A novel chronic wound biofilm model sustaining coexistence of Pseudomonas aeruginosa and Staphylococcus aureus suitable for testing of antibiofilm effect of antimicrobial solutions and wound dressings (original) (raw)
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Current Status of In Vitro Models and Assays for Susceptibility Testing for Wound Biofilm Infections
Biomedicines, 2019
Biofilm infections have gained recognition as an important therapeutic challenge in the last several decades due to their relationship with the chronicity of infectious diseases. Studies of novel therapeutic treatments targeting infections require the development and use of models to mimic the formation and characteristics of biofilms within host tissues. Due to the diversity of reported in vitro models and lack of consensus, this review aims to provide a summary of in vitro models currently used in research. In particular, we review the various reported in vitro models of Pseudomonas aeruginosa biofilms due to its high clinical impact in chronic wounds and in other chronic infections. We assess advances in in vitro models that incorporate relevant multispecies biofilms found in infected wounds, such as P. aeruginosa with Staphylococcus aureus, and additional elements such as mammalian cells, simulating fluids, and tissue explants in an attempt to better represent the physiological ...
Antibiotics
Normal wound healing occurs in three phases—the inflammatory, the proliferative, and the remodeling phase. Chronic wounds are, for unknown reasons, arrested in the inflammatory phase. Bacterial biofilms may cause chronicity by arresting healing in the inflammatory state by mechanisms not fully understood. Pseudomonas aeruginosa, a common wound pathogen with remarkable abilities in avoiding host defense and developing microbial resistance by biofilm formation, is detrimental to wound healing in clinical studies. The host response towards P. aeruginosa biofilm-infection in chronic wounds and impact on wound healing is discussed and compared to our own results in a chronic murine wound model. The impact of P. aeruginosa biofilms can be described by determining alterations in the inflammatory response, growth factor profile, and count of leukocytes in blood. P. aeruginosa biofilms are capable of reducing the host response to the infection, despite a continuously sustained inflammatory r...
Biofilm model on mice skin wounds
Acta Cirúrgica Brasileira
To evaluate a biofilm model of Pseudomonas aeruginosa in excisional cutaneous wound in mice. Methods: Preclinical, translational study conducted with 64 C57BL/6 mice randomly assigned to control and intervention groups. Evaluation was on days D0, D3, D5, D7 and D10 of wound making. The profile of biofilm formation and induction was evaluated using wound closure kinetics, quantitative culture, and evaluation of wounds using transmission electron microscopy (TEM). Clinical evaluation was performed by liver tissue culture, weight variation, and quantification of leukocytes in peripheral blood. Analyses were performed with GraphPad Prism software. Results: Bacterial load for induction of infection with P. aeruginosa and survival of animals was 10 4 UFC•mL-1. In D5 (p < 0.0001) and D7 (p < 0.01), animals in the intervention group showed a delay in the healing process and had their wounds covered by necrotic tissue until D10. Statistical differences were observed in wound cultures and weight at D5 and D7 (p < 0.01). Liver cultures and leukocyte quantification showed no statistical differences. No bacteria in planktonic or biofilm form were identified by TEM. Conclusion: The findings raise questions about the understanding of the ease of formation and high occurrence of biofilm in chronic wounds.
