*Edited by Manal Mohammad Baddour*

Skin is a natural barrier to infection. Surgical breakage of skin can lead to surgical site infections (SSIs). SSIs are relatively common and constitute a problematic issue in surgical procedures. Most common organisms include Gram-positive, such as Staphylococcus and Streptococcus, as well as Gram-negative, such as Pseudomonas and others, bacteria. The extent and outcome of SSI can vary widely depending on the procedure, organism, extent, and other factors, and can result in discomfort, severe morbidity, or even life-threatening conditions.It is thus mandatory to be aware of and follow WHO and CDC guidelines for the prevention of SSIs and to reduce risk factors for acquisition. This book sheds light on certain aspects related to SSIs and how to avoid them.

ISBN 978-1-83968-534-7

Surgical Infections - Some Facts

Published in London, UK © 2020 IntechOpen © ktsimage / iStock

## Surgical Infections Some Facts

*Edited by Manal Mohammad Baddour*


**5. Alternatives to fresh microalgae**

Marine microalgae have been the traditional food component in finfish and shellfish aquaculture, e.g. for larval and juvenile animals [77]; they are indeed essential in hatchery and nursery of bivalves, shrimp and some finfish cultures. Microalgae are also used to produce zooplankton – typically rotifers, which are in turn fed to freshly hatched carnivorous fish [78]. As aquaculture industry expands [79] – and since microalgal biomass cultivation on-site may represent up to 30% of the operating costs [13], there is a demand for marine microalgae that cannot be met by the conventional methods used in hatcheries – thus forcing one to resort to substitutes with mediocre results that bring about several problems [44,80].

Despite the obvious advantages of alive microalgae in aquaculture, the current trend is to avoid using them because of their high cost and difficulty in producing, concentrating and storing them [8,81]. Alternatives that are potentially more cost-effective have been investigated – including nonliving food, viz. microalga pastes, dried microalgae, microencapsulates, cryopreservation, flocculation, bacteria or yeasts; they have been tested *in vitro* and in actual hatcheries, but met with variable degrees of success [82,83]. For instance, in Japan, where *Nannochloropsis oculata* is the most important cultured feed for the rotifer *Brachionus plicatilis*, concentrated suspensions and frozen biomass of this microalga are commercially available [84]; and partial replacement of alive microalgae by microencapsulated and yeast-based diets is indeed a routine practice in hatcheries for penaeid shrimp [24,85]. However, most these approaches have proven unsuitable as major dietary components, because of their lower nutritional value than mixtures of alive microalgae.

Several criteria should be addressed in attempts to find substitutes for alive microalgae as diet in aquaculture. From a nutrition standpoint, alive microalgae possess higher nutritional value and better digestibility than most substitutes; note that the nutritional quality depends critically on such biochemical constituents as PUFAs, vitamins, sterols and carbohydrates [86].

Useful bacteria can provide only a part of the metabolic requirements in aquaculture – by supplying a few organic molecules and vitamins. Under conditions close to those found in rearing facilities, the bacterial input should not represent more than 15% of the microalgal contribution for mollusk larvae and juveniles of many species [87,88]. Yeasts were as well investigated as an alternative food source – but poor results were observed [83,89]. Therefore, these two alternatives are not suitable to fully replace alive microalgae.

decade; while many types of experimental PBRs have been considered, built and tested, very few have actually succeeded on a commercial level. Commercial application of photobioreactor technology remains indeed restricted to the production of two Chlorophyte

Scale up of photobioreactors from bench to commercial scale is not trivial – since it needs changes in illumination, gas transfer and temperature to be taken into account, all of which are severely affected by turbulence in the reactor, and consequently require a tight control. Therefore, scale up appears to be much more of an engineering problem than a biological one; and general recommendations as to possible maximum scales have accordingly been

Marine microalgae have been the traditional food component in finfish and shellfish aquaculture, e.g. for larval and juvenile animals [77]; they are indeed essential in hatchery and nursery of bivalves, shrimp and some finfish cultures. Microalgae are also used to produce zooplankton – typically rotifers, which are in turn fed to freshly hatched carnivorous fish [78]. As aquaculture industry expands [79] – and since microalgal biomass cultivation on-site may represent up to 30% of the operating costs [13], there is a demand for marine microalgae that cannot be met by the conventional methods used in hatcheries – thus forcing one to resort to substitutes with mediocre results that bring about several

