A novel antimicrobial coating to prevent periprosthetic joint infection

Abstract

Aims Periprosthetic joint infection (PJI) is a debilitating condition with a substantial socioeconomic burden. A novel autologous blood glue (ABG) has been developed, which can be prepared during surgery and sprayed onto prostheses at the time of implantation. The ABG can potentially provide an antimicrobial coating which will be effective in preventing PJI, not only by providing a physical barrier but also by eluting a well-known antibiotic. Hence, this study aimed to assess the antimicrobial effectiveness of ABG when impregnated with gentamicin and stem cells. Methods Gentamicin elution from the ABG matrix was analyzed and quantified in a time-dependent manner. The combined efficiency of gentamicin and ABG as an anti-biofilm coating was investigated on titanium disks. Results ABG-gentamicin was bactericidal from 10 μg/ml and could release bactericidal concentrations over seven days, preventing biofilm formation. A concentration of 75 μg/ml of gentamicin in ABG showed the highest bactericidal effect up to day 7. On titanium disks, a significant bacterial reduction on ABG-gentamicin coated disks was observed when compared to both uncoated (mean 2-log reduction) and ABG-coated (mean 3-log reduction) disks, at days 3 and 7. ABG alone exhibited no antimicrobial or anti-biofilm properties. However, a concentration of 75 μg/ml gentamicin in ABG sustains release over seven days and significantly reduced biofilm formation. Its use as an implant coating in patients with a high risk of infection may prevent bacterial adhesion perioperatively and in the early postoperative period. Conclusion ABG’s use as a carrier for stem cells was effective, as it supported cell growth. It has the potential to co-deliver compatible cells, drugs, and growth factors. However, ABG-gentamicin’s potential needs to be further justified using in vivo studies. Cite this article: Bone Joint Res 2020;9(12):848–856.

Animal experimental investigation on the efficacy of antibiotic therapy with linezolid, vancomycin, cotrimoxazole, and rifampin in treatment of periprosthetic knee joint infections by MRSA

“…In the future, antimicrobial coatings could play a role in preventing PJI. [38][39][40] In conclusion, the study has proven to be suitable for the evaluation of different antibiotic regimes in periprosthetic MRSA infections of knee joints. Rifampin was the only monotherapy that led to a significant bacterial count reduction in bone and implant.…”

Lactobacillus cell‐free supernatant as a novel bioagent and biosurfactant against Pseudomonas aeruginosa in the prevention and treatment of orthopedic implant infection

“…Autoclave sterilized roughened ( R a 6 μm) surgical‐grade titanium alloy (Ti‐6Al‐4V) discs, 13 mm diameter × 3 mm thick were investigated. PA was serially diluted to 10 4 CFU/ml and the CFS of LA, LF and LP with the disc were co‐inoculated with PA (500 μl each) and incubated for 5 days on an orbital shaker (80 rpm) at 37°C in order to promote biofilm formation 37,38 . On Day 5, discs were gently washed with PBS so as not to disturb any attached bacteria before being transferred into PBS where detachment was achieved by vortexing for 60 s, sonicating for 15 min and then revortexing for a further 60 sec.…”

“…Discs were then incubated on an orbital shaker (80 rpm) for 48 hr at 37°C. Following biofilm formation, the suspension was discarded, and discs gently washed twice in PBS prior to exposure to the CFS of LA, LP, and LF over a 5‐day period 37,38 . On Day 0 (prior to CFS treatment) and Day 5, an AlamarBlue Cell Metabolic assay (BioRad, UK) was carried out to investigate bacterial viability following CFS exposure (repeats of five 39 ).…”

Platelets mediate trained immunity against bone and joint infections in a mouse model

“…Moreover, this type of infection has a high recurrence rate and is difficult to treat, as most antibiotics struggle to penetrate the hard bone to reach the infected area, and some bacteria can escape the host's immune system and antibiotics by remaining dormant in host cells, replicating intracellularly, and breaking out when the host's immune system is compromised. [1][2][3] The innate immune response is the cornerstone of host immunity during the acute phase of a response following exposure to pathogens. 4 Immediately after microbial invasion, the innate immune system is activated in a conservative and non-specific fashion.…”

“…Moreover, this type of infection has a high recurrence rate and is difficult to treat, as most antibiotics struggle to penetrate the hard bone to reach the infected area, and some bacteria can escape the host’s immune system and antibiotics by remaining dormant in host cells, replicating intracellularly, and breaking out when the host’s immune system is compromised. 1 - 3 …”