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Emergency Medicine And Covid-19: Now And Next Year, Theodore A. Christopher, Adrienne N. Christopher

Department of Emergency Medicine Faculty Papers

The COVID-19 pandemic is responsible for infecting to date more than 93 million people worldwide and causing more than 2 million deaths. That the vast majority of deaths have occurred in the United States (U.S.) can be attributed to nonadherence by Americans to basic public health mitigation strategies that are known to curtail coronavirus spread. Emergency Departments (ED’s) throughout the U.S. experienced a dramatic decrease in patient visits during the first surge of COVID-19, followed by an ED patient visit rebound to approximately 80% of pre-COVID-19 numbers, which have remained relatively stable through the current second COVID-19 surge. The pandemic …

Outcomes Of Implant Removal And Capsulectomy For Breast Implant Illness In 248 Patients., Jacob Y. Katsnelson, Joseph R. Spaniol, Joshua C. Buinewicz, Frederick V. Ramsey, Brian R. Buinewicz

Abington Jefferson Health Papers

Background: Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII.

Methods: We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic …

A Novel Framework To Guide Antibiotic Stewardship Nursing Practice., Mary Lou Manning, Monika Pogorzelska-Maziarz, Cindy Hou, Nikunj Vyas, Marianne Kraemer, Eileen Carter, Elizabeth Monsees

College of Nursing Faculty Papers & Presentations

BACKGROUND: There is a pervasive view among some nurses and health care disciplines that antibiotic stewardship (AS) is solely a physician or pharmacist responsibility. There is an urgent need to alter this view so that nurses can seize every opportunity to prevent patient harm from antibiotics and optimize antibiotic use. One challenge to achieving full nurse engagement as equal members of the AS team is lack of an organizing framework to illustrate relationships of phenomena and concepts inherent to adoption of AS nursing practices.

METHODS: We sought to create a framework derived from the peer-reviewed literature, systematic and scoping reviews, …

Lipid-Nanoparticle-Encapsulated Mrna Vaccines Induce Protective Memory Cd8 T Cells Against A Lethal Viral Infection., Cory J Knudson, Pedro Alves-Peixoto, Hiromi Muramatsu, Colby Stotesbury, Lingjuan Tang, Paulo J C Lin, Ying K Tam, Drew Weissman, Norbert Pardi, Luis J. Sigal

Department of Microbiology and Immunology Faculty Papers

It is well established that memory CD8 T cells protect susceptible strains of mice from mousepox, a lethal viral disease caused by ectromelia virus (ECTV), the murine counterpart to human variola virus. While mRNA vaccines induce protective antibody (Ab) responses, it is unknown whether they also induce protective memory CD8 T cells. We now show that immunization with different doses of unmodified or N(1)-methylpseudouridine-modified mRNA (modified mRNA) in lipid nanoparticles (LNP) encoding the ECTV gene EVM158 induced similarly strong CD8 T cell responses to the epitope TSYKFESV, albeit unmodified mRNA-LNP had adverse effects at the inoculation site. A single immunization …

Coronavirus Disease 2019 (Covid-19): Multisystem Review Of Pathophysiology, Tanveer Mir, Talal Almas, Jasmeet Kaur, Mohammed Faisaluddin, David Song, Waqas Ullah, Sahil Mamtani, Hiba Rauf, Sunita Yadav, Sharaad Latchana, Nara Miriam Michaelson, Michael Connerney, Yasar Sattar

Division of Internal Medicine Faculty Papers & Presentations

Abstract Coronavirus disease-19 (COVID-19) pandemic is associated with high morbidity and mortality. COVID-19, which is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), affects multiple organ systems through a myriad of mechanisms. Afflicted patients present with a vast constellation of symptoms, from asymptomatic disease to life-threatening complications. The most common manifestations pertain to mild pulmonary symptoms, which can progress to respiratory distress syndrome and venous thromboembolism. However, in patients with renal failure, life-threatening cardiac abnormalities can ensue. Various mechanisms such as viral entry through Angiotensin receptor (ACE) affecting multiple organs and thus releasing pro-inflammatory markers have been postulated. …

