In Vivo Efficacy of Antimicrobial-Coated Devices

Darouiche, Rabih O.; Mansouri, Mohammad D.; Zakarevicz, Devin; AlSharif, Atef; Landon, Gene

doi:10.2106/jbjs.f.00414

Cited by 74 publications

(56 citation statements)

References 29 publications

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“…The elution and turbidity studies do not fully replicate conditions within an orthopaedic defect; however, the tests have previously been used with various drug delivery systems to characterize elution patterns and confirm antibiotic activity [41,57,73]. ''Rinsing'' or ''dipping'' metal implants in antibiotic has shown some biofilm inhibitory properties [19,31,59], although we did not include control groups with coupons soaked in antibiotics for in vitro tests because antibiotic coatings applied in this manner and not chemically bonded to the implants have been shown to release over 90% of antibiotic within 6 hours and are less effective in vivo than prefabricated coatings [19,37]. We did, however, have an experimental group in the in vivo study with coadministration of antibiotics to uncoated wires, which is similar to this type of implant treatment.…”

Section: Discussionmentioning

confidence: 99%

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

Jennings

Carpenter

Troxel

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Orthopaedic biomaterials are susceptible to biofilm formation. A novel lipid-based material has been developed that may be loaded with antibiotics and applied as an implant coating at point of care. However, this material has not been evaluated for antibiotic elution, biofilm inhibition, or in vivo efficacy.Questions/purposes (1) Do antibiotic-loaded coatings inhibit biofilm formation? (2) Is the coating effective in preventing biofilm in vivo? Methods Purified phosphatidylcholine was mixed with 25% amikacin or vancomycin or a combination of 12.5% of both. A 7-day elution study for coated titanium and stainless steel coupons was followed by turbidity and zone of inhibition assays against Staphylococcus aureus and Pseudomonas aeruginosa. Coupons were inoculated with bacteria and incubated 24 hours (N = 4 for each test group). Microscopic images of biofilm were obtained. After washing and vortexing, attached bacteria were counted. A mouse biofilm model was modified to include coated and uncoated stainless steel wires inserted into the lumens of catheters inoculated with a mixture of S aureus or P aeruginosa. Colony-forming unit counts (N = 10) and scanning electron microscopy imaging of implants were used to determine antimicrobial activity. Results Active antibiotics with colony inhibition effects were eluted for up to 6 days. Antibiotic-loaded coatings inhibited biofilm formation on in vitro coupons (log-fold reductions of 4.3 ± 0.4 in S aureus and 3.1 ± 0 for P aeruginosa in phosphatidylcholine-only coatings, 5.6 ± 0 for S aureus and 3.1 ± 0 for P aeruginosa for combinationloaded coatings, 5.5 ± 0.3 for S aureus in vancomycinloaded coatings, and 3.1 ± 0 for P aeruginosa for amikacinloaded coatings (p \ 0.001 for all comparisons of antibiotic-loaded coatings against uncoated controls for both bacterial strains, p \ 0.001 for comparison of antibioticloaded coatings against phosphatidylcholine only for S aureus, p = 0.54 for comparison of vancomycin versus combination coating in S aureus, P = 0.99 for comparison of antibiotic-and unloaded phosphatidylcholine coatings in P aeruginosa). Similarly, antibiotic-loaded coatings reduced attachment of bacteria to wires in vivo (log-fold

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Section: Discussionmentioning

confidence: 99%

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

Jennings

Carpenter

Troxel

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Third, our study is shortterm and it is difficult to speculate whether the silver coating will show increased infection resistance in the long term. The length of the study was not long enough to evaluate infections with low-virulence organisms such as S epidermidis, which may not manifest clinically until months or years after insertion of a prosthesis [11], but it was long enough to evaluate infection due to the most common causative bacteria (ie, S aureus). Fourth, we did not examine blood silver level to see whether the safe limit was exceeded.…”

Section: Discussionmentioning

confidence: 99%

“…The suspension was further diluted with sterile saline solution to achieve 10 4 CFU/mL. The rabbits were inoculated with 50 lL bacterial suspension (amount of inoculum: 5 9 10 2 CFU) [11,31].…”