Despite the obvious advantages of alive microalgae in aquaculture, the current trend is to avoid using them because of their high cost and difficulty in producing, concentrating and storing them [8,81]. Alternatives that are potentially more cost-effective have been investigated – including nonliving food, viz. microalga pastes, dried microalgae, microencapsulates, cryopreservation, flocculation, bacteria or yeasts; they have been tested *in vitro* and in actual hatcheries, but met with variable degrees of success [82,83]. For instance, in Japan, where *Nannochloropsis oculata* is the most important cultured feed for the rotifer *Brachionus plicatilis*, concentrated suspensions and frozen biomass of this microalga are commercially available [84]; and partial replacement of alive microalgae by microencapsulated and yeast-based diets is indeed a routine practice in hatcheries for penaeid shrimp [24,85]. However, most these approaches have proven unsuitable as major dietary components, because of their lower nutritional value than mixtures of alive

Several criteria should be addressed in attempts to find substitutes for alive microalgae as diet in aquaculture. From a nutrition standpoint, alive microalgae possess higher nutritional value and better digestibility than most substitutes; note that the nutritional quality depends critically on such biochemical constituents as PUFAs, vitamins, sterols and carbohydrates [86]. Useful bacteria can provide only a part of the metabolic requirements in aquaculture – by supplying a few organic molecules and vitamins. Under conditions close to those found in rearing facilities, the bacterial input should not represent more than 15% of the microalgal contribution for mollusk larvae and juveniles of many species [87,88]. Yeasts were as well investigated as an alternative food source – but poor results were observed [83,89].

Therefore, these two alternatives are not suitable to fully replace alive microalgae.

microalgae: *Chlorella* and *Haematococcus* [62,75].

**5. Alternatives to fresh microalgae**

produced [75,76].

problems [44,80].

microalgae.

An alternative diet with an apparently better potential is microalgal pastes or concentrates [90-92]; these are prepared by centrifugation (up to 1:500 concentration) or flocculation (up to 1:100 concentration). Concentrates prepared from distinct microalgae vary in their suitability – with diatoms being the most promising; and they have a shelf life of between 2 and 8 weeks, when stored below 4°C. Commercially, microalgal concentrates can be prepared under two different scenarios: (a) by hatcheries on-site, which prepare concentrates as back-up or as a means to store overproduction; or (b) by remote production, centralized at a large facility – with a greater economy of scale, with the resulting concentrates dispatched to hatcheries upon request.

The advantage of such concentrates is that they can be used "off-the-shelf", thus contributing favorably to the cost-efficiency in hatcheries. On the other hand, the lower nutritional value of most dried microalgae compared to alive feed, and the limited availability of commercial dried products appear as main shortcomings. Globally speaking, concentrates have low levels (or even absence) of ω3-PUFA, and lead to a difficult digestion by bivalve larvae [93]. The genus *Tetraselmis* seems to be a good candidate for microalgal paste, but its nutritional quality deteriorates quite rapidly [94]; experiments have indicated that such substitutes should be used as supplement only when rations of live microalgae are insufficient. Furthermore, spray-dried microalgae and microalga paste may be useful to replace up to 50% of alive microalgae. Coutteau and Sorgeloos [13] reported that artificial or non-living diets are rarely applied in routine processing of bivalves, and are mostly considered as a backup food source only. Centrifuged concentrates of *P. lutheri*, in combination with *Chaetoceros calcitrans* or *S. costatum*, lead to 85-90% of the growth when a mixed diet of alive microalgae for oyster *Saccostrea glomerata* larvae is used [92].

Centrifugation has been successfully applied to prepare concentrates, but it has some limitations – i.e. the process involves exposing cells to high gravitational and shear forces that damage the cell structure. On the other hand, processing of large culture volumes is time-consuming and requires costly equipment, i.e. a specialized continuous centrifuge. Research on post-harvest preservation is required to extend shelf-life beyond 4 to 8 weeks, and also to prepare concentrates from flagellate species (e.g. *Isochrysis* sp. and *P. lutheri*).

