Sterilization of Biofilm on a Titanium Surface Using a Combination of Nonthermal Plasma and Chlorhexidine Digluconate.

Tripti Thapa Gupta,Surya B Karki,Halim Ayan,Jyl S Matson,Daniel J Gehling

doi:10.1155/2017/6085741

Abstract

Nosocomial infections caused by opportunistic bacteria pose major healthcare problem worldwide. Out of the many microorganisms responsible for such infections, Pseudomonas aeruginosa is a ubiquitous bacterium that accounts for 10–20% of hospital-acquired infections. These infections have mortality rates ranging from 18 to 60% and the cost of treatment ranges from $20,000 to $80,000 per infection. The formation of biofilms on medical devices and implants is responsible for the majority of those infections. Only limited progress has been made to prevent this issue in a safe and cost-effective manner. To address this, we propose employing jet plasma to break down and inactivate biofilms in vitro. Moreover, to improve the antimicrobial effect on the biofilm, a treatment method using a combination of jet plasma and a biocide known as chlorhexidine (CHX) digluconate was investigated. We found that complete sterilization of P. aeruginosa biofilms can be achieved after combinatorial treatment using plasma and CHX. A decrease in biofilm viability was also observed using confocal laser scanning electron microscopy (CLSM). This treatment method sterilized biofilm-contaminated surfaces in a short treatment time, indicating it to be a potential tool for the removal of biofilms present on medical devices and implants.

Highlights

Adherence of bacteria to implanted medical devices and damaged tissues can lead to biomaterial-associated infections (BAIs), often resulting in severe disease and implant failures
BAI is largely due to the ability of the bacteria to encase and protect themselves in a matrix composed of polysaccharide and protein, known as a biofilm [1, 2]
Since neither plasma nor CHX at clinically safe doses is completely effective at eradicating BAIs, the key objective of the present study is to determine the efficacy of a combination treatment approach using plasma and CHX for the reduction of bacterial biofilms compared to using plasma and CHX treatment individually

Summary

Introduction

Adherence of bacteria to implanted medical devices and damaged tissues can lead to biomaterial-associated infections (BAIs), often resulting in severe disease and implant failures. Removal of the medical device or internal prosthesis is the primary surgical treatment for such BAIs. removal is associated with increased patient morbidity and mortality, and it causes higher healthcare cost because of repeated surgeries, extended hospitalization, rehabilitation, and antibiotic therapy. A single prosthetic joint BAI has an average, estimated healthcare related cost of at least $50,000 and up to $130,000 [3,4,5]. These costs underestimate the true impact to the patient, as this cost does not include the long-term physical and social impairments that the patients potentially endure [6, 7]

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