Potential Immunomodulatory Properties Of Biologically Active Components Of Spices Against Sars-Cov-2 And Pan Β-Coronaviruses, Sourodip Sengupta, Debina Bhattacharyya, Grishma Kasle, Souvik Karmakar, Omkar Sahu, Anirban Ganguly, Sankar Addya, Jayasri Das Sarma

Kimmel Cancer Center Faculty Papers

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced COVID-19 has emerged as a defining global health crisis in current times. Data from the World Health Organization shows demographic variations in COVID-19 severity and lethality. Diet may play a significant role in providing beneficial host cell factors contributing to immunity against deadly SARS-CoV-2 pathogenesis. Spices are essential components of the diet that possess anti-inflammatory, antioxidant, and antiviral properties. Hyperinflammation, an aberrant systemic inflammation associated with pneumonia, acute respiratory failure, and multiorgan dysfunction, is a major clinical outcome in COVID-19. Knowing the beneficial properties of spices, we hypothesize that spice-derived bioactive components …

Loss Of N1-Methylation Of G37 In Trna Induces Ribosome Stalling And Reprograms Gene Expression, Isao Masuda, Jae-Yeon Hwang, Thomas Christian, Sunita Maharjan, Fuad Mohammad, Howard Gamper, Allen R. Buskirk, Ya-Ming Hou

Department of Biochemistry and Molecular Biology Faculty Papers

N¹-methylation of G37 is required for a subset of tRNAs to maintain the translational reading-frame. While loss of m¹G37 increases ribosomal +1 frameshifting, whether it incurs additional translational defects is unknown. Here, we address this question by applying ribosome profiling to gain a genome-wide view of the effects of m¹G37 deficiency on protein synthesis. Using E coli as a model, we show that m¹G37 deficiency induces ribosome stalling at codons that are normally translated by m¹G37-containing tRNAs. Stalling occurs during decoding of affected codons at the ribosomal A site, indicating …

Validating Deep Learning Inference During Chest X-Ray Classification For Covid-19 Screening., Robbie Sadre, Baskaran Sundaram, Sharmila Majumdar, Daniela Ushizima

Department of Radiology Faculty Papers

The new coronavirus unleashed a worldwide pandemic in early 2020, and a fatality rate several times that of the flu. As the number of infections soared, and capabilities for testing lagged behind, chest X-ray (CXR) imaging became more relevant in the early diagnosis and treatment planning for patients with suspected or confirmed COVID-19 infection. In a few weeks, proposed new methods for lung screening using deep learning rapidly appeared, while quality assurance discussions lagged behind. This paper proposes a set of protocols to validate deep learning algorithms, including our ROI Hide-and-Seek protocol, which emphasizes or hides key regions of interest …

Filling Gaps And Setting Boundaries: Examining Utilization Of Health And Social Services At Jeffhope Student Run Clinics., Roy Wang, Amanda Guth, Alyssa Tate, Michele Ly, James D. Plumb Md, Mph

Department of Medicine Faculty Papers

The objective of this study was to describe the frequency that healthcare and social support services offered by JeffHOPE, a student run clinic for people experiencing homelessness in Philadelphia, PA, were utilized by patients. This study also aimed to investigate where patients would seek medical care on a given day had they not been able to access JeffHOPE. This study was conducted via mixed methods consisting of retrospective chart review of patient encounter records and a patient survey conducted weekly throughout 2019, both at a single clinic site, and retrospective chart review of January through March 2020 records at 5 …

Perceptions And Challenges Experienced By African Physicians When Prescribing Methotrexate For Rheumatic Disease: An Exploratory Study, Carol A Hitchon, Girsh M Mody, Candace H Feldman, Yan Lau, Steven Shi, Michele Meltzer, Rosie Scuccimarri, Michael E Weinblatt, Ines Colmegna

Department of Medicine Faculty Papers

Objective: Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations.

Methods: African physicians who self-identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L-HDI versus MH-HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI.

Results: Physicians (23 rheumatologists; …

Perceptions And Challenges Experienced By African Physicians When Prescribing Methotrexate For Rheumatic Disease: An Exploratory Study, Carol A Hitchon, Girsh M Mody, Candace H Feldman, Yan Lau, Steven Shi, Michele Meltzer, Rosie Scuccimarri, Michael E Weinblatt, Ines Colmegna

Department of Medicine Faculty Papers

OBJECTIVE: Guidelines for methotrexate (MTX) use in rheumatic disease may not be feasible for physicians practicing in the least developed countries. We aimed to understand the experiences of MTX prescribers relating to MTX use for rheumatic disease in African countries to inform the development of culturally and geographically appropriate recommendations.