Alternative processes have meanwhile been developed that are potentially less damaging to cells – including foam fractionation [95], flocculation [96,97] and filtration [98]. Sandbank [99] fed microalgae, grown in waste-water and flocculated with aluminium sulfate, to common carp (*Cyprinus carpia*); a diet containing 25% of microalgal meal led to a growth comparable to that by the control diet, with no harmful effects detected upon long term health of the fish. Millamena et al. [96] successfully fed *Penaeus monodon* larvae with dried, flocculated *C. calcitrans* and *Tetraselmis chuii* cells. However, a common disadvantage encountered was that the harvested cells are difficult to disaggregate back to single cells, which is a requirement to feed them to filter-feeding species such as bivalves [100].

A novel technique was developed for flocculation of marine microalgae that appears useful in aquaculture: it entails adjustment of pH of the culture using NaOH, followed by addition of a non-ionic polymer, Magnafloc LT-25; the ensuing flocculate is then harvested and neutralized, thus leading to a final concentration of between 200- and 800-fold. This process was successfully applied to harvest cells of *C. calcitrans* and *C. muelleri, Thalassiosira pseudonana, Attheya septentrionalis, Nitzschia closterium, Skeletonema* sp.*, Tetraselmis suecica* and *Rhodomonas salina*, with efficiencies above 80%; it proved rapid, simple and inexpensive, and relatively independent of processed volume (unlike concentration by centrifugation). The harvested material was readily disaggregated to single cell suspensions by dilution in seawater, coupled with mild agitation. Microscopic examination proved that the final cells are indistinguishable from the nonflocculated ones; and assay for chlorophyll of the concentrates prepared from cultures of up to 130 L showed marginal degradation by 2 weeks of storage [100].

Cryopreservation has been thoroughly adopted by culture collections to preserve strains, but may also find an application in aquaculture [80]. Viable cryostorage of biological specimens has followed various protocols of cooling/thawing rates and cryoprotectant addition, which have been developed and tuned more or less empirically [101]. Recall that temperatures used for cryostorage are well below freezing – down to even -196 ºC in liquid helium, when biological specimens are to be stored without limit [102]. While cryostorage is generally thought to be innocuous to the cell, the events occurring upon freezing or thawing can lead to severe damage, or even cell death. Moreover, cryoprotectants that enhance the cell viability at cryogenic temperatures are usually toxic at physiological temperatures [103] – an obstacle that is overcome by reducing the exposure time or the temperature of incubation prior to cryopreservation [104]. Knowledge of cryoprotectant tolerance levels for microalgae is still limited [105], as well as for early larval stages and for zooplankton that are cultivated and rely on the availability of microalgae for growth. In general, cryopreservation possesses a high potential for culture collections, and may also offer a solution for reliable supply of microalgae in aquaculture. For instance, marine microalgae used in aquaculture were successfully cryopreserved under 4, -20 and -80 ºC using common cryoprotectants (i.e. methanol, dimethylsulfoxide, propylene glycol and polyvinylpyrrolidone), with promising results at least for *Chlorella minutissima, Chlorella stigmatophora, Isochrysis galbana* and *Dunaliella tertiolecta* [80].

Several products based on thraustochytrids (i.e. microorganisms with a taxonomy related to certain microalgal classes), from the genus *Schizochytrium*, have been marketed through Aquafauna Biomarine and Sanders Brine Shrimp. These products have high concentrations of DHA [106], and have accordingly been applied as alternatives to commercial oil enrichment of zooplankton fed to larvae. As direct feeds, most such products have a lower nutritional value than mixtures of microalgae, yet some performed well as components of a mixed diet with alive microalgae [83,107].

In general, substitutes of alive microalgae should present an appropriate physical behavior – and this constitutes a significant challenge; in particular, they should not aggregate or easily break apart. Drying microalgae can cause, due to oxidation, a loss of PUFAs [108], which are essential components for larval growth [87]; the poor performance reported for dried microalgae was associated chiefly with the difficulty to keep cells in suspension without disintegrating them, so as to avoid said oxidation [13]. Moreover, when cell walls are broken, a high fraction of water-soluble components cannot be ingested by the organism, and may consequently interfere with the water quality of the aquaculture [109]. Therefore, pathogenic bacterial proliferation may occur, and cause costly production losses. Similar difficulties arise when using microalga paste, because the preparation procedures (i.e. centrifugation, flocculation or filtration) and/or preservation techniques (i.e. additives or freezing) must ensure that cell wall integrity is essentially preserved.

