Sodium hypochlorite is more effective than chlorhexidine for eradication of bacterial biofilm of staphylococci and Pseudomonas aeruginosa

Abstract

Purpose Periprosthetic infection is a common reason for surgical revision. Given the increasing resistance of bacteria to antibiotics (e.g., VRE, 4-MRGN) local antiseptic treatment is gaining in importance. However, no standard guideline-based treatment recommendation is yet available. The aim of this study was to investigate the efectiveness of sodium hypochlorite and chlorhexidine against bacterial bioilms. Furthermore, the toxicity of both antiseptics towards human chondrocytes was examined. Methods Human chondrocytes were isolated, cultivated and treated with sodium hypochlorite and chlorhexidine. The viability of cultures was assessed by determination of cell count, XTT and MTT ELISAs, and luorescent staining with propidium iodide. Bacterial strains of Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa were added to liquid media and incubated overnight. After determination of bacterial concentrations polyethylene (PE) devices were inoculated with bacteria for 48 h until bioilms formed. The devices were then washed, treated with antiseptics for 2 and 5 min and subsequently spread on agar plates. Results Sodium hypochlorite is more efective than chlorhexidine in penetrating bioilms of S. aureus, S. epidermidis and P. aeruginosa. Both antiseptics are chondrotoxic, but sodium hypochlorite damages human chondrocytes less than chlorhexidine in vitro. Conclusions The indings conirm the efectiveness of sodium hypochlorite and chlorhexidine against bacterial bioilms. Both antiseptics can be recommended for the treatment of periprosthetic infections. The toxic efects of sodium hypochlorite and chlorhexidine towards chondrocytes may mean there is a risk of damage to cartilage tissue. Level of evidence Controlled experimental study.

Topical Antibiofilm Agents With Potential Utility in the Treatment of Chronic Rhinosinusitis: A Narrative Review

“…Tests of sodium hypochlorite and hypochlorous acid solutions have yielded more promising results. Eradication of S. aureus biofilms after exposures as short as 2 min, and P. aeruginosa in as short as 5 min, has been observed using 0.08% sodium hypochlorite ( Röhner et al, 2020 ). Likewise, 0.15% hypochlorous acid has been seen to cause a 6 log 10 reduction in viable cells after 5 min exposure ( Herruzo and Herruzo, 2020 ).…”

“…Preparations with antimicrobial efficacy are also more likely to exhibit cytotoxicity. Sodium hypochlorite at this concentration is toxic to cultured human fibroblasts and keratinocytes and ex-vivo human chondrocytes ( Severing et al, 2019 ; Röhner et al, 2020 ).…”

“…Biofilm eradication is reported at concentrations as low as 0.005% for S. aureus and 0.01% for P. aeruginosa after 24 h exposure ( Sivaranjani et al, 2021 ), though this is not consistently observed ( Lefebvre et al, 2016 ). At higher concentrations (0.05–0.1%), S. aureus biofilms were eradicated in some studies in as little as 5 min ( Hoekstra et al, 2017 ; Röhner et al, 2020 ). In contrast, other studies have reported that the same concentration of chlorhexidine failed to produce even a 3 log 10 reduction in viable S. aureus biofilms after a 3 min exposure ( Premkumar et al, 2021 ), or achieved an intermediate result ( Ferran et al, 2016 ).…”

Cytotoxic effect of sodium hypochlorite (Lavanox 0.08%) and chlorhexidine gluconate (Irrisept 0.05%) on human osteoblasts

“…To prevent tissue damage in our setting, the exposure time is limited to a few minutes, followed by irrigation with saline solution [16,17], although most investigations about the bactericidal effect were performed using longer exposure times [4,[6][7][8][9][10][11][12]18]. Nonetheless, there is a lack of knowledge about the effect of industrially solutions like Lavanox® or Irrisept® on osteoblasts, even after a shorter exposure time of just a few minutes.…”

Potential application of novel technology developed for instant decontamination of personal protective equipment before the doffing step

“…Examples include physical agents such as UV light [ 41 ] and chemical agents such as alcoholic solutions [ 5 , 42 ], quaternary ammonium compounds [ 43 , 44 ], ozone gas [ 45 ] and sodium hypochlorite [ 46 ]. Sodium hypochlorite is one of the most well-known and used biocidal agents worldwide due to its broad-spectrum microbicidal properties [ 47 ]. Compared with other chlorine-containing biocides, the use of sodium hypochlorite is characterized by a relatively lower toxicity when in contact with mucous membranes, the equipment required for its synthesis are simpler, its handling is safer, and its operation and preparation costs are lower, which makes its use feasible in hospitals [ 48 ].…”