Abstract
PurposePost-operative infections are relatively common after posterior spine surgery, and there are several observations reflecting different infection complications related to various metals implanted. Here, we selected an array of different bacterial species that are often found in infections associated with orthopaedic implants and tested for inhibition by hydrogen peroxide-treated titanium (Ti-peroxy).MethodsTo study the possibility of using Ti-peroxy as an antimicrobial prophylaxis, we developed a protocol for standardized susceptibility testing of bacteria.ResultsImportantly, we found that the resulting Ti-peroxy was highly antimicrobial against all aerobic species tested, among others, Staphylococcus aureus and Pseudomonas aeruginosa. Proteus mirabilis was slightly more resistant than, for example, Klebsiella pneumoniae and enterococci. In contrast, anaerobic bacteria Cutibacterium acnes and Parvimonas micra were equally susceptible compared to staphylococci.ConclusionsOur findings suggest that the Ti-peroxy is a promising perioperative antimicrobial strategy that may be highly effective for prevention of post-operative infections. We therefore suggest application of hydrogen peroxide to implants prior to implantation.Graphical abstractThese slides can be retrieved under Electronic supplementary material.
Highlights
And late deep infection after posterior spine surgery with instrumentation is a relatively common complication, often necessitating implant removal
We chose a large panel of different bacterial species that are commonly found in patients who have undergone spine surgery complicated by deep infection (Table 1) [1]
To analyse the inhibitory effect on growth, bacteria were incubated with the Ti-peroxide, and, in addition, hydrogen peroxide-treated Cr 50 Ln or Cr/Ni was included as controls
Summary
And late deep infection after posterior spine surgery with instrumentation is a relatively common complication, often necessitating implant removal. The rate of post-operative surgical site infections after spine surgery varies based on patient comorbidities from 0.7 to 4.3% among patients without risk factors to 2.0 to 10% in patients with obesity, diabetes and neuromuscular diseases [2]. The rate of late implant-associated deep infection after posterior spinal instrumentation is, significantly reduced when using a metal work made from titanium alloy compared with stainless steel [3,4,5]. Infection rate with titanium implants was 3.53% as compared to 11.56% with stainless-steel implants (p < 0.0001) In yet another investigation (n = 540), the infection rate was 1.33% compared to 4.56% for titanium and stainless-steel implants (p < 0.0001), respectively [7].
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