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标签标注的冲洗液与手工混合冲洗液对生物膜的抗菌效果

Antimicrobial efficacy of on-label vs. hand-mixed irrigation solutions against biofilms.

作者信息

Falconer Robert, Smith Tyler, Rothberg David, Gililland Jeremy, Ashton Nicholas, Williams Dustin

机构信息

Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84108, USA.

Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, 84112, USA.

出版信息

Biofilm. 2025 Jul 8;10:100304. doi: 10.1016/j.bioflm.2025.100304. eCollection 2025 Dec.

Abstract

Wound irrigation is routinely performed as part of the DAIR procedure and for hardware infections, yet the most effective irrigation solution for reducing bacterial bioburden is unknown. Clinicians can choose on-label, commercially available irrigation solutions or hand-mix preparations off-label on the operating back table. Current methods for evaluating antiseptic efficacy often do not represent the clinical scenario. Here, we present a proof-of-concept setup to evaluate whether on-label, commercially available irrigation solutions were superior at reducing bacterial biofilm burden compared to off-label, hand-mixed irrigation solutions. ATCC 49525 (Xen36) biofilms were grown on Grade 5 titanium simulated fracture fixation plates and secured to sections of autoclaved bovine femur with cortical bone screws. Fourteen irrigation solutions (three commercial, eleven hand-mixed) and one untreated control group were evaluated by irrigating the biofilm-ridden plates and quantifying the remaining bioburden using a 10-fold dilution series to determine the log reduction. None of the fourteen treatments reduced bioburden statistically significantly compared to the untreated control, where no irrigation was performed. Additionally, no treatment achieved the FDA benchmark of a 4 log reduction for antibacterial activity. An off-label, hand-mixed 0.472 % w/v chlorhexidine gluconate solution reduced the greatest bioburden overall, with a 1.43 ± 0.20 log reduction. On-label irrigation products did not reduce bioburden more than off-label, hand-mixed solutions clinicians often prepare in the operating room. Musculoskeletal infections remain a significant clinical challenge and contribute to increasing healthcare costs. The antimicrobial efficacy of irrigation products should be assessed using clinically relevant models.

摘要

伤口冲洗是清创、抗生素和植入物保留(DAIR)程序的常规操作部分,也是治疗硬件感染的常用方法,但目前尚不清楚哪种冲洗液在减少细菌生物负荷方面最有效。临床医生可以选择标签上标明的市售冲洗液,也可以在手术备用桌上自行配制非标签冲洗液。目前评估防腐剂效果的方法往往不能反映临床实际情况。在此,我们展示了一个概念验证装置,以评估标签上标明的市售冲洗液在减少细菌生物膜负荷方面是否优于非标签的手工混合冲洗液。将ATCC 49525(Xen36)生物膜接种在5级钛模拟骨折固定板上,并用皮质骨螺钉固定在高压灭菌的牛股骨段上。通过冲洗带有生物膜的钢板,并使用10倍稀释系列对剩余的生物负荷进行定量,以确定对数减少量,从而评估14种冲洗液(3种市售,11种手工混合)和1个未处理对照组。与未进行冲洗的未处理对照组相比,这14种处理方法均未在统计学上显著降低生物负荷。此外,没有一种处理方法达到美国食品药品监督管理局(FDA)规定的抗菌活性4对数减少的基准。一种非标签的手工混合0.472% w/v葡萄糖酸氯己定溶液总体上减少的生物负荷最大,对数减少量为1.43±0.20。标签上标明的冲洗产品在减少生物负荷方面并不比临床医生在手术室经常配制的非标签手工混合溶液更有效。肌肉骨骼感染仍然是一个重大的临床挑战,并导致医疗成本不断增加。应使用临床相关模型评估冲洗产品的抗菌效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/926c/12275869/0e49065f3c6f/gr1.jpg

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