The Effect of Pathophysiologic Glucose Concentration on Biofilm Growth In Vitro
نویسنده
چکیده
Introduction: Surgical site infections are the second most common cause of nosocomial infection in the United States and lead to longer hospital stays, higher mortality rates, and increased cost. Diabetes mellitus has been linked to postoperative and nosocomial infection by many authors. There have been several efforts to define target ranges for perioperative blood glucose in an effort to help curb post-operative infection rates. For most clinicians perioperative blood glucose control is a concern that revolves around host optimization. It is accepted that elevated blood glucose concentration leads to non-enzymatic glycosylation of cells in the body. This includes soft tissue that must be dissected and repaired during surgery as well as cells of the immune system. Previous authors have reported that elevated blood glucose levels effect both the cellular and humeral arms of the immune response thus compromising a host’s ability to combat a potential infection. It is also well known that prosthetic joint infections(PJI) arise from biofilm forming bacteria. It has long been recognized that the growth rate of bacteria is dependent on the concentration of nutrients present in the media. It was not appreciated until recently that some of those nutrients may play a role as signaling molecules, affecting the behavior of the bacteria to which they are exposed. Recent research by multiple centers has suggested that the potential of bacteria to form biofilm is moderated by the concentration of glucose present in the media. Fluorescence studies suggest that the presence of increasing concentrations of glucose affects the agr pathway, leading to the formation of biofilm. It has also been suggested that the pH of the local cellular environment may play a role in this signaling process. Additional studies have found that in controlled conditions, there is a consistent increase in biofilm production across many different strains and bacterial types in media with high (1%) concentrations of glucose. The concentrations used to generate biofilms in many of these studies are in a greatly super-physiological range, however, and authors may not account for the presence of glucose in the media when they additionally supplement the media with glucose. This study seeks to explore the relationship between biofilm formation and glucose concentration in a physiologic to pathophysiological range. This study asks the question: What is the effect of pathological concentrations of glucose on biofilm growth? Methods: Strain Selection: Two standardized strains were selected for this work: Staphylococus epidermidis (ATCC 35984) and Staphylococcus aureus (ATCC 49230, UAMS 1).
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