METHODS: African physicians who self-identified as MTX prescribers from countries classified as having a low versus a medium or high Human Development Index (L-HDI versus MH-HDI) participated in semistructured interviews between August 2016 and September 2017. Interviews were transcribed verbatim, coded thematically, and stratified by HDI.

RESULTS: Physicians (23 rheumatologists; …

A Single Dose Of Replication-Competent Vsv-Vectored Vaccine Expressing Sars-Cov-2 S1 Protects Against Virus Replication In A Hamster Model Of Severe Covid-19., Delphine C. Malherbe, Drishya Kurup, Christoph Wirblich, Adam J. Ronk, Chad Mire, Natalia Kuzmina, Noor Shaik, Sivakumar Periasamy, Matthew A. Hyde, Julie M. Williams, Pei-Yong Shi, Matthias J. Schnell, Alexander Bukreyev

Department of Microbiology and Immunology Faculty Papers

The development of effective countermeasures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent responsible for the COVID-19 pandemic, is a priority. We designed and produced ConVac, a replication-competent vesicular stomatitis virus (VSV) vaccine vector that expresses the S1 subunit of SARS-CoV-2 spike protein. We used golden Syrian hamsters as animal models of severe COVID-19 to test the efficacy of the ConVac vaccine. A single vaccine dose elicited high levels of SARS-CoV-2 specific binding and neutralizing antibodies; following intranasal challenge with SARS-CoV-2, animals were protected from weight loss and viral replication in the lungs. No enhanced pathology was observed …

Capacity Building For A New Multicenter Network Within The Echo Idea States Pediatric Clinical Trials Network., Robert D Annett, Scott Bickel, John C Carlson, Kelly Cowan, Sara Cox, Mark J Fisher, J Dean Jarvis, Alberta S Kong, Jessica S Kosut, Kurtis R Kulbeth, Abbot Laptook, Pearl A Mcelfish, Mary M Mcnally, Lee Pachter, Do, Barbara A Pahud, Lee A Pyles, Jennifer Shaw, Kari Simonsen, Jessica Snowden, Christine B Turley, Andrew M Atz

Department of Medicine Faculty Papers

Introduction: Research capacity building is a critical component of professional development for pediatrician scientists, yet this process has been elusive in the literature. The ECHO IDeA States Pediatric Clinical Trials Network (ISPCTN) seeks to implement pediatric trials across medically underserved and rural populations. A key component of achieving this objective is building pediatric research capacity, including enhancement of infrastructure and faculty development. This article presents findings from a site assessment inventory completed during the initial year of the ISPCTN.

Methods: An assessment inventory was developed for surveying ISPCTN sites. The inventory captured site-level activities designed to increase clinical trial research …

Comparison Of Lethal And Nonlethal Mouse Models Of Orientia Tsutsugamushi Infection Reveals T-Cell Population-Associated Cytokine Signatures Correlated With Lethality And Protection, Alison Luce-Fedrow, Suchismita Chattopadhyay, Teik-Chye Chan, Gregory Pearson, John B. Patton, Allen L. Richards

Department of Microbiology and Immunology Faculty Papers

The antigenic diversity of Orientia tsutsugamushi as well as the interstrain difference(s) associated with virulence in mice impose the necessity to dissect the host immune response. In this study we compared the host response in lethal and non-lethal murine models of O. tsutsugamushi infection using the two strains, Karp (New Guinea) and Woods (Australia). The models included the lethal model: Karp intraperitoneal (IP) challenge; and the nonlethal models: Karp intradermal (ID), Woods IP, and Woods ID challenges. We monitored bacterial trafficking to the liver, lung, spleen, kidney, heart, and blood, and seroconversion during the 21-day challenge. Bacterial trafficking to all …

Closing Gaps In The Care Of Patients With Heart-Kidney Disease: The Time Is Now., Janani Rangaswami

Department of Medicine Faculty Papers

No abstract present.

