Vertebral osteomyelitis caused by vancomycin-tolerant methicillin-resistant Staphylococcus aureus bacteremia: Experience with teicoplanin plus fosfomycin combination therapy

An 85-year-old female presented with fever and consciousness disturbance for 3 days. The patient's blood culture subsequently revealed persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia despite the administration of vancomycin or teicoplanin monotherapy. Gallium inflammation scan and magnetic resonance image of the spine disclosed osteomyelitis and discitis at the level of L4–5. Surgical debridement was not feasible in this debilitated patient. Because of the creeping minimal inhibitory concentration of vancomycin of the causative isolate (1.5 μg/mL) and clinical failure with glycopeptide monotherapy, we changed the antibiotic therapy to a fosfomycin and teicoplanin combination therapy. The patient showed improved clinical response in terms of her enhanced consciousness as well as subsidence of persisted bacteremia. Despite the potential side effects of fosfomycin (such as diarrhea and hypernatremia), it combined with a glycopeptide may be an alternative therapy for invasive refractory MRSA infections

A Tailored Biomimetic Hydrogel as Potential Bioink to Print a Cell Scaffold for Tissue Engineering Applications: Printability and Cell Viability Evaluation

The present study established a maximum standard for printing quality and developed a preliminary ideal index to print three-dimensional (3D) construct using the Gly-Arg-Gly-Asp (GRGD) peptide modified Pluronic-F127 hydrogel (hereafter defined as 3DG bioformer (3BE)) as bioink. In addition, the biocompatibility of 3BE for 3D printing applications was carefully investigated. For biocompatibility study and ideal printing parameter, we used the formulation of 3BE in three different concentrations (3BE-1: 25%, 3BE-2: 30%, and 3BE-3: 35%). The 3BE hydrogels were printed layer by layer as a cube-like construct with all diameters of the needle head under the same feed (100 mm/s). The printing parameters were determined using combinations of 3BE-1, 3BE-2, and 3BE-3 with three different standard needle sizes (Φ 0.13 mm, Φ 0.33 mm, and Φ 0.9 mm). The printed constructs were photographed and observed using optical microscopy. The cell viability and proliferation were evaluated using Live/Dead assay and immunofluorescence staining. Results showed that a stable of printed line and construct could be generated from the 3BE-3 combinations. Cytotoxicity assay indicated that the 3BE hydrogels possessed well biocompatibility. Bioprinting results also demonstrated that significant cell proliferation in the 3BE-3 combinations was found within three days of printing. Therefore, the study discovered the potential printing parameters of 3BE as bioink to print a stable construct that may also have high biocompatibility for cell encapsulation. This finding could serve as valuable information in creating a functional scaffold for tissue engineering applications

A Tailored Biomimetic Hydrogel as Potential Bioink to Print a Cell Scaffold for Tissue Engineering Applications: Printability and Cell Viability Evaluation

The present study established a maximum standard for printing quality and developed a preliminary ideal index to print three-dimensional (3D) construct using the Gly-Arg-Gly-Asp (GRGD) peptide modified Pluronic-F127 hydrogel (hereafter defined as 3DG bioformer (3BE)) as bioink. In addition, the biocompatibility of 3BE for 3D printing applications was carefully investigated. For biocompatibility study and ideal printing parameter, we used the formulation of 3BE in three different concentrations (3BE-1: 25%, 3BE-2: 30%, and 3BE-3: 35%). The 3BE hydrogels were printed layer by layer as a cube-like construct with all diameters of the needle head under the same feed (100 mm/s). The printing parameters were determined using combinations of 3BE-1, 3BE-2, and 3BE-3 with three different standard needle sizes (Φ 0.13 mm, Φ 0.33 mm, and Φ 0.9 mm). The printed constructs were photographed and observed using optical microscopy. The cell viability and proliferation were evaluated using Live/Dead assay and immunofluorescence staining. Results showed that a stable of printed line and construct could be generated from the 3BE-3 combinations. Cytotoxicity assay indicated that the 3BE hydrogels possessed well biocompatibility. Bioprinting results also demonstrated that significant cell proliferation in the 3BE-3 combinations was found within three days of printing. Therefore, the study discovered the potential printing parameters of 3BE as bioink to print a stable construct that may also have high biocompatibility for cell encapsulation. This finding could serve as valuable information in creating a functional scaffold for tissue engineering applications