Chronic wounds are presumed to persist in the inflammatory state, preventing healing. Emerging evidence indicates a clinical impact of bacterial biofilms in soft tissues, including Pseudomonas aeruginosa (PA) biofilms. To further investigate this, we developed a chronic PA biofilm wound infection model in C3H/HeN and BALB/c mice. The chronic wound was established by an injection of seaweed alginate-embedded P. aeruginosa PAO1 beneath a third-degree thermal lesion providing full thickness skin necrosis, as in human chronic wounds. Cultures revealed growth of PA, and both alginate with or without PAO1 generated a polymorphonuclear-dominated inflammation early after infection. However, both at days 4 and 7, there were a more acute polymorphonuclear-dominated and higher degree of inflammation in the PAO1 containing group (p < 0.05). Furthermore, PNA-FISH and supplemented DAPI staining showed bacteria organized in clusters, resembling biofilms, and inflammation located adjacent to the PA. The chronic wound infection showed a higher number of PAO1 in the BALB/c mice at day 4 after infection as compared to C3H/HeN mice (p < 0.006). In addition, a higher concentration of interleukin-1beta in the chronic wounds of BALB/c mice was observed at day 7 (p < 0.02), despite a similar number of bacteria in the two mouse strains. The present study succeeded in establishing a chronic PA biofilm infection in mice. The results showed an aggravating impact of local inflammation induced by PA biofilms. In conclusion, our findings indicate that improved infection control of chronic wounds reduces the inflammatory response and may improve healing.
Assessing the effect of an antimicrobial wound dressing on biofilms
2008
To date the effect of silver-containing wound dressings on biofilms, known to be present in chronic wounds, has not been determined or documented. In this current study, we aimed to determine the antimicrobial effect of a silver-containing dressing on biofilms grown in a chambered slide model. Before the addition of a wound dressing onto a 24-hour biofilm, composed of either Pseudomonas aeruginosa, Enterobacter cloacae, Staphylococcus aureus, or a mixed bacterial community, a fluorescent dye was applied. This enabled the viability of sessile bacteria to be monitored in real-time, using a rapid form of confocal laser scanning microscopy over a contact time period of 48 hours. By analyzing all the three-dimensional data generated from the confocal time-lapse sequences, 90% of all sessile bacteria within the biofilm were observed to progressively turn red (i.e., died) within 24 hours. Total bacterial kill in the biofilm was achieved after 48 hours. This research has shown that the dressing was effective in killing the tested bacteria evident in both the tested mono and polymicrobial biofilms, which provides valuable evidence that this dressing may have an effect on biofilms found in recalcitrant chronic wounds.
Wound Repair and Regeneration, 2011
A growing body of evidence suggests that in addition to hypoxia, ischemiareperfusion injury, and intrinsic host factors, bacterial biofilms represent a fourth major pillar in chronic wound pathogenesis. Given that most studies to date rely on in vitro or observational clinical data, our aim was to develop a novel, quantitative animal model enabling further investigation of the biofilm hypothesis in vivo. Dermal punch wounds were created in New Zealand rabbit ears, and used as uninfected controls, or inoculated with green fluorescent protein-labeled Staphylococcus aureus to form wounds with bacteria predominantly in the planktonic or biofilm phase. Epifluorescence and scanning electron microscopy revealed that S. aureus rapidly forms mature biofilm in wounds within 24 hours of inoculation, with persistence of biofilm viability over time seen through serial bacterial count measurement and laser scanning confocal imaging at different time points postwounding and inoculation. Inflammatory markers confirmed that the biofilm phenotype creates a characteristic, sustained, low-grade inflammatory response, and that over time biofilm impairs epithelial migration and granulation tissue in-growth, as shown histologically. We have established and validated a highly quantitative, reproducible in vivo biofilm model, while providing evidence that the biofilm phenotype specifically contributes to profound cutaneous wound healing impairment. Our model highlights the importance of bacterial biofilms in chronic wound pathogenesis, providing an in vivo platform for further inquiry into the basic biology of bacterial biofilm-host interaction and high-throughput testing of antibiofilm therapeutics.
