Effectiveness of topical adjuvants in reducing biofilm formation on orthopedic implants: an in vitro analysis

Kia, Cameron; Cusano, Antonio; Messina, James C.; Muench, Lukas N.; Chadayammuri, Vivek; McCarthy, Mary Beth; Umejiego, Ezigbobiara N.; Mazzocca, Augustus D.

doi:10.1016/j.jse.2020.12.009

Cited by 14 publications

(19 citation statements)

References 40 publications

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“…Recently, multiple studies have demonstrated Bactisure ™ mediated antibiofilm activity on orthopaedic materials common in joint replacement including cobaltchrome, titanium, stainless steel, and polymethylmethacrylate [27][28][29]. To further investigate the potential of this technology in other areas of orthopaedic practice, an in vitro assessment of antibiofilm activity in combination with antibiotic treatment was performed, followed by an evaluation of efficacy in a rat model of contaminated musculoskeletal trauma.…”

Section: Discussionmentioning

confidence: 99%

Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma

et al. 2022

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Background Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a barrier to treatment, is a primary mode by which infecting pathogens persist at the wound site. Therefore, a pressing need exists to identify irrigation methods that can disrupt biofilm and expose pathogens to treatment. This study aims to evaluate the antibiofilm wound lavage, Bactisure™, in comparison with saline for care of severe musculoskeletal wounds and elucidate potential effects on antibiotic treatment success. Methods UAMS-1 Staphylococcus aureus biofilms were formed in vitro and treated with Bactisure™ wound lavage or sterile normal saline, alone, or in combination with sub-biofilm inhibitory levels of vancomycin. Characterization methods included quantification of biofilm biomass, quantification of viable biofilm bacteria, and biofilm matrix imaging. For in vivo assessment, a delayed treatment model of contaminated open fracture was used wherein a critical-sized defect was created in a rat femur and wound site inoculated with UAMS-1. Following a 6 h delay, wounds were debrided, irrigated with lavage of interest, and antibiotic treatments administered. Bacterial enumeration was performed on bone and hardware samples after two weeks. Results An immediate reduction in biofilm biomass was observed in vitro following antibiofilm lavage treatment, with a subsequent 2- to 3- log reduction in viable bacteria achieved after 24 h. Furthermore, biofilms treated with antibiofilm lavage in combination with vancomycin exhibited a minor, but statistically significant, decrease in viable bacteria compared to irrigation alone. In vivo, a minor, not statistically significant, decrease in median bioburden was observed for the antibiofilm lavage compared to saline when used in combination with antibiotics. However, the percentage of bone and hardware samples with detectable bacteria was reduced from 50 to 38%. Conclusions These results suggest that the antibiofilm wound lavage, Bactisure™, may hold promise in mitigating infection in contaminated musculoskeletal wounds and warrants further investigation. Here, we proposed multiple mechanisms in vitro by which this antibiofilm lavage may help mitigate infection, and demonstrate this treatment slightly outperforms saline in controlling bioburden in vivo.

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Section: Discussionmentioning

confidence: 99%

Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma

et al. 2022

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“…During this in vitro study, media treated with Irrisept were found to have the highest statistically significant remaining colonies of all bacterial strains when compared to other solutions. Betadine and Bactisure, which is a combination of water, sodium acetate, benzalkonium chloride, acetic acid, and ethanol, were comparable in their efficacy in eradicating bacterial biofilms [50,51].…”

Section: Role Of Intra-articular Irrigationmentioning

confidence: 99%

A review of current practices in periprosthetic joint infection debridement and revision arthroplasty

et al. 2022

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Background Periprosthetic joint infection remains a significant challenge for arthroplasty surgeons globally. Over the last few decades, there has been much advancement in terms of treatment and diagnosis, however, the fight rages on. As management of periprosthetic joint infections continues to evolve, it is critical to reflect back on current debridement practices to establish common ground as well as identify areas for future research and improvement. Body In order to understand the debridement techniques of periprosthetic joint infections, one must also understand how to diagnose a periprosthetic joint infection. Multiple definitions have been elucidated over the years with no single consensus established but rather sets of criteria. Once a diagnosis has been established the decision of debridement method becomes whether to proceed with single vs two-stage revision based on the probability of infection as well as individual patient factors. After much study, two-stage revision has emerged as the gold standard in the management of periprosthetic infections but single-stage remains prominent with further and further research. Conclusion Despite decades of data, there is no single treatment algorithm for periprosthetic joint infections and subsequent debridement technique. Our review touches on the goals of debridement while providing a perspective as to diagnosis and the particulars of how intraoperative factors such as intraarticular irrigation can play pivotal roles in infection eradication. By providing a perspective on current debridement practices, we hope to encourage future study and debate on how to address periprosthetic joint infections best.

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“…Bactisure is a surgical lavage with ethanol, acetic acid, sodium acetate, benzalkonium chloride, and water that is used to remove biofilms 60 . Kia et al 60 performed an in vitro study comparing the effectiveness of Bactisure and Irrisept. Staphylococcus aureus , Staphylococcus epidermidis , and C. acnes were grown on metal disks made of metals commonly used in shoulder implants.…”

Section: Surgical Skin Preparation Additionsmentioning

confidence: 99%

“…Irrisept has been shown to be bactericidal against biofilms; however, it may also be cytotoxic 61 . Bactisure is a surgical lavage with ethanol, acetic acid, sodium acetate, benzalkonium chloride, and water that is used to remove biofilms 60 . Kia et al 60 performed an in vitro study comparing the effectiveness of Bactisure and Irrisept.…”

Section: Surgical Skin Preparation Additionsmentioning

confidence: 99%

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Techniques for Decreasing Bacterial Load for Open Shoulder Surgery

et al. 2022

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Benzoyl peroxide (BPO) 5% has been shown to reduce Cutibacterium acnes load on the skin. BPO 5% with miconazole nitrate (MN) 2% may be beneficial, whereas BPO 5% with clindamycin cream 1% to 1.2% does not seem to have additive effects when compared with BPO 5% alone. Chlorhexidine gluconate solutions reduce the total bacterial load on the skin, but do not seem to have a significant effect on C. acnes.» ChloraPrep seems to be the best surgical skin preparation to decrease overall positive skin cultures. Preincisional hydrogen peroxide 3% application has been shown to be a cost-effective practice to inhibit growth of C. acnes. Vancomycin powder before deltopectoral interval closure has antimicrobial effects against C. acnes and is a cost-effective practice. Finally, Bactisure surgical lavage is protective against the formation of biofilms.» IV cefazolin has been shown to be more effective for shoulder arthroplasty infection prophylaxis than antibiotic alternatives such as vancomycin. Thus, patients with a questionable history of penicillin allergy should undergo additional testing.

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Effectiveness of topical adjuvants in reducing biofilm formation on orthopedic implants: an in vitro analysis

Cited by 14 publications

References 40 publications

Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma

Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma

A review of current practices in periprosthetic joint infection debridement and revision arthroplasty

Techniques for Decreasing Bacterial Load for Open Shoulder Surgery

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