*Rhodomonas salina*, with efficiencies above 80%; it proved rapid, simple and inexpensive, and relatively independent of processed volume (unlike concentration by centrifugation). The harvested material was readily disaggregated to single cell suspensions by dilution in seawater, coupled with mild agitation. Microscopic examination proved that the final cells are indistinguishable from the nonflocculated ones; and assay for chlorophyll of the concentrates prepared from cultures of up to 130 L showed marginal degradation by 2

Cryopreservation has been thoroughly adopted by culture collections to preserve strains, but may also find an application in aquaculture [80]. Viable cryostorage of biological specimens has followed various protocols of cooling/thawing rates and cryoprotectant addition, which have been developed and tuned more or less empirically [101]. Recall that temperatures used for cryostorage are well below freezing – down to even -196 ºC in liquid helium, when biological specimens are to be stored without limit [102]. While cryostorage is generally thought to be innocuous to the cell, the events occurring upon freezing or thawing can lead to severe damage, or even cell death. Moreover, cryoprotectants that enhance the cell viability at cryogenic temperatures are usually toxic at physiological temperatures [103] – an obstacle that is overcome by reducing the exposure time or the temperature of incubation prior to cryopreservation [104]. Knowledge of cryoprotectant tolerance levels for microalgae is still limited [105], as well as for early larval stages and for zooplankton that are cultivated and rely on the availability of microalgae for growth. In general, cryopreservation possesses a high potential for culture collections, and may also offer a solution for reliable supply of microalgae in aquaculture. For instance, marine microalgae used in aquaculture were successfully cryopreserved under 4, -20 and -80 ºC using common cryoprotectants (i.e. methanol, dimethylsulfoxide, propylene glycol and polyvinylpyrrolidone), with promising results at least for *Chlorella minutissima, Chlorella*

Several products based on thraustochytrids (i.e. microorganisms with a taxonomy related to certain microalgal classes), from the genus *Schizochytrium*, have been marketed through Aquafauna Biomarine and Sanders Brine Shrimp. These products have high concentrations of DHA [106], and have accordingly been applied as alternatives to commercial oil enrichment of zooplankton fed to larvae. As direct feeds, most such products have a lower nutritional value than mixtures of microalgae, yet some performed well as components of a

In general, substitutes of alive microalgae should present an appropriate physical behavior – and this constitutes a significant challenge; in particular, they should not aggregate or easily break apart. Drying microalgae can cause, due to oxidation, a loss of PUFAs [108], which are essential components for larval growth [87]; the poor performance reported for dried microalgae was associated chiefly with the difficulty to keep cells in suspension without disintegrating them, so as to avoid said oxidation [13]. Moreover, when cell walls are broken, a high fraction of water-soluble components cannot be ingested by the organism, and may consequently interfere with the water quality of the aquaculture [109]. Therefore, pathogenic bacterial proliferation may occur, and cause costly production losses. Similar difficulties arise when using microalga paste, because the preparation procedures (i.e. centrifugation, flocculation or filtration) and/or preservation techniques (i.e. additives or

*stigmatophora, Isochrysis galbana* and *Dunaliella tertiolecta* [80].

freezing) must ensure that cell wall integrity is essentially preserved.

mixed diet with alive microalgae [83,107].

weeks of storage [100].

Products other than alive microalgae must obviously be free of bacterial contamination and devoid of toxicity. Consequently, the use of alive bacteria as a food source in hatcheries seems somehow inappropriate, since physical and chemical treatments are often used to limit bacterial contamination that would otherwise be responsible for drastic larval mortality [110]. Oyster larvae fed with alive microalga diets underwent improved growth via addition of some bacterial isolates [111,112], but this advantage may obviously not be possible in a treated microalgal product. However, in alive microalgae, the natural bacterial flora was proven to enhance the health of molluscs. Langdon and Bolton [88] showed that antibiotic suppression of the bacterial flora in artificial feed of juvenile oysters reduced their growth.

In conclusion, mitigated or unsuccessful results when using nonliving microalgae have turned alive microalgae into the first choice in aquaculture feeding. Only partial replacement thereof has been possible in studies encompassing preserved non-living algae [113], microencapsulated diets [88] or spray-dried algae [114]; but no whole replacement can be recommended, despite intensive research efforts in that direction [107]. Consequently, novel solutions to totally replace microalgae in aquaculture diets cannot at present be widely adopted [4,24,81].

