Department of Orthopedic Surgery, UConn Health, Farmington, CT, USA.
Department of Orthopedic Surgery, UConn Health, Farmington, CT, USA.
J Shoulder Elbow Surg. 2021 Sep;30(9):2177-2183. doi: 10.1016/j.jse.2020.12.009. Epub 2021 Jan 30.
The treatment of periprosthetic joint infection is complicated by the presence of residual biofilm, which resists eradication owing to bacterial adherence to orthopedic implants. The purpose of this study was to compare Bactisure (Zimmer Biomet, Warsaw, IN, USA), povidone-iodine (Betadine), and chlorhexidine gluconate solution (Irrisept; Irrimax, Gainesville, FL, USA) in reducing biofilm formation of Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes inoculated on cobalt-chrome, titanium, and stainless steel disks, representing metals commonly used for shoulder arthroplasty. The hypothesis was that there would be no significant difference in biofilm reduction among the 3 topical adjuvants.
Strains of S aureus (ATCC 35556), S epidermidis (ATCC 35984), and C acnes (LMG 16711) were grown on cobalt-chrome, titanium, and stainless steel disks. For each strain, the disks were divided into 4 groups: (1) control, (2) povidone-iodine (Betadine), (3) chlorhexidine gluconate (Irrisept), and (4) Bactisure. Bacteria were grown on 5% sheep blood agar plates. Biofilm eradication was quantified using adenosine triphosphate bioluminescence and compared with controls 48 and 72 hours after implementation of the topical adjuvant.
At 72 hours after implementation of the topical adjuvant, a statistically significant reduction in colony-forming units was observed for all topical adjuvants across all tested metals, as compared with their respective control. With respect to the topical adjuvants themselves, Bactisure more consistently demonstrated the most significant reduction in colony-forming units across all bacteria when the tested medium was adjusted for, with the exception of S aureus, which showed similar results to Betadine at 72 hours.
By use of commonly encountered topical adjuvants on S aureus-, S epidermidis-, and C acnes-inoculated disks of various implant metals, a significant reduction in biofilm production was observed. Bactisure, a recent Food and Drug Administration-approved topical adjuvant, demonstrated the overall greatest efficacy of the agents studied.
假体周围关节感染的治疗较为复杂，因为存在残留的生物膜，而生物膜会使细菌黏附于骨科植入物，从而导致其难以被清除。本研究旨在比较 Bactisure（美国 Zimmer Biomet，印第安纳州华沙）、聚维酮碘（Betadine）和葡萄糖酸氯己定溶液（Irrisept；美国 Irrimax，佛罗里达州盖恩斯维尔）在减少接种于钴铬、钛和不锈钢盘的金黄色葡萄球菌、表皮葡萄球菌和痤疮丙酸杆菌生物膜形成方面的效果。假设是这 3 种局部辅助剂在减少生物膜方面没有显著差异。
金黄色葡萄球菌（ATCC 35556）、表皮葡萄球菌（ATCC 35984）和痤疮丙酸杆菌（LMG 16711）菌株在钴铬、钛和不锈钢盘上生长。对于每种菌株，将圆盘分为 4 组：（1）对照组，（2）聚维酮碘（Betadine）组，（3）葡萄糖酸氯己定（Irrisept）组，和（4）Bactisure 组。细菌在 5%羊血琼脂平板上生长。在实施局部辅助剂后 48 小时和 72 小时，使用三磷酸腺苷生物发光法定量检测生物膜清除率，并与对照组进行比较。
在实施局部辅助剂 72 小时后，与各自的对照组相比，所有测试金属上的所有局部辅助剂均观察到细菌的菌落形成单位显著减少。就局部辅助剂本身而言，Bactisure 在调整测试介质后，在所有细菌中表现出更一致的最显著的菌落形成单位减少，除了金黄色葡萄球菌，其在 72 小时时与 Betadine 表现出相似的结果。
在各种植入金属的金黄色葡萄球菌、表皮葡萄球菌和痤疮丙酸杆菌接种盘上使用常见的局部辅助剂，观察到生物膜生成显著减少。Bactisure 是一种最近获得美国食品和药物管理局批准的局部辅助剂，在研究的药物中显示出最高的总体功效。
