Evaluation of anti-biofilm activity of acidic amino acids and synergy with ciprofloxacin on Staphylococcus aureus biofilms

Acidic amino acids, aspartic acid (Asp) and glutamic acid (Glu) can enhance the solubility of many poorly soluble drugs including ciprofloxacin (Cip). One of the mechanisms of resistance within a biofilm is retardation of drug diffusion due to poor penetration across the matrix. To overcome this challenge, this work set to investigate novel counter ion approach with acidic amino acids, which we hypothesised will disrupt the biofilm matrix as well as simultaneously improve drug effectiveness. The anti-biofilm activity of D-Asp and D-Glu was studied on Staphylococcus aureus biofilms. Synergistic effect of combining D-amino acids with Cip was also investigated as a strategy to overcome anti-microbial resistance in these biofilms. Interestingly at equimolar combinations, D-Asp and D-Glu were able to significantly disperse (at 20 mM and 40 mM) established biofilms and inhibit (at 10 mM, 20 mM and 40 mM) new biofilm formation in the absence of an antibiotic. Moreover, our study confirmed L-amino acids also exhibit anti-biofilm activity. The synergistic effect of acidic amino acids with Cip was observed at lower concentration ranges (<40 mM amino acids and <90.54 µM, respectively), which resulted in 96.89% (inhibition) and 97.60% (dispersal) reduction in CFU with exposure to 40 mM amino acids. Confocal imaging indicated that the amino acids disrupt the honeycomb-like extracellular DNA (eDNA) meshwork whilst also preventing its formation

Iliopsoas bursitis and femoral vein thrombosis complicating total hip arthroplasty in an elderly patient

Predominantly, cystic or solid extra-articular pelvic masses have been increasingly recognized as a complication of hip arthroplasty and have been described in association with both metal-on-polyethylene and metal-on-metal implants. These late and uncommon complications cause a number of clinical symptoms, including limb swelling and erythema, pain, limp or restricted movement, palpable groin lump, femoral nerve irritation or palsy. Here, we report a case of a hemorrhagic cystic mass causing deep vein thrombosis (DVT) in the femoral vein 9 years after the patient had undergone a ceramic-on-ceramic cementless total hip arthroplasty