Williams Dustin L, Vinciguerra John, Lerdahl Julia M, Bloebaum Roy D
Bone and Joint Research Laboratory 151F, George E. Wahlen Department of Veterans Affairs, 500 Foothill Drive, Salt Lake City, UT, 84148, USA,
Clin Orthop Relat Res. 2015 Mar;473(3):928-35. doi: 10.1007/s11999-014-3673-z.
Biofilm-related periprosthetic infections are catastrophic to patients and clinicians. Data suggest the addition of vitamin E to UHMWPE may have the ability to reduce biofilm formation on the surface of UHMWPE; however, previous studies were performed using stagnant broth solutions that may not have simulated a physiologic environment. In addition, the observed differences in levels of bacterial attachment, though statistically significant, may not be clinically significant.
QUESTIONS/PURPOSES: We blended vitamin E with UHMWPE material and tested it for the ability to resist biofilm formation using a clinical isolate of methicillin-resistant Staphylococcus aureus (MRSA). Three additional materials were tested for comparison: highly crosslinked UHMWPE, compression-molded UHMWPE, and polyetheretherketone. We also determined whether the surface roughness of these materials facilitated biofilm formation.
Using a flow cell system, samples of each material type were placed into separate chambers. A 10% solution of brain-heart infusion broth containing 10(5) colony-forming units (CFUs)/mL was flowed through the flow cell over 48 hours. The number of bacteria that adhered to the surface was quantified and biofilm formation was observed qualitatively using scanning electron microscopy. Optical profilometry was used to determine the surface roughness of each material type.
Vitamin E-blended UHMWPE did not reduce biofilm formation of a clinically relevant strain of MRSA compared to materials that did not have vitamin E. More specifically, vitamin E-blended materials had similar amounts of biofilm formation (~ 8 log10 CFUs/cm(2)) compared to materials not containing vitamin E (~ 8.1 log10 CFUs/cm(2)) (p > 0.4). The roughness of vitamin E-blended material surfaces (mean ± SD: 1.85 ± 0.46 µm) compared to that of materials without vitamin E (2.06 ± 1.24 µm) did not appear to influence biofilm formation.
Under physiologically relevant conditions, vitamin E-blended UHMWPE did not have the ability to reduce the formation of biofilms by MRSA.
These data indicate that the addition of vitamin E to UHMWPE may not reduce clinically relevant rates of biofilm-related periprosthetic infections of total joint arthroplasty devices.
生物膜相关的假体周围感染对患者和临床医生而言是灾难性的。数据表明，在超高分子量聚乙烯（UHMWPE）中添加维生素E可能有能力减少UHMWPE表面生物膜的形成；然而，以往的研究是在静态肉汤溶液中进行的，可能无法模拟生理环境。此外，观察到的细菌附着水平差异虽然具有统计学意义，但可能不具有临床意义。
问题/目的：我们将维生素E与UHMWPE材料混合，并使用耐甲氧西林金黄色葡萄球菌（MRSA）的临床分离株测试其抵抗生物膜形成的能力。另外测试了三种材料用于比较：高度交联的UHMWPE、压缩成型的UHMWPE和聚醚醚酮。我们还确定了这些材料的表面粗糙度是否促进生物膜形成。
使用流动腔系统，将每种材料类型的样本放入单独的腔室中。含有10⁵菌落形成单位（CFU）/mL的10%脑心浸液肉汤溶液在48小时内流经流动腔。对附着在表面的细菌数量进行定量，并使用扫描电子显微镜定性观察生物膜形成。使用光学轮廓仪确定每种材料类型的表面粗糙度。
与不含维生素E的材料相比，含维生素E的UHMWPE并没有减少临床相关MRSA菌株的生物膜形成。更具体地说，含维生素E的材料与不含维生素E的材料相比，生物膜形成量相似（~8 log₁₀ CFU/cm²）（含维生素E的材料约为8 log₁₀ CFU/cm²，不含维生素E的材料约为8.1 log₁₀ CFU/cm²）（p>0.4）。含维生素E的材料表面粗糙度（平均值±标准差：1.85±0.46 µm）与不含维生素E的材料（2.06±1.24 µm）相比，似乎并未影响生物膜形成。
在生理相关条件下，含维生素E的UHMWPE没有能力减少MRSA生物膜的形成。
这些数据表明，在UHMWPE中添加维生素E可能不会降低全关节置换装置生物膜相关假体周围感染的临床相关发生率。