Pathogens and Disease, 2018
Debate regarding the coexistence of Staphylococcus aureus and Pseudomonas aeruginosa in wounds remains contentious, with the dominant hypothesis describing a situation akin to niche partitioning, whereby both microorganisms are present but occupy distinct regions of the wound without interacting. In contrast, we hypothesised that these microorganisms do interact during early co-colonisation in a manner beneficial to both bacteria. We assessed competitive interaction between S. aureus and P. aeruginosa in biofilm cultured for 24-72 h and bacterial aggregates analogous to those observed in early (<24h) biofilm formation, and interaction with human keratinocytes. We observed that S. aureus predominated in biofilm and nonattached bacterial aggregates, acting as a pioneer for the attachment of P. aeruginosa. We report for the first time that S. aureus mediates a significant (P<0.05) increase in the attachment of P. aeruginosa to human keratinocytes, and that P. aeruginosa promotes an invasive phenotype in S. aureus. We show that coinfected keratinocytes exhibit an intermediate inflammatory response concurrent with impaired wound closure that is in keeping with a sustained pro-inflammatory response which allows for persistent microbial colonisation. These studies demonstrate that, contrary to the dominant hypothesis, interactions between S. aureus and P. aeruginosa may be an important factor for both colonisation and pathogenicity in the chronic infected wound.
Detection of Biofilm production in microorganisms complicating Chronic wound infections
Tropical Journal of Pathology and Microbiology, 2017
Introduction: The presence of biofilm facilitates the development of infections by compromising the immune system of the patient and by contributing to the failure of antibiotic therapy, which may result in recurrent infections and the emergence of multidrug resistant pathogens. Objectives: The objective of this study is to determine the biofilm forming ability of the microorganisms infecting chronic wounds and to correlate the drug resistance with biofilm formation. Material and Methods: Wound swabs were collected from 50 patients with non-healing ulcers. Microorganisms isolated by standard microbiological techniques were screened for biofilm production by tissue culture plate method. Antibiotic sensitivity tests were done for appropriate panel of antibiotics by Kirby Bauer disc diffusion test. Results: All the 50 samples were culture positive. The most common organism isolated was Staphylococcus aureus, CoNS, Enterococcus faecalis, Beta hemolytic Streptococci, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia, Acinetobacter and Proteus vulgaris. Biofilm formation was determined by Tissue Culture Plate method in 63 identified isolates (39 in monomicrobial & 24 in polymicrobial infections) and 38 (60.32 %) isolates were positive for biofilm production. Most of the isolates in polymicrobial infections were strong biofilm producers. Biofilm producers were found to be more resistant to almost all the groups of antibiotics. Conclusion: If we understand the wound's microbial flora, it allows us to manage and treat the wound better. New strategies targeting biofilm disruption or prevention of biofilm formation are important new approaches in the management of chronic wounds.
Microscopic and physiologic evidence for biofilm-associated wound colonization in vivo
Wound Repair and Regeneration, 2008
A biofilm is a collection of microbial cells that are attached to a surface and embedded in a self-produced extrapolymeric substance. The understanding of the biofilm phenotype is important in the understanding of bacteria in vitro but it has been difficult to translate biofilm science to the clinical setting. More recently, preliminary criteria for defining biofilm associated diseases have been proposed and the purpose of this study was to create a biofilm-associated wound model based on these criteria. Using a porcine model, partial thickness wounds were inoculated with a wound isolate Staphylococcus aureus strain. Wounds were then treated with either one of two topical antimicrobial agents (mupriocin cream or triple antibiotic ointment) within 15 minutes to represent planktonic bacteria or 48 hours after initial inoculation to represent biofilm-associated wound infection. Using light microscopy, scanning electron microscopy and epifluorescence microscopy, we were able to observe biofilm-like structures in wounds after 48 hours of inoculation and occlusion. The in vivo antimicrobial assay was used to demonstrate that both mupirocin cream and the triple antibiotic ointment were effective in reducing planktonic S. aureus but had reduced efficacy against biofilm-embedded S. aureus. Our results demonstrated that S. aureus form firmly attached microcolonies and colonies of bacteria encased in an extracellular matrix on the surface of the wounds. These biofilm-like communities also demonstrated increased antimicrobial resistance when compared with their planktonic phenotype in vivo. The structural and physiological results support the hypothesis that bacterial biofilms play a role in wound colonization and infection.