Abstract
Periprosthetic infection (PPI) is a devastating complication in joint replacement surgery. On the background of an aging population, the number of joint replacements and associated complications is expected to increase. The capability for biofilm formation and the increasing resistance of different microbes to antibiotics have complicated the treatment of PPI, requiring the need for the development of alternative treatment options. The bactericidal effect of the naturally occurring amino alcohol sphingosine has already been reported. In our study, we demonstrate the antimicrobial efficacy of sphingosine on three different strains of biofilm producing Staphylococcus epidermidis, representing one of the most frequent microbes involved in PPI. In an in vitro analysis, sphingosine’s capability for prevention and treatment of biofilm-contamination on different common orthopedic implant surfaces was tested. Coating titanium implant samples with sphingosine not only prevented implant contamination but also revealed a significant reduction of biofilm formation on the implant surfaces by 99.942%. When testing the antimicrobial efficacy of sphingosine on sessile biofilm-grown Staphylococcus epidermidis, sphingosine solution was capable to eliminate 99.999% of the bacteria on the different implant surfaces, i.e., titanium, steel, and polymethylmethacrylate. This study provides evidence on the antimicrobial efficacy of sphingosine for both planktonic and sessile biofilm-grown Staphylococcus epidermidis on contaminated orthopedic implants. Sphingosine may provide an effective and cheap treatment option for prevention and reduction of infections in joint replacement surgery.Key messages• Here we established a novel technology for prevention of implant colonization by sphingosine-coating of orthopedic implant materials.• Sphingosine-coating of orthopedic implants prevented bacterial colonization and significantly reduced biofilm formation on implant surfaces by 99.942%.• Moreover, sphingosine solution was capable to eliminate 99.999% of sessile biofilm-grown Staphylococcus epidermidis on different orthopedic implant surfaces.
Highlights
Biofilm formation is known as the key factor for the evolution and persistence of an infection of indwelling devices [1]
We investigate the effect of sphingosine on Staphylococcus epidermidis, an organism that is prevalent in orthopedic infections and notorious for forming biofilms
The results showed that 10 μM sphingosine, equal to a total of 5 nmol of sphingosine, was able to eliminate all bacteria (Fig. 1)
Summary
Biofilm formation is known as the key factor for the evolution and persistence of an infection of indwelling devices [1]. Bacteria adherent to implant surfaces produce a complexhydrated matrix of glycocalyx that coats the bacteria. This layer is called biofilm and enables bacterial colonization to evade immunological defense or antibiotic treatment [2,3,4]. Less common than an infection related to catheters, infections associated with orthopedic implants are more difficult to manage [1]. Often, these infections result in periprosthetic infections (PPI) leading to implant failure and destruction of surrounding tissue, patient disability, and on occasion, death [1, 2]. PPI is one of the main reasons for revision in joint replacement (hip 15%, knee 25%) [5]
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