Markel David C, Bou-Akl Therese, Wu Bin, Pawlitz Paula, Ren Weiping
The CORE Institute, Novi, Michigan, USA.
Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.
Bone Joint Res. 2024 Nov 1;13(11):622-631. doi: 10.1302/2046-3758.1311.BJR-2023-0334.R2.
The efficacy of saline irrigation for treatment of implant-associated infections is limited in the presence of porous metallic implants. This study evaluated the therapeutic efficacy of antibiotic doped bioceramic (vancomycin/tobramycin-doped polyvinyl alcohol composite (PVA-VAN/TOB-P)) after saline wash in a mouse infection model implanted with titanium cylinders.
Air pouches created in female BalBc mice by subcutaneous injection of air. In the first of two independent studies, pouches were implanted with titanium cylinders (400, 700, and 100 µm pore sizes) and inoculated with (1 × 10 or 1 × 10 colony-forming units (CFU)/pouch) to establish infection and biofilm formation. Mice were killed after one week for microbiological analysis. In the second study, pouches were implanted with 400 µm titanium cylinders and inoculated with (1 × 10 or 1 × 10 CFU/pouch). Four groups were tested: 1) no bacteria; 2) bacteria without saline wash; 3) saline wash only; and 4) saline wash plus PVA-VAN/TOB-P. After seven days, the pouches were opened and washed with saline alone, or had an additional injection of PVA-VAN/TOB-P. Mice were killed 14 days after pouch wash.
The first part of the study showed that low-grade infection was more significant in 400 µm cylinders than cylinders with larger pore sizes (p < 0.05). The second part of the study showed that saline wash alone was ineffective in eradicating both low- and high-grade infections. Saline plus PVA-VAN/TOB-P eradicated the titanium cylinder-associated infections, as manifested by negative cultures of the washouts and supported by scanning electron microscopy and histology.
Porous titanium cylinders were vulnerable to bacterial infection and biofilm formation that could not be treated by saline irrigation alone. Application of PVA-VAN/TOB-P directly into the surgical site alone or after saline wash represents a feasible approach for prevention and/or treatment of porous implant-related infections.
在存在多孔金属植入物的情况下，盐水冲洗治疗植入物相关感染的疗效有限。本研究在植入钛圆柱体的小鼠感染模型中，评估了盐水冲洗后抗生素掺杂生物陶瓷（万古霉素/妥布霉素掺杂聚乙烯醇复合材料（PVA-VAN/TOB-P））的治疗效果。
通过皮下注射空气在雌性BalBc小鼠体内创建气袋。在两项独立研究的第一项中，将钛圆柱体（孔径分别为400、700和100 µm）植入气袋，并接种（1×10⁶或1×10⁷菌落形成单位（CFU）/气袋）以建立感染和生物膜形成。一周后处死小鼠进行微生物学分析。在第二项研究中，将400 µm的钛圆柱体植入气袋并接种（1×10⁶或1×10⁷ CFU/气袋）。测试了四组：1）无细菌；2）有细菌但未进行盐水冲洗；3）仅进行盐水冲洗；4）盐水冲洗加PVA-VAN/TOB-P。七天后，打开气袋，仅用盐水冲洗，或额外注射PVA-VAN/TOB-P。气袋冲洗14天后处死小鼠。
研究的第一部分表明，400 µm圆柱体中的低度感染比孔径较大的圆柱体更显著（p < 0.05）。研究的第二部分表明，仅盐水冲洗在根除低度和高度感染方面均无效。盐水加PVA-VAN/TOB-P根除了与钛圆柱体相关的感染，冲洗液培养阴性表明了这一点，并得到扫描电子显微镜和组织学的支持。
多孔钛圆柱体易受细菌感染和生物膜形成影响，仅盐水冲洗无法治疗。单独或在盐水冲洗后将PVA-VAN/TOB-P直接应用于手术部位是预防和/或治疗多孔植入物相关感染的可行方法。
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