Section: Methodsmentioning

confidence: 99%

“…Each implant was placed in a sterile tube containing 2 mL sterile normal saline solution, after which the tube was sonicated using an ultrasonic cleaner in a water bath for 3 minutes [11]. We inoculated 50-lL aliquots of the original suspension and serial 10-fold dilutions in sterile saline solution (10 À1 , 10 À2 , 10 À3 , and 10 À4 dilutions) onto 5% sheep blood agar plates.…”

Section: Fig 3 a Graph Shows Agmentioning

confidence: 99%

“…Such materials include antibiotics [2,3,11,12], such as gentamicin and vancomycin, or silver and silver-containing compounds [4-7, 9-11, 16, 27]. The mechanism of the antimicrobial action of silver ions is closely related to their interaction with thiol (sulfhydryl) groups [20].…”

Section: Introductionmentioning

confidence: 99%

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A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance

Köse

Otuzbir

Pekşen

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Despite progress in surgical techniques, 1% to 2% of joint arthroplasties become complicated by infection. Coating implant surfaces with antimicrobial agents have been attempted to prevent initial bacterial adhesion to implants with varying success rates. We developed a silver ion-containing calcium phosphate-based ceramic nanopowder coating to provide antibacterial activity for orthopaedic implants. Questions/purposes We asked whether titanium prostheses coated with this nanopowder would show resistance to bacterial colonization as compared with uncoated prostheses. Methods We inserted titanium implants (uncoated [n = 9], hydroxyapatite-coated [n = 9], silver-coated [n = 9]) simulating knee prostheses into 27 rabbits' knees. Before implantation, 5 9 10 2 colony-forming units of Staphylococcus aureus were inoculated into the femoral canal. Radiology, microbiology, and histology findings were quantified at Week 6 to define the infection, microbiologically by increased rate of implant colonization/ positive cultures, histologically by leukocyte infiltration, necrosis, foreign-body granuloma, and devitalized bone, and radiographically by periosteal reaction, osteolysis, or sequestrum formation. Results Swab samples taken from medullary canals and implants revealed a lower proportion of positive culture in silver-coated implants (one of nine) than in uncoated (eight of nine) or hydroxyapatite-coated (five of nine) implants.

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Evaluating antimicrobials and implant materials for infection prevention around transcutaneous osseointegrated implants in a rabbit model

Chou¹,

Petti

Szakacs

et al. 2009

J Biomedical Materials Res

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Transcutaneous osseointegrated implants can improve function for select amputee patients, but infection serves as a significant limitation of implantable transcutaneous devices. This study examined the efficacy of an antimicrobial, pexiganan acetate (SUPONEX), and a porous tantalum implant material (Trabecular Metal) in preventing pin tract infection of osseointegrated implants in a rabbit model. Thirty-seven rabbits were randomized to three groups: Ti-control group (n = 11) with titanium alloy implant and no antimicrobial, Ti-Pexiganan group (n = 8) with titanium alloy implant and topical pexiganan acetate 1% applied daily at the skin/implant interface, and Ta-control group (n = 18) with porous tantalum implant and no antimicrobial. All implants were placed transcutaneously through skin, muscle, and bone. Rabbits were monitored for infection for 24 weeks. We observed a 75% reduction in rates of pin tract infection in the Ti-Pexiganan group compared to that observed in the Ti-control group (p = 0.019). No difference in rates of infection was observed between the Ta-control group and the Ti-control group (p = 0.230). In conclusion, pexiganan acetate may be an important antimicrobial for transcutaneous osseointegrated implants. Porous tantalum will not likely prevent pin tract infection without additional methods of soft tissue immobilization around the implant site.

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In Vivo Efficacy of Antimicrobial-Coated Devices

Abstract: It is possible that orthopaedic devices coated with this unique combination of antimicrobial agents may protect against the development of clinical infection in humans.

Cited by 74 publications

References 29 publications

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance

Evaluating antimicrobials and implant materials for infection prevention around transcutaneous osseointegrated implants in a rabbit model

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