A Rare Fatal Case Of Adenovirus Serotype 4 Associated Acute Disseminated Encephalomyelitis In An Adult: A Case Report, Zahra Qamar, Catherine Tucker, Lawrence C. Kenyon, Tricia. Royer

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease directed against the myelin sheath of the central nervous system that typically presents 1–4 weeks after an infection or vaccination, most commonly in children. We describe a case of a young female who presented with rapidly progressive mental deterioration and died secondary to ADEM following an adenovirus upper respiratory tract infection.

Emerging Advances Of Nanotechnology In Drug And Vaccine Delivery Against Viral Associated Respiratory Infectious Diseases (Varid), Amir Seyfoori, Mahdieh Shokrollahi Barough, Pooneh Mokarram, Mazaher Ahmadi, Parvaneh Mehrbod, Alireza Sheidary, Tayyebeh Madrakian, Mohammad Kiumarsi, Tavia Walsh, Kielan D Mcalinden, Chandra C Ghosh, Pawan Sharma, Amir A Zeki, Saeid Ghavami, Mohsen Akbari

Center for Translational Medicine Faculty Papers

Viral-associated respiratory infectious diseases are one of the most prominent subsets of respiratory failures, known as viral respiratory infections (VRI). VRIs are proceeded by an infection caused by viruses infecting the respiratory system. For the past 100 years, viral associated respiratory epidemics have been the most common cause of infectious disease worldwide. Due to several drawbacks of the current anti-viral treatments, such as drug resistance generation and non-targeting of viral proteins, the development of novel nanotherapeutic or nano-vaccine strategies can be considered essential. Due to their specific physical and biological properties, nanoparticles hold promising opportunities for both anti-viral treatments and …

Circumcision As An Intervening Strategy Against Hiv Acquisition In The Male Genital Tract, Adhikarimayum Lakhikumar Sharma, Joseph Hokello, Mudit Tyagi

Center for Translational Medicine Faculty Papers

Unsafe sex with HIV-infected individuals remains a major route for HIV transmission, and protective strategies, such as the distribution of free condoms and pre-or post-prophylaxis medication, have failed to control the spread of HIV, particularly in resource-limited settings and high HIV prevalence areas. An additional key strategy for HIV prevention is voluntary male circumcision (MC). International health organizations (e.g., the World Health Organization, UNAIDS) have recommended this strategy on a larger scale, however, there is a general lack of public understanding about how MC effectively protects against HIV infection. This review aims to discuss the acquisition of HIV through the …

On The Road From Phenotypic Plasticity To Stem Cell Therapy., Lorraine Iacovitti

Farber Institute for Neuroscience Faculty Papers

In 1981, I published a paper in the first issue of The Journal of Neuroscience with my postdoctoral mentor, Richard Bunge. At that time, the long-standing belief that each neuron expressed only one neurotransmitter, known as Dale's Principle (Dale, 1935), was being hotly debated following a report by French embryologist Nicole Le Douarin showing that neural crest cells destined for one transmitter phenotype could express characteristics of another if transplanted to alternate sites in the developing embryo (Le Douarin, 1980). In the Bunge laboratory, we were able to more directly test the question of phenotypic plasticity in the controlled environment …

Covid-19 Treatment Combinations And Associations With Mortality In A Large Multi-Site Healthcare System., Dagan Coppock, Michael Baram, Anna Marie Chang, Patricia Henwood, Alan Kubey, Ross Summer, John Zurlo, Michael Li, Bryan Hess

Division of Infectious Diseases and Environmental Medicine Faculty Papers

INTRODUCTION: During the early months of the COVID-19 pandemic, mortality associated with the disease declined in the United States. The standard of care for pharmacological interventions evolved during this period as new and repurposed treatments were used alone and in combination. Though these medications have been studied individually, data are limited regarding the relative impact of different medication combinations. The objectives of this study were to evaluate the association of COVID-19-related mortality and observed medication combinations and to determine whether changes in medication-related practice patterns and measured patient characteristics, alone, explain the decline in mortality seen early in the COVID-19 …

Intracranial Mycoplasma Hominis Infection Following Emergent Craniectomy, Zahra Qamar, Stavropoula Tjoumakaris, Matthew Pattengill, Maliha Ahmed, Bryan Hess

Division of Infectious Diseases and Environmental Medicine Faculty Papers

We present a case of a young healthy female who developed recurrent cranial wound infections after a traumatic injury, the etiologic organism finally identified as Mycoplasma hominis, an uncommon and difficult to isolate bacterium.

