Biofilm formation and migration on ventricular assist device drivelines

Yue Qu, David McGiffin, Christina Kure, Berkay Ozcelik, John Fraser, Helmut Thissen, Anton Y. Peleg

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Objectives: Driveline infections remain an important complication of ventricular assist device therapy, with biofilm formation being a major contributor. This study aimed to elucidate factors that govern biofilm formation and migration on clinically relevant ventricular assist device drivelines. Methods: Experimental analyses were performed on HeartWare HVAD (HeartWare International Inc, Framingham, Mass) drivelines to assess surface chemistry and biofilm formation. To mimic the driveline exit site, a drip-flow biofilm reactor assay was used. To mimic a subcutaneous tissue environment, a tunnel-based interstitial biofilm assay was developed. Clinical HVAD drivelines explanted at the time of cardiac transplantation were also examined by scanning electron microscopy. Results: Common causative pathogens of driveline infections were able to adhere to the smooth and velour sections of the HVAD driveline and formed robust biofilms in the drip-flow biofilm reactor; however, Pseudomonas aeruginosa and Candida albicans had greater biomass. Biofilm migration within the interstitial driveline tunnel was evident for Staphylococcus epidermidis, Staphylococcus aureus, and C albicans, but not P aeruginosa. Biofilm formation by staphylococci was 500 to 10,000 times higher in the tunnel-based model compared with our exit site model. The 3-dimensional structure of the driveline velour and the use of silicone adhesive in driveline manufacturing were found to promote biofilm growth, and explanted patient drivelines demonstrated inadequate tissue in-growth along the entire velour with micro-gaps between velour fibers. Conclusions: This work highlights the predilection of pathogens to different parts of the driveline, the importance of the subcutaneous tunnel to biofilm formation and migration, and the presence of micro-gaps in clinical drivelines that could facilitate invasive driveline infections.

Original languageEnglish
Number of pages15
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - 6 Mar 2019

Keywords

  • biofilms
  • Candida albicans
  • driveline
  • interstitial biofilm
  • Pseudomonas aeruginosa
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • VAD

Cite this

@article{70b6eecba1804bb6aa654da07a2f7b85,
title = "Biofilm formation and migration on ventricular assist device drivelines",
abstract = "Objectives: Driveline infections remain an important complication of ventricular assist device therapy, with biofilm formation being a major contributor. This study aimed to elucidate factors that govern biofilm formation and migration on clinically relevant ventricular assist device drivelines. Methods: Experimental analyses were performed on HeartWare HVAD (HeartWare International Inc, Framingham, Mass) drivelines to assess surface chemistry and biofilm formation. To mimic the driveline exit site, a drip-flow biofilm reactor assay was used. To mimic a subcutaneous tissue environment, a tunnel-based interstitial biofilm assay was developed. Clinical HVAD drivelines explanted at the time of cardiac transplantation were also examined by scanning electron microscopy. Results: Common causative pathogens of driveline infections were able to adhere to the smooth and velour sections of the HVAD driveline and formed robust biofilms in the drip-flow biofilm reactor; however, Pseudomonas aeruginosa and Candida albicans had greater biomass. Biofilm migration within the interstitial driveline tunnel was evident for Staphylococcus epidermidis, Staphylococcus aureus, and C albicans, but not P aeruginosa. Biofilm formation by staphylococci was 500 to 10,000 times higher in the tunnel-based model compared with our exit site model. The 3-dimensional structure of the driveline velour and the use of silicone adhesive in driveline manufacturing were found to promote biofilm growth, and explanted patient drivelines demonstrated inadequate tissue in-growth along the entire velour with micro-gaps between velour fibers. Conclusions: This work highlights the predilection of pathogens to different parts of the driveline, the importance of the subcutaneous tunnel to biofilm formation and migration, and the presence of micro-gaps in clinical drivelines that could facilitate invasive driveline infections.",
keywords = "biofilms, Candida albicans, driveline, interstitial biofilm, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, VAD",
author = "Yue Qu and David McGiffin and Christina Kure and Berkay Ozcelik and John Fraser and Helmut Thissen and Peleg, {Anton Y.}",
year = "2019",
month = "3",
day = "6",
doi = "10.1016/j.jtcvs.2019.02.088",
language = "English",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
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}

Biofilm formation and migration on ventricular assist device drivelines. / Qu, Yue; McGiffin, David; Kure, Christina; Ozcelik, Berkay; Fraser, John; Thissen, Helmut; Peleg, Anton Y.

