Efficacy of Surgical/Wound Washes against Bacteria: Effect of Different In Vitro Models

Abstract

Topical antiseptics are often used to treat chronic wounds with biofilm infections and during salvage of biofilm contaminated implants, but their antibacterial efficacy is frequently only tested against non-aggregated planktonic or free-swimming organisms. This study evaluated the antibacterial and antibiofilm efficacy of four commercial surgical washes Bactisure, TorrenTX, minimally invasive lavage (MIS), and Betadine against six bacterial species: Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pyogenes, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli, which are commonly isolated from surgical site infections and chronic wound infections using different in vitro models. We determined minimum planktonic inhibitory and eradication concentration and minimum 1-day-old biofilm inhibition and eradication concentration of antiseptics in 96-well plates format with 24 h contact time. We also tested the efficacy of antiseptics at in-use concentration and contact time in the presence of biological soil against 3-day-old biofilm grown on coupons with shear in a bioreactor, such that the results are more applicable to the clinical biofilm situations. In the 96-well plate model, the minimum concentration required to inhibit or kill planktonic and biofilm bacteria was lower for Bactisure and TorrenTX than for MIS and Betadine. However, Betadine and Bactisure showed better antibiofilm efficacy than TorrenTX and MIS in the 3-day-old biofilm bioreactor model at in-use concentration. The minimal concentration of surgical washes required to inhibit or kill planktonic bacterial cells and biofilms varies, suggesting the need for the development and use of biofilm-based assays to assess antimicrobial therapies, such as topical antiseptics and their effective concentrations. The antibiofilm efficacy of surgical washes against different bacterial species also varies, highlighting the importance of testing against various bacterial species to achieve a thorough understanding of their efficacy.

Real-World Evidence of the Impact of a Novel Surgical Irrigant on Surgical Site Infections in Primary Total Knee Arthroplasty Performed at an Ambulatory Surgery Center

“… 45 The novel irrigant exhibited equivalent, or better antimicrobial inhibitory and eradication activity against these and other microorganisms in planktonic or mature biofilm form when compared to betadine solution containing 10% w/v povidone iodine (PI). 46 Organizations such as the CDC and World Health Organization have addressed PI as an irrigant prior to wound closure. 47 , 48 In contrast to XP, a soak time in the surgical cavity is recommended for dilute PI followed by an extensive rinse with saline.…”

Efficacy of a Novel Intraoperative Surgical Irrigant in Preventing Periprosthetic Joint Infections in Primary Knee, Hip, and Shoulder Arthroplasties: A Retrospective Analysis

“…30 , 31 In in vitro studies, XP exhibited antimicrobial activity against all bacteria evaluated, including planktonic and superstructure biofilms formed from microorganisms like Pseudomonas aeruginosa , Staphylococcus aureus and Cutibacterium acnes determined to be causative agents of PJIs/PSIs. 31 , 32 Additionally, XP exhibited equivalent, or better antimicrobial activity against microorganisms in comparison to Betadine solution (10% w/v Povidone Iodine [PI]). 31 , 32 Dilute PI has been evaluated for use by the CDC and World Health Organization as an intraoperative irrigant.…”

“… 31 , 32 Additionally, XP exhibited equivalent, or better antimicrobial activity against microorganisms in comparison to Betadine solution (10% w/v Povidone Iodine [PI]). 31 , 32 Dilute PI has been evaluated for use by the CDC and World Health Organization as an intraoperative irrigant. 33 , 34 In contrast to XP, dilute PI when used intraoperatively in joint replacement surgeries requires a soak time followed by an extensive rinse with saline solution.…”

An in vitro Study of Betadine’s Ability to Eliminate Live Bacteria on the Eye: Should It Be Used for Protection against Endophthalmitis?

“…Betadine is a widely used antiseptic and antimicrobial in many ophthalmology procedures and other surgical procedures by applying it to the surface of the eye, a skin wound, or as a prep for surgery [ 1 , 2 , 3 , 4 , 21 , 22 , 23 ]. The discomfort in patients after applying betadine in the eye is infrequent; however, some patients report a burning sensation [ 24 , 25 , 26 ].…”