biofilm. Therefore, new treatments are needed for more effective bacteria clearance. This study was to investigate whether low frequency ultrasound (LFU) can enhance the activity of antimicrobial agents against MRSA biofilm infection. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of vancomycin (VAN), linezolid (LIN), and levofloxacin (LEV) against three clinical isolated strains, including one methicillin-susceptible Staphylococcus aureus (MSSA) strain and two MRSA strains. Effects of various influencing factors, such as antimicrobial agents, drug concentrations, ultrasonic intensity, and single (S-LFU, 5 or 15 min) or multiple ultrasound (M-LFU, 5 min every 8 h), on the inhibition of biofilms were investigated. The bactericidal effects of S-LFU or M-LFU on MRSA or MSSA biofilms were determined by colony counts. Right after ultrasound, synergistic effects were observed in groups of S-LFU combined with three antimicrobial agents against MSSA biofilm, but for MRSA biofilm, only S-LFU plus VAN had synergistic effect. At the time point of 24 h, M-LFU plus VAN treatment had synergistic bactericidal effect against MRSA and MSSA biofilms, and the synergy showed that VAN is concentration-dependent, but no synergistic effects were observed in all S-LFU combination groups. In conclusion, combination of M-LFU and antimicrobial agents had a better synergistic effect than S-LFU against MRSA or MSSA biofilm. LFU may be useful in treating biofilm infection in the future.

Engineered biomaterial and biophysical stimulation as combinatorial strategies to address prosthetic infection by pathogenic bacteria

A plethora of antimicrobial strategies are being developed to address prosthetic infection. The currently available methods for implant infection treatment include the use of antibiotics and revision surgery. Among the bacterial strains, Staphylococcus species pose significant challenges particularly, with regard to hospital acquired infections. In order to combat such life threatening infectious diseases, researchers have developed implantable biomaterials incorporating nanoparticles, antimicrobial reinforcements, surface coatings, slippery/non-adhesive and contact killing surfaces. This review discusses a few of the biomaterial and biophysical antimicrobial strategies, which are in the developmental stage and actively being pursued by several research groups. The clinical efficacy of biophysical stimulation methods such as ultrasound, electric and magnetic field treatments against prosthetic infection depends critically on the stimulation protocol and parameters of the treatment modality. A common thread among the three biophysical stimulation methods is the mechanism of bactericidal action, which is centered on biophysical rupture of bacterial membranes, the generation of reactive oxygen species (ROS) and bacterial membrane depolarization evoked by the interference of essential ion-transport. Although the extent of antimicrobial effect, normally achieved through biophysical stimulation protocol is insufficient to warrant therapeutic application, a combination of antibiotic/ROS inducing agents and biophysical stimulation methods can elicit a clinically relevant reduction in viable bacterial numbers. In this review, we present a detailed account of both the biomaterial and biophysical approaches for achieving maximum bacterial inactivation. Summarizing, the biophysical stimulation methods in a combinatorial manner with material based strategies can be a more potent solution to control bacterial infections. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2174-2190, 2017.