Irrigation Fluids Used for the Prevention and Treatment of Orthopaedic Infections

Abstract

➤ Intrawound irrigation is a mainstay in the prevention and treatment of surgical site infections.➤ There are 3 components of irrigation: delivery method, volume, and type of solution (with and without additives).➤ A low-pressure delivery system for a 1 to 9-L volume of solution should be used to irrigate wounds, with a greater volume indicated in the setting of contaminated or infected wounds.➤ Operative irrigation solutions are frequently supplemented with the addition of surfactants, antibiotics, or antiseptics.➤ There is limited evidence with regard to the optimal antiseptic or whether antiseptics confer any advantage. Current literature suggests that surfactants and antibiotics should be avoided.➤ To date, most studies on irrigation solutions in orthopaedics are retrospective, necessitating the organization of prospective randomized controlled trials to guide future evidence-based decisions.

Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

“…Fungicidal --Viricidal Some effect MOA: mechanism of action; EPS: extracellular polymeric substances; HOCl: hypochlorous acid; CHG: Chlorhexidine gluconate. Table content reproduced with permission from Kavolus et al (2020). and 2018 international consensus meeting (ICM) on musculoskeletal infections recommend against the use of antibiotic irrigation in PJI and SSI prevention and treatment (Blom et al, 2019).…”

“…Although CHG has demonstrated efficacy against grampositive and gram-negative pathogens (Van Meurs et al, 2014), other studies have shown its antibacterial effect offset by increased host tissue toxicity (Liu et al, 2018). Higher CHG concentrations (0.5 % to 2 %) have been shown to substantially reduce human fibroblast, myoblast, osteoblast, and stromal cell survival (Kavolus et al, 2020;Van Meurs et al, 2014). Furthermore, some studies report antibiotic resistance after CHG exposure, as well as Enterococcus faecium and Pseudomonas resistance to CHG itself (Kavolus et al, 2020).…”

“…Higher CHG concentrations (0.5 % to 2 %) have been shown to substantially reduce human fibroblast, myoblast, osteoblast, and stromal cell survival (Kavolus et al, 2020;Van Meurs et al, 2014). Furthermore, some studies report antibiotic resistance after CHG exposure, as well as Enterococcus faecium and Pseudomonas resistance to CHG itself (Kavolus et al, 2020). Hypersensitivity reactions and anaphylaxis, although rare, also remain a concern.…”

Total Knee Periprosthetic Joint Infection in the Setting of Hematologic Malignancy: Considerations for Management

“…However, the exact DAIR methodology that provides the greatest success for immunosuppressed patients remains unclear. Irrigation with Betadine (Avrio Health L.P.; Stamford, CT, USA) and chlorhexidine seems to be the most effective approach in preventing infection recurrence [30,31]. A 2-stage DAIR approach with the use of antibiotic-eluting beads may help improve results in this patient population [32].…”

Musculoskeletal microbiology: The utility of the microbiome in orthopedics

“…27,28 The need for improved preventive approaches is so severe that many surgeons use antibacterial strategies with known toxic effects on local cells/tissues (excessive vancomycin powder, soap washes, etc.). 29,30 However, clinical studies suggest that even perfect adherence to infection prevention protocols are unlikely to reduce the incidence of infection in elective surgeries below 1%-2% (the current rates of PJI). 31,32 Further advances in sterile technique and even the use of robotic surgery will not remove the greatest source of microbial contamination: the patient.…”