An Update On The Hiv Dna Vaccine Strategy, Joseph Hokello, Adhikarimayum Lakhikumar Sharma, Mudit Tyagi

Center for Translational Medicine Faculty Papers

In 2020, the global prevalence of human immunodeficiency virus (HIV) infection was estimated to be 38 million, and a total of 690,000 people died from acquired immunodeficiency syndrome (AIDS)–related complications. Notably, around 12.6 million people living with HIIV/AIDS did not have access to life-saving treatment. The advent of the highly active antiretroviral therapy (HAART) in the mid-1990s remarkably enhanced the life expectancy of people living with HIV/AIDS as a result of improved immune functions. However, HAART has several drawbacks, especially when it is not used properly, including a high risk for the development of drug resistance, as well as undesirable …

Social Intervention By The Numbers: Evidence Behind The Specific Public Health Guidelines In The Covid-19 Pandemic., Michael P. Savage, David L. Fischman, Mamas A. Mamas

Department of Medicine Faculty Papers

Coronavirus disease 2019 (COVID-19) has rapidly become a worldwide pandemic ushering in a global health and economic crisis. In the absence of vaccines or definitive drug therapies, current strategies against COVID-19 rely on preventing the transmission of disease through nonpharmaceutical interventions such as social distancing and proper hand hygiene. For practical and perhaps ethical reasons, the clinical efficacy of these public health measures for managing pandemics has not been demonstrated in randomized controlled clinical trials. Accordingly, guideline recommendations for using nonpharmaceutical interventions are based primarily on observational and modeling studies and on expert opinion. A recent position paper from the …

Reforming The Pre-Operative Clearance Process In The Covid-19 Era, Ritam Ghosh, Md, René Daniel, Md, Jesse Edwards, Md, Catriona Harrop, Md, Janeen Duckworth, Msn, Amy Della Penna, Msn

Health Equity and Quality Improvement (HEQI) Summit

The problem at hand was increasing cancellation rates, increasing frustration amongst physicians, and lack of communication which guided our interventions

Some of the interventions used to improve the process are:

• PAT practioners routinely checking laboratory tests after the initial visit
• PAT practioners routinely documenting addendums in medical record in order to improve transparency and medical record
• Two step verification process: residents/surgeons going through medical record and communicating to PAT practioners if clearance was not ironclad
• Consulting physicians (i.e. cardiologists) with improved communication and documentation with PAT practioners in the event of additional testing necessary prior to clearance
• PAT physicians communicate …

Plasma Adenosine Deaminase (Ada)-1 And -2 Demonstrate Robust Ontogeny Across The First Four Months Of Human Life., Oludare A. Odumade, Alec L. Plotkin, Jensen Pak, Olubukola T. Idoko, Matthew A. Pettengill, Tobias R. Kollmann, Al Ozonoff, Beate Kampmann, Ofer Levy, Kinga K. Smolen

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Background: Human adenosine deaminases (ADAs) modulate the immune response: ADA1

Methods: In a subgroup of the EPIC002-study, clinical data and plasma samples were collected from 540 Gambian infants at four time-points: day of birth; first week of life; one month of age; and four months of age. Concentrations of total extracellular ADA, ADA1, and ADA2 were measured by chromogenic assay and evaluated in relation to clinical data. Plasma cytokines/chemokine were measured across the first week of life and correlated to ADA concentrations.

Results: ADA2 demonstrated a steady rise across the first months of life, while ADA1 concentration significantly decreased 0.79-fold …

Reporting And Analyzing Race And Ethnicity In Orthopaedic Clinical Trials: A Systematic Review., Ryan W. Paul, Donghoon Lee, Joseph Brutico, Fotios P. Tjoumakaris, Michael G. Ciccotti, Kevin B, Freedman

Rothman Institute Papers

BACKGROUND: The distinction between race and ethnicity should be carefully understood and described for demographic data collection. Racial healthcare differences have been observed across many orthopaedic subspecialties. However, the frequency of reporting and analyzing race and ethnicity in orthopaedic clinical trials has not been determined. Therefore, the primary purpose of this systematic review was to determine how frequently race and ethnicity are reported and analyzed in orthopaedic clinical trials.

