A Comprehensive In Vitro Evaluation of Medihoney as an Anti-Biofilm Agent in Preventing Ventricular Assist Device Driveline Infections

Abstract

Purpose Medihoney is routinely applied to the exit site of Ventricular Assist Device (VAD) drivelines in patients in many Australian hospitals to prevent driveline infections. Its effectiveness as a prophylactic measure remains unclear. We performed a comprehensive in vitro study using microbiological assays that closely mimic the in vivo environment of the driveline exit-site to assess the effectiveness of medihoney in preventing biofilm-related driveline infections. Methods Antimicrobial efficacy testing of medihoney was performed against 24 clinically-relevant bacterial and fungal strains grown as planktonic and biofilm cells. The minimum inhibitory concentration (MIC), minimum biofilm inhibitory concentration, minimum eradication concentration of medihoney, and the activity of individual components of medihoney were assessed. A colony biofilm assay and a drip-flow biofilm reactor assay that mimic chronic wounds and the driveline exit site were used to evaluate medihoney activity in inhibiting early adherent organism monolayers and mature biofilms. Results Medihoney demonstrated activity against planktonic organism cells in 5/6 S. aureus strains, 6/6 of S. epidermidis strains, 1/6 of P. aeruginosa strains and 4/6 of Candida strains using a qualitative disk diffusion susceptibility assay and a quantitative broth microdilution assay [MICs, 10% weight/volume (W/V) medihoney concentrations]. Higher concentrations of medihoney (30-50%, W/V) were required to inhibit the growth of biofilm cells. Eradication of biofilms could not be achieved by medihoney, even at the highest concentration studied. The antibiofilm properties of medihoney were multi-faceted, including sugar content, pH, osmolality and the proposed active ingredient, methylglyoxal (MGO). MGO actually played a less important role than other medihoney characteristics. The colony biofilm assay and the drip flow biofilm reactor showed that medihoney was unable to prevent the maturation of biofilms after early organism adherence, and only had a weak activity against established biofilms. Conclusion Our work suggests a suboptimal effectiveness of medihoney in preventing driveline exit site infections due to biofilm development, warranting further clinical trials before its widespread use can be justified.