Manchester Maggie, Doub James B
The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, Baltimore, MD, USA.
Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
J Clin Orthop Trauma. 2025 Apr 9;66:103013. doi: 10.1016/j.jcot.2025.103013. eCollection 2025 Jul.
Fungal prosthetic joint infections (PJI) are increasing yet we have a poor understanding on the proper treatment of these complex infections especially with respect to most advantageous lavage solutions to use clinically. Consequently, the objective of this study was to determine which commonly used lavage solutions are most advantageous at dispersing fungal biofilms.
Nine clinical isolates from past fungal prosthetic joint infections were used to form biofilms in 24 microwell plates. Then different lavage solutions were instilled, and residual biofilm were measured and compared to normal saline lavage solutions. Moreover, fungal biofilms were directly observed with scanning electron microscopy.
All lavage solutions evaluated significantly (p < 0.05) reduced fungal biofilms compared to normal saline. However, chlorhexidine gluconate and sodium hypochlorite were able to disperse fungal biofilms significantly (p˂0.05) more than the other lavage solutions. As well, scanning electron microscopy showed fungal biofilms are typically composed of hyphae and yeast forms for most Candidal species.
All lavage solutions can reduce Candidal biofilms, but chlorhexidine gluconate and sodium hypochlorite were the most advantageous agents in disrupting Candidal biofilms. Yet given the potential tissue toxicity associated with sodium hypochlorite should prioritize the use of chlorohexidine as lavage solutions in the clinical treatment of fungal PJI to help degrade biofilms on retained hardware and tissues. However, further studies are needed to determine the mechanism associated with degradation of fungal biofilms as well as evaluating novel ways to prevent Candidal hyphae formation in PJI.
真菌性人工关节感染（PJI）的病例正在增加，但我们对这些复杂感染的恰当治疗，尤其是临床上最有利的灌洗溶液了解不足。因此，本研究的目的是确定哪些常用的灌洗溶液在分散真菌生物膜方面最具优势。
使用从过去的真菌性人工关节感染中分离出的9种临床菌株，在24孔微孔板中形成生物膜。然后滴入不同的灌洗溶液，测量残留生物膜，并与生理盐水灌洗溶液进行比较。此外，用扫描电子显微镜直接观察真菌生物膜。
与生理盐水相比，所有评估的灌洗溶液均能显著（p<0.05）减少真菌生物膜。然而，葡萄糖酸氯己定和次氯酸钠比其他灌洗溶液更能显著（p˂0.05）分散真菌生物膜。同样，扫描电子显微镜显示，大多数念珠菌属的真菌生物膜通常由菌丝和酵母形式组成。
所有灌洗溶液均可减少念珠菌生物膜，但葡萄糖酸氯己定和次氯酸钠是破坏念珠菌生物膜最具优势的药物。然而，鉴于次氯酸钠可能存在的组织毒性，在真菌性PJI的临床治疗中，应优先使用氯己定作为灌洗溶液，以帮助降解保留的硬件和组织上的生物膜。然而，需要进一步研究以确定与真菌生物膜降解相关的机制，以及评估预防PJI中念珠菌菌丝形成的新方法。