METHODS: The top 10 journals by impact factor in the field of orthopaedics were manually screened from 2015 to 2019. All randomized controlled trials related to orthopaedics and assessing clinical outcomes …

Resistance To Lethal Ectromelia Virus Infection Requires Type I Interferon Receptor In Natural Killer Cells And Monocytes But Not In Adaptive Immune Or Parenchymal Cells., Carolina R Melo-Silva, Pedro Alves-Peixoto, Natasha Heath, Lingjuan Tang, Brian Montoya, Cory J Knudson, Colby Stotesbury, Maria Ferez, Eric B. Wong, Luis J. Sigal

Department of Microbiology and Immunology Faculty Papers

Type I interferons (IFN-I) are antiviral cytokines that signal through the ubiquitous IFN-I receptor (IFNAR). Following footpad infection with ectromelia virus (ECTV), a mouse-specific pathogen, C57BL/6 (B6) mice survive without disease, while B6 mice broadly deficient in IFNAR succumb rapidly. We now show that for survival to ECTV, only hematopoietic cells require IFNAR expression. Survival to ECTV specifically requires IFNAR in both natural killer (NK) cells and monocytes. However, intrinsic IFNAR signaling is not essential for adaptive immune cell responses or to directly protect non-hematopoietic cells such as hepatocytes, which are principal ECTV targets. Mechanistically, IFNAR-deficient NK cells have reduced …

When Total Joint Arthroplasty After Septic Arthritis Can Be Safely Performed, Timothy L. Tan, Chi Xu, Feng-Chih Kuo, Elie Ghanem, Jaiben George, Noam Shohat, Ji-Ying Chen, Mel S Lee, Carlos Higuera, Javad Parvizi

Rothman Institute Papers

Background: Patients undergoing total joint arthroplasty (TJA) following septic arthritis are at higher risk for developing periprosthetic joint infection (PJI). Minimal literature is available to guide surgeons on the optimal timing of TJA after completing treatment for prior native joint septic arthritis. This multicenter study aimed to determine the optimal timing of TJA after prior septic arthritis and to examine the role of preoperative serology in predicting patients at risk for developing PJI.

Methods: A total of 207 TJAs were performed after prior septic arthritis from 2000 to 2017 at 5 institutions. Laboratory values, prior treatment, time from the initial …

Risk Scores And Machine Learning To Identify Patients With Acute Periprosthetic Joints Infections That Will Likely Fail Classical Irrigation And Debridement., Marjan Wouthuyzen-Bakker, Noam Shohat, Javad Parvizi Md, Alex Soriano

Rothman Institute Papers

The most preferred treatment for acute periprosthetic joint infection (PJI) is surgical debridement, antibiotics and retention of the implant (DAIR). The reported success of DAIR varies greatly and depends on a complex interplay of several host-related factors, duration of symptoms, the microorganism(s) causing the infection, its susceptibility to antibiotics and many others. Thus, there is a great clinical need to predict failure of the "classical" DAIR procedure so that this surgical option is offered to those most likely to succeed, but also to identify those patients who may benefit from more intensified antibiotic treatment regimens or new and innovative treatment …

Staphylococcus Aureus Floating Biofilm Formation And Phenotype In Synovial Fluid Depends On Albumin, Fibrinogen, And Hyaluronic Acid, Samantha Knott, Dylan Curry, Neil Zhao, Pallavi Metgud, Sana Dastgheyb, Caroline Purtill, Marc I. Harwood, Md, Antonia F Chen, Thomas P Schaer, Michael Otto, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

Biofilms are typically studied in bacterial media that allow the study of important properties such as bacterial growth. However, the results obtained in such media cannot take into account the bacterial localization/clustering caused by bacteria–protein interactions in vivo and the accompanying alterations in phenotype, virulence factor production, and ultimately antibiotic tolerance. We and others have reported that methicillin-resistant or methicillin-susceptible Staphylococcus aureus (MRSA or MSSA, respectively) and other pathogens assemble a proteinaceous matrix in synovial fluid. This proteinaceous bacterial aggregate is coated by a polysaccharide matrix as is characteristic of biofilms. In this study, we identify proteins important for this …