Abstract
Background. Perioperative topical tranexamic acid as antifibrinolytic agent is often used for total joint replacement to reduce bleeding currently. Staphylococcus aureus was the most common isolates from perioperative infection of prosthetic joint. The influence of topical application with tranexamic acid on the incidence of acute prosthetic joint infection of Staphylococcus aureus has not been clarified. Methods. Mouse model of Staphylococcus aureus knee prosthesis infection was constructed. Tranexamic acid was intra-articular injected during the perioperative period. CFU counting from tissue and implant sample was evaluated 3 days and 7 days after inoculating of Staphylococcus aureus. Bacterial growth curve, biofilm formation, aggregation, and plasmin inhibition of Staphylococcus aureus were tested with tranexamic acid added to the synovial culture medium. Results. There were no significant differences of CFU counting from tissue and implant samples in knee prosthesis infection after a single local injection of tranexamic acid at the postoperative 3 or 7 days. The amount of bacterial colonization on the surface of implant increased after 3 days’ continuous local injection of tranexamic acid. Tranexamic acid has no effect on bacterial growth at the concentration (10 mg/ml) of clinical application, but it can inhibit bacterial aggregation and mildly inhibit biofilm formation. Plasmin can significantly inhibit biofilm formation which can be revised by adding tranexamic acid. Conclusion. Although continuous local injection of tranexamic acid can promote the biofilm formation of Staphylococcus aureus on the surface of articular implant, it has clinical safety for using one single local injection of tranexamic acid during the perioperative period.
Highlights
Tranexamic acid can competitively inhibit the activation of plasminogen and the binding of plasmin to fibrin as synthetic analogues of the amino acid lysine, inhibiting fibrin degradation [1, 2]
Mice with a single local injection of tranexamic acid during the perioperative period showed no significant difference in Staphylococcus aureus colonization of tissue and implant sample after 3 and 7 days (Figures 1(a) and 1(b))
Mice with continuous local injection of tranexamic acid for 3 days showed no significant increase of bacterial colonization in tissue (Figure 1(c)), there was significant higher CFU counting from implant (Figure 1(d))
Summary
Tranexamic acid can competitively inhibit the activation of plasminogen and the binding of plasmin to fibrin as synthetic analogues of the amino acid lysine, inhibiting fibrin degradation [1, 2]. Intravenous administration and local injection of tranexamic acid are usually used in the perioperative period of total joint replacement [7]. The influence of topical application with tranexamic acid on the incidence of acute prosthetic joint infection of Staphylococcus aureus has not been clarified. Biofilm formation, aggregation, and plasmin inhibition of Staphylococcus aureus were tested with tranexamic acid added to the synovial culture medium. There were no significant differences of CFU counting from tissue and implant samples in knee prosthesis infection after a single local injection of tranexamic acid at the postoperative 3 or 7 days. Continuous local injection of tranexamic acid can promote the biofilm formation of Staphylococcus aureus on the surface of articular implant, it has clinical safety for using one single local injection of tranexamic acid during the perioperative period
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