Semeshchenko D, Veiga M F, Visus M, Farinati A, Huespe I, Buttaro M A, Slullitel P A
'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Bacteriology Department, Italian Hospital of Buenos Aires, ACK1199, Buenos Aires, Argentina.
J Hosp Infect. 2025 Jan;155:185-191. doi: 10.1016/j.jhin.2024.11.012. Epub 2024 Nov 22.
There is no consensus on the irrigation solution and concentration that should be used when performing a debridement, antibiotics, and implant retention (DAIR) surgery.
To determine the minimum biofilm eradication concentration (MBEC) of five antibacterial solutions and to compare their efficacies in eradicating staphylococcal biofilm embedded on a titanium surface.
Meticillin-sensitive Staphylococcus aureus (MSSA) and meticillin-resistant S. aureus (MRSA) ATCC standard strains were grown over porous Ti-6Al-4V acetabular screw-caps. Antibacterial solutions were povidone-iodine, rifampicin, silver nitrate, copper sulphate, and chlorhexidine. MBEC values were calculated for MSSA and MRSA. After 24 h, screw-caps were exposed for 3 min to each solution. Bacterial separation from each specimen was performed with vortex agitation and footprint on agar plate in triplicate. Colony forming units (cfu) were counted pre- and post-agitation, and the delta of cfu/mL was calculated for each solution. A threefold log reduction in cfu was considered a measure of solution efficacy. Comparison between groups was made with Fisher's test.
MBEC values for MSSA and MRSA, respectively, were as follows: 8000 μg/mL and 16,000 μg/mL for povidone-iodine; 64 μg/mL and 128 μg/mL for rifampicin; 10,000 μg/mL and 5120 μg/mL for silver nitrate; 900 μg/mL and 900 μg/mL for copper sulphate; 16 μg/mL and 32 μg/mL for chlorhexidine. Rifampicin, copper sulphate and chlorhexidine were ineffective against MSSA and MRSA biofilm compared with povidone-iodine (P<0.01) and silver nitrate (P=0.015) that had a delta cfu reduction >8 log. Povidone-iodine and silver nitrate showed negative footprints without visible MSSA (P=0.005) and MRSA (P=0.014).
Povidone-iodine and silver nitrate were the only irrigating solutions capable of eradicating at least 99.9% of 24-h biofilm.
在进行清创、抗生素应用和植入物保留（DAIR）手术时，对于应使用的冲洗液及其浓度尚无共识。
确定五种抗菌溶液的最低生物膜根除浓度（MBEC），并比较它们在根除钛表面葡萄球菌生物膜方面的效果。
将甲氧西林敏感金黄色葡萄球菌（MSSA）和耐甲氧西林金黄色葡萄球菌（MRSA）ATCC标准菌株接种在多孔Ti-6Al-4V髋臼螺帽上。抗菌溶液为聚维酮碘、利福平、硝酸银、硫酸铜和氯己定。计算MSSA和MRSA的MBEC值。24小时后，将螺帽在每种溶液中暴露3分钟。通过涡旋振荡从每个标本中分离细菌，并在琼脂平板上进行三次印迹。在振荡前后计数菌落形成单位（cfu），并计算每种溶液的cfu/mL差值。cfu减少三倍对数被视为溶液效果的衡量标准。采用Fisher检验进行组间比较。
MSSA和MRSA的MBEC值分别如下：聚维酮碘为8000μg/mL和16000μg/mL；利福平为64μg/mL和128μg/mL；硝酸银为10000μg/mL和5120μg/mL；硫酸铜为900μg/mL和900μg/mL；氯己定为16μg/mL和32μg/mL。与聚维酮碘（P<0.01）和硝酸银（P=0.015）相比，利福平、硫酸铜和氯己定对MSSA和MRSA生物膜无效，聚维酮碘和硝酸银的cfu减少量>8对数。聚维酮碘和硝酸银显示无可见MSSA（P=0.005）和MRSA（P=0.014）的阴性印迹。
聚维酮碘和硝酸银是仅有的能够根除至少99.9%的24小时生物膜的冲洗液。