In: Journal of Thoracic and Cardiovascular Surgery, 06.03.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Biofilm formation and migration on ventricular assist device drivelines

AU - Qu, Yue

AU - McGiffin, David

AU - Kure, Christina

AU - Ozcelik, Berkay

AU - Fraser, John

AU - Thissen, Helmut

AU - Peleg, Anton Y.

PY - 2019/3/6

Y1 - 2019/3/6

N2 - Objectives: Driveline infections remain an important complication of ventricular assist device therapy, with biofilm formation being a major contributor. This study aimed to elucidate factors that govern biofilm formation and migration on clinically relevant ventricular assist device drivelines. Methods: Experimental analyses were performed on HeartWare HVAD (HeartWare International Inc, Framingham, Mass) drivelines to assess surface chemistry and biofilm formation. To mimic the driveline exit site, a drip-flow biofilm reactor assay was used. To mimic a subcutaneous tissue environment, a tunnel-based interstitial biofilm assay was developed. Clinical HVAD drivelines explanted at the time of cardiac transplantation were also examined by scanning electron microscopy. Results: Common causative pathogens of driveline infections were able to adhere to the smooth and velour sections of the HVAD driveline and formed robust biofilms in the drip-flow biofilm reactor; however, Pseudomonas aeruginosa and Candida albicans had greater biomass. Biofilm migration within the interstitial driveline tunnel was evident for Staphylococcus epidermidis, Staphylococcus aureus, and C albicans, but not P aeruginosa. Biofilm formation by staphylococci was 500 to 10,000 times higher in the tunnel-based model compared with our exit site model. The 3-dimensional structure of the driveline velour and the use of silicone adhesive in driveline manufacturing were found to promote biofilm growth, and explanted patient drivelines demonstrated inadequate tissue in-growth along the entire velour with micro-gaps between velour fibers. Conclusions: This work highlights the predilection of pathogens to different parts of the driveline, the importance of the subcutaneous tunnel to biofilm formation and migration, and the presence of micro-gaps in clinical drivelines that could facilitate invasive driveline infections.

AB - Objectives: Driveline infections remain an important complication of ventricular assist device therapy, with biofilm formation being a major contributor. This study aimed to elucidate factors that govern biofilm formation and migration on clinically relevant ventricular assist device drivelines. Methods: Experimental analyses were performed on HeartWare HVAD (HeartWare International Inc, Framingham, Mass) drivelines to assess surface chemistry and biofilm formation. To mimic the driveline exit site, a drip-flow biofilm reactor assay was used. To mimic a subcutaneous tissue environment, a tunnel-based interstitial biofilm assay was developed. Clinical HVAD drivelines explanted at the time of cardiac transplantation were also examined by scanning electron microscopy. Results: Common causative pathogens of driveline infections were able to adhere to the smooth and velour sections of the HVAD driveline and formed robust biofilms in the drip-flow biofilm reactor; however, Pseudomonas aeruginosa and Candida albicans had greater biomass. Biofilm migration within the interstitial driveline tunnel was evident for Staphylococcus epidermidis, Staphylococcus aureus, and C albicans, but not P aeruginosa. Biofilm formation by staphylococci was 500 to 10,000 times higher in the tunnel-based model compared with our exit site model. The 3-dimensional structure of the driveline velour and the use of silicone adhesive in driveline manufacturing were found to promote biofilm growth, and explanted patient drivelines demonstrated inadequate tissue in-growth along the entire velour with micro-gaps between velour fibers. Conclusions: This work highlights the predilection of pathogens to different parts of the driveline, the importance of the subcutaneous tunnel to biofilm formation and migration, and the presence of micro-gaps in clinical drivelines that could facilitate invasive driveline infections.

KW - biofilms

KW - Candida albicans

KW - driveline

KW - interstitial biofilm

KW - Pseudomonas aeruginosa

KW - Staphylococcus aureus

KW - Staphylococcus epidermidis

KW - VAD

UR - http://www.scopus.com/inward/record.url?scp=85063758548&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2019.02.088

DO - 10.1016/j.jtcvs.2019.02.088

M3 - Article

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -