Parker Dana M, Koch John A, Gish Charles G, Brothers Kimberly M, Li William, Gilbertie Jessica, Rowe Sarah E, Conlon Brian P, Byrapogu Venkata K C, Urish Kenneth L
Arthritis and Arthroplasty Design Lab, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Center for One Health Research, Edward Via College of Osteopathic Medicine, Blacksburg, VA 24060, USA.
Life (Basel). 2023 May 23;13(6):1230. doi: 10.3390/life13061230.
Hydrogen peroxide, povidone-iodine, and chlorhexidine are antiseptics that are commonly added to irrigants to either prevent or treat infection. There are little clinical data available that demonstrate efficacy of adding antiseptics to irrigants in the treatment of periprosthetic joint infection after biofilm establishment. The objective of the study was to assess the bactericidal activity of the antiseptics on planktonic and biofilm. For planktonic irrigation, was exposed to different concentrations of antiseptics. biofilm was developed by submerging a Kirschner wire into normalized bacteria and allowing it to grow for forty-eight hours. The Kirschner wire was then treated with irrigation solutions and plated for CFU analysis. Hydrogen peroxide, povidone-iodine, and chlorhexidine were bactericidal against planktonic bacteria with over a 3 log reduction ( < 0.0001). Unlike cefazolin, the antiseptics were not bactericidal (less than 3 log reduction) against biofilm bacteria but did have a statistical reduction in biofilm as compared to the initial time point ( < 0.0001). As compared to cefazolin treatment alone, the addition of hydrogen peroxide or povidone-iodine to cefazolin treatment only additionally reduced the biofilm burden by less than 1 log. The antiseptics demonstrated bactericidal properties with planktonic ; however, when used to irrigate biofilms, these antiseptics were unable to decrease biofilm mass below a 3 log reduction, suggesting that biofilm has a tolerance to antiseptics. This information should be considered when considering antibiotic tolerance in established biofilm treatment.
过氧化氢、聚维酮碘和洗必泰是常用的防腐剂，通常添加到冲洗液中以预防或治疗感染。目前几乎没有临床数据表明在生物膜形成后向冲洗液中添加防腐剂对假体周围关节感染的治疗有效。本研究的目的是评估防腐剂对浮游菌和生物膜的杀菌活性。对于浮游菌冲洗，将其暴露于不同浓度的防腐剂中。通过将克氏针浸入标准化细菌中并使其生长48小时来形成生物膜。然后用冲洗液处理克氏针并进行菌落形成单位（CFU）分析接种培养。过氧化氢、聚维酮碘和洗必泰对浮游菌具有杀菌作用，杀菌率超过3个对数级降低（P<0.0001）。与头孢唑林不同，这些防腐剂对生物膜细菌没有杀菌作用（降低幅度小于3个对数级），但与初始时间点相比，生物膜确实有统计学上的减少（P<0.0001）。与单独使用头孢唑林治疗相比，在头孢唑林治疗中添加过氧化氢或聚维酮碘仅使生物膜负荷额外降低不到1个对数级。这些防腐剂对浮游菌具有杀菌特性；然而，当用于冲洗生物膜时，这些防腐剂无法将生物膜量降低到3个对数级以下，这表明生物膜对防腐剂具有耐受性。在考虑已形成生物膜治疗中的抗生素耐受性时，应考虑这些信息。
