BackgroundBiosurfactants (BS) are amphiphilic compounds produced by microbes, either on the cell surface or secreted extracellularly. BS exhibit strong antimicrobial and anti-adhesive properties, making them good candidates for applications used to combat infections. In this study, our goal was to assess the in vitro antimicrobial, anti-adhesive and anti-biofilm abilities of BS produced by Lactobacillus jensenii and Lactobacillus rhamnosus against clinical Multidrug Resistant (MDR) strains of Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus (MRSA). Cell-bound BS from both L. jensenii and L. rhamnosus were extracted and isolated. The surface activities of crude BS samples were evaluated using an oil spreading assay. The antimicrobial, anti-adhesive and anti-biofilm activities of both BS against the above mentioned MDR pathogens were determined.ResultsSurface activities for both BS ranged from 6.25 to 25 mg/ml with clear zones observed between 7 and 11 cm. BS of both L. jensenii and L. rhamnosus showed antimicrobial activities against A. baumannii, E. coli and S. aureus at 25-50 mg/ml. Anti-adhesive and anti-biofilm activities were also observed for the aforementioned pathogens between 25 and 50 mg/ml. Finally, analysis by electron microscope indicated that the BS caused membrane damage for A. baumannii and pronounced cell wall damage in S. aureus.ConclusionOur results indicate that BS isolated from two Lactobacilli strains has antibacterial properties against MDR strains of A. baumannii, E. coli and MRSA. Both BS also displayed anti-adhesive and anti-biofilm abilities against A. baumannii, E. coli and S. aureus. Together, these capabilities may open up possibilities for BS as an alternative therapeutic approach for the prevention and/or treatment of hospital-acquired infections.

T he natural history of vancomycin-resistant enterococcus (VRE) infection is such that VRE colonization, predominantly of the gastrointestinal tract, typically precedes infection. At Mayo Medical Center (Rochester, MN), routine aerobic bacterial throat, rectal, wound, biliary, and urinary surveillance cultures have been collected from liver transplant recipients as part of a selective bowel antibiotic decontamination program for liver transplant patients. Beginning in 1995, as a result of these surveillance cultures, VRE colonization was identified in liver and kidney transplant patients. The purpose of this study is to describe the natural history of VRE colonization in liver and kidney transplant patients. Methods Cultures for VRERoutine surveillance aerobic bacterial throat, rectal, wound, biliary, and urinary cultures have been collected from hospitalized liver transplant recipients as part of a selective bowel decontamination program for liver transplant patients since the inception of the liver transplant program at Mayo Medical Center in 1985. Surveillance cultures were originally obtained twice weekly for 1 week posttransplantation and then weekly until selective bowel decontamination was discontinued (ϳ3 weeks). Through these surveillance cultures, VRE colonization was detected in the liver transplant population.Beginning November 1995, admission and twice-weekly rectal surveillance cultures were collected from all patients admitted to the adult liver, kidney, and kidney/pancreas transplant unit. These specimens were cultured on primary sheep blood agar or subculture of enriched brain heart infusion broth to Columbia colistin-nalidixic acid (CNA) agar. Subsequent to the identification of the first patient with VRE colonization, some of these cultures were ordered as "VRE screens" and cultured on selective media, as follows. Beginning October 1995, in-house CNA agar with 16 g/mL of vancomycin was used. In June 1996, Enterococcosel agar with 8 g/mL of vancomycin (Becton Dickinson, Cockeysville, MD) was substituted. The study period extended from 1985 through December 1997. Selective Bowel DecontaminationSelective bowel decontamination was performed using a mixture of 80 mg of gentamicin, 100 mg of polymyxin E, and 2 million U of nystatin administered orally or by nasogastric tube 4 times daily, beginning at least 2 days before liver transplantation and discontinued at the time of discharge from the initial hospitalization. This regimen was resumed when patients were rehospitalized. Orabase paste (Colgate, Surgery, ‡Hepatology, and §Clinical Microbiology, Mayo Clinic and Foundation, Rochester, MN; and ʈCorixa Corporation, From the *Divisions of Infectious Diseases, †Transplantation

Transmission of pathogens from donor to recipient is a potential complication of organ transplantation. Herein, we describe the clinical course and outcomes of 4 transplant recipients who received tissues from a donor with multi-organ infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. Recipient 1 underwent simultaneous liver and kidney transplantation for alpha-1 antitrypsin deficiency and alcohol-related cirrhosis, and acute tubular necrosis, respectively. Soon after transplantation, he developed an infected hematoma and peritonitis due to KPC-producing K. pneumoniae despite receiving tigecycline prophylaxis. He was treated with a prolonged course of tigecycline, amikacin, and meropenem, in conjunction with surgical evacuation and percutaneous drainage of the infected fluid collections. Recipient 2 underwent living-donor liver transplantation for cholangiocarcinoma and primary sclerosing cholangitis using vein graft from the donor infected with KPC-producing K. pneumoniae. Culture of the preservation fluid containing the vein graft was positive for KPC-producing K. pneumoniae. The patient received preemptive amikacin and tigecycline, and he did not develop any infection (as evidenced by negative surveillance blood cultures). The isolates from the donor and Recipients 1 and 2 were indistinguishable by pulsed-field gel electrophoresis. Recipients 3 and 4 underwent kidney and heart transplantation, respectively; both patients received perioperative tigecycline prophylaxis and did not develop infections due to KPC-producing K. pneumoniae. All transplant recipients had good short-term outcomes. These cases highlight the importance of inter-institutional communication and collaboration to ensure the successful management of recipients of organs from donors infected with multidrug-resistant organisms.

VRE BSIs remain a difficult-to-treat clinical situation. Differences in toxicity between the agents used to treat it are clear, but therapeutic differences are more difficult to discern. Meta-analyses suggest that a moderate advantage for linezolid over daptomycin may exist, but problems with the nature of studies that they included make definitive conclusions difficult.

There is disagreement about the association between missing teeth and the presence of temporomandibular disorder (TMD).Aim: To investigate whether, the span of edentulousness, gender, number of quadrants involved, pathological migration and the type of kennedy's classification are related to the temporomandibular joint (TMJ) dysfunction signs. Materials and methods:Clinical examination of 250 patients (males 99 and females 151) was done among the age group of 35 to 45 years. The patients were partially edentulous for 6 months or more and did not wear any kind of prosthesis.Results: Among 250 subjects, females showed more TMJ dysfunction signs. Clicking sounds were present in 46.5%, mandibular deviation was present in 40% of individuals, TMJ tenderness was observed in 32% and masseter was involved in 32% of individual. Temporomandibular joint dysfunction signs in relation to pathologic migration of teeth show that clicking and mandibular deviation was present in 54.5 and 49.2% and among muscles masseter muscle tenderness 41.9% was more commonly present. Masseter muscle tenderness 64.1% was seen in individuals who were edentulous for more than 5 years. Conclusion:Females subjects had a significantly higher prevalence of TMJ dysfunction signs then male subjects. As the span and time of edentulousness, the number of missing teeth and the number of quadrant involved increased, the signs of dysfunction became more prevalent. Among the TMJ dysfunction signs deviation and clicking sound were most frequently observed. The masseter muscle was most commonly affected and demonstrated muscle tenderness.