### **6. Use of microalgae to enrich zooplankton**

Microalgae have an important role in aquaculture, also as a means to enrich zooplankton for feeding fish and other larvae afterwards. In addition to providing proteins (that contain essential amino acids) and energy, they carry such other key nutrients as vitamins, essential PUFAs, pigments and sterols – which are transferred up through the food chain. For instance, PUFA-rich microalgae, such as *Pavlova* sp. and *Isochrysis* sp., have been successfully fed to zooplankton to enrich them in DHA [115]. However, when the level of enrichment attained is not sufficient, commercial oil-emulsions are often used. Recently, such products as dried preparations of *Schizochytrium* sp. (which contain 5-15% of their DW as DHA) have been utilized, which produce levels of DHA enrichment in zooplankton comparable to use of commercial oils [116] – and also produce DHA to EPA ratios of 1–2, which are considered favorable for fish larval nutrition [117].

Brown, Skabo & Wilkinson [118] described that rotifers fed with microalgae (e.g. *Isochrysis*  sp. and *N. oculata*) become rapidly enriched with ascorbic acid (AsA), whereas rotifers fed on baker's yeast (which itself is deficient in AsA) contained only residual amounts of AsA.; after 16 h of starving, rotifers lost ca. 10% of their AsA, while retaining ca. 50% of the total AsA ingested. Similarly, the concentration of AsA in *Artemia* sp. may be increased by feeding with microalgae [119]. However, little information is available on the transfer of other vitamins from microalgae to fish larvae.

Rønnestad, Helland & Lie [120] demonstrated that microalgal pigments transferred to zooplankton may add to their nutritional value; recall that the dominant pigments in the copepod *Temora* sp. are lutein and astaxanthin, whereas in *Artemia* it is canthaxanthin. When these microalgae were fed to copepods and then to halibut larvae, adequate amounts of vitamin A were found, but not when halibut was fed on *Artemia*; this was attributed to the ability of larvae to convert lutein and/or astaxanthin, but not canthaxanthin to vitamin A. They accordingly recommended that *Artemia* should routinely be enriched with astaxanthin and lutein (the latter pigment is common in "green" microalgae, e.g. *Tetraselmis* sp.) to improve their nutritional value.

A common procedure during culture of both larval fish and prawns is to add microalgae (i.e. "green water") to intensive culture systems, together with the zooplankton prey [121]. The most popular microalga species used for this purpose are *N. oculata* and *T. suecica*. Addition of microalgae to larval tanks can also improve the production of larvae, but their exact mechanism of action remains unclear. Light attenuation (i.e. shading effects) may have a beneficial effect on larvae; however, maintenance of nutritional quality of the zooplankton, excretion of vitamins or other growth-promoting substances by the microalgae, and probiotic effects of the microalgae have also been hypothesized. Maintenance of NH3- and O2-balances has also been proposed, but this assumption failed to be supported by experimental evidence [121]. More research is still needed on the application of other microalgae – especially those species rich in DHA, to green water systems. Green water may also be applied to extensive outdoor production facilities, by fertilizing ponds in attempts to stimulate microalgal growth, and consequently zooplankton production.


*3.3. Influence of Capillary Shape on the Crack Growth Life*

The crack propagation curves obtained for a part-through crack are shown in Figure 11. It can be clearly seen that varying the aspect ratio of the capillary actually has a negligible effect, as the impact on the crack propagation life remains below 2.5% variation (see Table 6). Increasing the aspect ratio of the capillary implies that the local reduction in area felt by the crack is less important than for circular capillaries. Crack propagation speeds in the neighborhood of the capillary are hence lower for elliptical capillaries. However, due to the vertical extension (along the *y*-axis) of the elliptical capillary, the time frame during which the crack propagates in a reduced available sectional area is also longer. This counterbalances the positive effect of lower propagation speeds, hence explaining why small difference in crack propagation life is obtained.

**Table 6.** Fatigue crack growth lives (*Nf* ), variations with respect to the circular capillary case (Δ*circular*) and cycles to detection (*Nd*) as a function of capillary aspect ratio, in the case of part-through crack.

**Figure 11.** Fatigue crack growth curves for various capillary aspect ratio and in the case of part-through crack.