Image-guided in situ detection of bacterial biofilms in a human prosthetic knee infection model: a feasibility study for clinical diagnosis of prosthetic joint infections

Jorrit W A Schoenmakers,Marina López-Álvarez,Marleen Van Oosten,Marjolein Heuker,Paul C Jutte,Jan Maarten Van Dijl,Wouter B Nagengast,Gooitzen M Van Dam

doi:10.1007/s00259-020-04982-w

Abstract

PurposeDue to an increased human life expectancy, the need to replace arthritic or dysfunctional joints by prosthetics is higher than ever before. Prosthetic joints are unfortunately inherently susceptible to bacterial infection accompanied by biofilm formation. Accurate and rapid diagnosis is vital to increase therapeutic success. Yet, established diagnostic modalities cannot directly detect bacterial biofilms on prostheses. Therefore, the present study was aimed at investigating whether arthroscopic optical imaging can accurately detect bacterial biofilms on prosthetic joints.MethodsHere, we applied a conjugate of the antibiotic vancomycin and the near-infrared fluorophore IRDye800CW, in short vanco-800CW, in combination with arthroscopic optical imaging to target and visualize biofilms on infected prostheses.ResultsWe show in a human post-mortem prosthetic knee infection model that a staphylococcal biofilm is accurately detected in real time and distinguished from sterile sections in high resolution. In addition, we demonstrate that biofilms associated with the clinically most relevant bacterial species can be detected using vanco-800CW.ConclusionThe presented image-guided arthroscopic approach provides direct visual diagnostic information and facilitates immediate appropriate treatment selection.

Highlights

Human life expectancy is presently higher than ever before
To assess the formation of genuine S. epidermidis biofilms on cobalt-chrome biomaterials, we investigated the presence of extracellular polymeric substances (EPS) by staining the bacteria that had adhered to discs and knee prostheses with Congo Red [13]
The clinical feasibility of detecting bacterial biofilms through TFLI was evaluated by total knee arthroplasty with prostheses coated with S. epidermidis biofilms on the lateral part and subsequent arthroscopy

Summary

Introduction

The need for biomaterials to replace arthritic or dysfunctional body parts by prosthetics has, never been greater [1]. Total joint replacement with a prosthesis is nowadays the most performed substitute, which usually contributes to an enhanced quality of life. 2% of the patients, experience device failure in the form of a bacterial infection of the prosthesis and adjacent tissue [2]. These prosthetic joint infections (PJIs) are dreaded complications. They are difficult to diagnose, can manifest at any time after arthroplasty, and usually require multiple surgeries and a prolonged course of antibiotic treatment [3–5]. The economic impact of PJIs is significant with yearly estimated treatment costs exceeding $1.5 billion in the USA alone [2]

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Conclusion