Abstract
Background: Prosthetic joint infections (PJI) are difficult to treat complications of joint arthroplasty. Debridement with implant retention is a common treatment strategy and frequently involves the use of pulsed lavage (PL). However, PL effects on biofilms and antibiotic activity have been scarcely studied in-vitro. We report the effects of PL, vancomycin or flucloxacillin used independently or in combination against Staphylococcus aureus biofilms.Methods: Biofilms of 3 methicillin-susceptible (MSSA) and of 3 methicillin-resistant (MRSA) S. aureus were grown on Ti6Al4V coupons in TGN (TSB + 1%glucose + 2%NaCl). After 24 h, PL was applied to half of the samples (50 mL saline from 5 cm). Samples were either reincubated for 24 h in TGN or TGN + flucloxacillin or vancomycin. Analyses included CFUs counts, biomass assays or fluorescence microscopy.Results: PL transiently reduced bacterial counts by 3–4 Log10 CFU/coupon, but bacterial regrowth to baseline levels was seen after 24 h. At 20 mg/L, flucloxacillin reduced both the CFU counts (3 Log10 CFU/coupon) and biomass (−70%) in one MSSA only, while vancomycin had no effects against MRSA. PL combined with a 24 h reincubation with vancomycin or flucloxacillin at 20 mg/L was synergistic (−5 to 6.5 Log10 CFU/coupon; 81–100% biomass reduction). Fluorescence microscopy confirmed that PL removed most of the biofilm and that subsequent antibiotic treatment partially killed bacteria.Conclusions: While PL only transiently reduces the bacterial load and antibiotics at clinically relevant concentrations show no or limited activity on biofilms, their combination is synergistic against MRSA and MSSA biofilms. These results highlight the need for thorough PL before antibiotic administration in PJI.
Highlights
Prosthetic Joint Infections (PJI), defined as infections involving joint replacement implants and the surrounding articular tissues, are devastating complications, affecting 0.5 to 2% of patients benefiting from hip or knee replacement [1, 2] and are among the most common causes of arthroplasty failures [3, 4].These infections result from either a peri-operative contamination of the joint, generating acute or late infections, or an hematogenous seeding of bacteria to the joint following a bacteremia [2]
The purpose of this study was to describe the effects of pulsed lavage and clinically relevant antibiotics used at recommended concentrations for systemic use, (i) in combination or (ii) independently, on the amount of cultivable cells, the biomass, and the microscopic aspects of MRSA and methicillin-susceptible S. aureus (MSSA) biofilms on titanium alloy coupons
All strains were susceptible to vancomycin in CA-MHB, but their minimal inhibitory concentration (MIC) was 2 to 3 dilutions higher when tested in TGN
Summary
Prosthetic Joint Infections (PJI), defined as infections involving joint replacement implants and the surrounding articular tissues, are devastating complications, affecting 0.5 to 2% of patients benefiting from hip or knee replacement [1, 2] and are among the most common causes of arthroplasty failures [3, 4]. These infections result from either a peri-operative contamination of the joint, generating acute (less than 4 weeks from the index surgery) or late infections, or an hematogenous seeding of bacteria to the joint following a bacteremia [2]. We report the effects of PL, vancomycin or flucloxacillin used independently or in combination against Staphylococcus aureus biofilms
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