Early implant‐associated osteomyelitis results in a peri‐implanted bacterial reservoir

Abstract

Implant‐associated osteomyelitis (IAO) is a common complication in orthopedic surgery. The aim of this study was to elucidate how deep IAO can go into the peri‐implanted bone tissue within a week. The study was performed in a porcine model of IAO. A small steel implant and either 104 CFU/kg body weight of Staphylococcus aureus or saline was inserted into the right tibial bone of 12 pigs. The animals were consecutively killed on day 2, 4 and 6 following implantation. Bone tissue around the implant was histologically evaluated. Identification of S. aureus was performed immunohistochemically on tissue section and with scanning electron microscopy and peptide nucleic acid in situ hybridization on implants. The distance of the peri‐implanted pathological bone area (PIBA), measured perpendicular to the implant, was significantly larger in infected animals compared to controls (p = 0.0014). The largest differences were seen after 4 and 6 days of inoculation, where PIBA measurements of up to 6 mm were observed. Positive S. aureus bacteria were identified on implants and from 25 μm to 6 mm into PIBA. This is important knowledge for optimizing outcomes of surgical debridement in osteomyelitis.

Novel porcine model of implant‐associated osteomyelitis: A comprehensive analysis of local, regional, and systemic response

“…Selected implants (13 implants from Group A pigs and two implants from Group B pigs) were placed in 10% formalin for peptide nucleic acid fluorescence in situ hybridization (PNA FISH). 20 A S. aureus specific probe 21 was used to visualize if the bacterium had attached to the surface of the implants. The evaluation of implants was blinded.…”

Porcine Models of Biofilm Infections with Focus on Pathomorphology

“…Biofilm is an important factor in sustaining chronic infections in humans (Donlan and Costerton, 2002 ; Costerton et al, 2003 ; Burmølle et al, 2010 ). The ability of bacteria to form biofilm in porcine models has been demonstrated in a number of studies (Davis et al, 2007 , 2013 ; Johansen et al, 2012a ; Roche et al, 2012 ; Jensen et al, 2016 ). However, when looking at the studies in this review (Tables 2 – 6 ), only five out of the thirty studies, actually commend on the formation of biofilm (Davis et al, 2007 , 2013 ; Johansen et al, 2012a ; Roche et al, 2012 ; Jensen et al, 2016 ).…”

“…Although, pigs have a denser osseous trabecular network, the lamellar bone structure is similar to humans (Pearce et al, 2007 ). Due to the similarities in bone composition and regeneration, the pig has been used as a model for several studies of both hematogenous and IAO (Wood et al, 1971 ; Koschmieder et al, 1975 ; Patterson et al, 1993 ; Rink et al, 2001 ; Jensen et al, 2010b , 2016 , 2017 ; Johansen et al, 2010 , 2012a , b , 2013 ; Tøttrup et al, 2016 ).…”

“…Before the implant insertion, three different doses of S. aureus were applied (Table 6 ), and the model showed good reproducibility when an inoculum dose of 10 4 CFU/ml was used (Figures 3E2,E3 ; Jensen et al, 2017 ). In a later study by Jensen et al ( 2016 ), the former porcine IAO model was used to examine the extension of infection into the peri-implanted bone tissue after 5 days (Table 6 ; Jensen et al, 2016 ). Recently, a study performed by Tøttrup et al ( 2016 ), focused on the penetration of cefuroxime into the infected bone lesions also using the porcine IAO model (Table 6 ; Tøttrup et al, 2016 ).…”

Silver Nanoparticles Coated Poly(L-Lactide) Electrospun Membrane for Implant Associated Infections Prevention

“…Bacterial infection has been a common headache in our daily life or clinics. Bacterial adhere on the surface of medical materials, resulting in infections or even failure of materials or surgery operation (Chen et al, 2016;Behzadi et al, 2017;Jensen et al, 2017;Shen et al, 2019), as for GBR technique, bacterial infection has been a major reason for failure of GBR in vivo (Slutzkey et al, 2015). And thus, it is definitely needed to develop an effectively antibacterial GBR membrane, which can regain sufficient bone, and reduce bacterial infections (Shi et al, 2019;Wang et al, 2019).…”