Antibiotic loaded calcium sulfate bead and pulse lavage eradicates biofilms on metal implant materials in vitro

Abstract

Pulse lavage (PL) debridement and antibiotic loaded calcium sulfate beads (CS-B) are both used for the treatment of biofilm related periprosthetic joint infection (PJI). However, the efficacy of these alone and in combination for eradicating biofilm from orthopaedic metal implant surfaces is unclear. The purpose of the study was to understand the efficacy of PL and antibiotic loaded CS-B in eradicating bacterial biofilms on 316L stainless steel (SS) alone and in combination in vitro. Biofilms of bioluminescent strains of Pseudomonas aeruginosa Xen41 and a USA300 MRSA Staphylococcus aureus SAP231 were grown on SS coupons for 3 days. The coupons were either, (i) debrided for 3 s with PL, (ii) exposed to tobramycin (TOB) and vancomycin (VAN) loaded CS-B for 24 h, or (iii) exposed to both. An untreated biofilm served as a control. The amount of biofilm was measured by bioluminescence, viable plate count and confocal microscopy using live/dead staining. PL alone reduced the CFU count of both strains of biofilms by approximately 2 orders of magnitude, from an initial cell count on metal surface of approximately 10 CFU/cm . The antibiotic loaded CS-B caused an approximate six log reduction and the combination completely eradicated viable biofilm bacteria. Bioluminescence and confocal imaging corroborated the CFU data. While PL and antibiotic loaded CS-B both significantly reduced biofilm, the combination of two was more effective than alone in removing biofilms from SS implant surfaces. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2349-2354, 2018.

Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Staphylococcus aureus Biofilms in an in-vitro Model

“…The independent use of pulsed lavage against S. aureus biofilms appeared to remove most of the biofilm cells and biomass in our experiments. This contrasts with previous studies that reported a 1 to 2 log 10 reduction in cell numbers following pulsed lavage (17,18,20). This discrepancy between our results and previous studies may be due to differences in strains, material surfaces or culture conditions.…”

“…This combination of pulsed lavage with antibiotics at concentrations compatible with a parenteral administration to simulate PJI has not been previously reported. Knecht et al published on the combination of pulsed lavage and incubation with tobramycin- and vancomycin-loaded calcium sulfate beads, showing a strong synergy ( 20 ). However, the antibiotic concentrations eluted in the culture medium were not determined, limiting the extrapolation of the results.…”

“…These failures may be partly explained by an inadequate removal of biofilms during the debridement surgery and their tolerance to antibiotics. However, only a few studies have looked into the effects of irrigation performed using standard pulsed lavage devices against S. aureus biofilms grown on metallic substrates, and none of these investigated the effects of its combination with antibiotics at clinically relevant dosages for systemic administration ( 17 – 20 ). The purpose of this study was to describe the effects of pulsed lavage and clinically relevant antibiotics used at recommended concentrations for systemic use, (i) in combination or (ii) independently, on the amount of cultivable cells, the biomass, and the microscopic aspects of MRSA and methicillin-susceptible S. aureus (MSSA) biofilms on titanium alloy coupons.…”

Mapping bacterial biofilms on recovered orthopaedic implants by a novel agar candle dip method

“…However, we did find evidence that the method might reveal locations which might be more prone to harboring biofilms. For example, cases 12 and 13 showed preferential biofilm formation around the femoral head non‐articulating ‘rim skirt’ surface and surface features and a similar pattern was seen in a biofilm grown in vitro and a previous explant case , suggesting factors such as surface roughness or the non‐abating nature of the rim skirt played a role in the harboring of bacteria. Such information may provide insight into the development of orthopaedic components with surface modifications to reduce bacterial attachment and biofilm formation.…”

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

“…The innovation of the DAPRI technique stays only on the combination of previously well described techniques which combine the known microbicidal power of the aforementioned procedures having a well-documented high synergistic power. 47,48 The addition of calcium sulphate beads constitutes a remarkable innovation as it allows to create an environment unfavorable to bacterial proliferation and biofilm synthesis for a period of time up to 40 days; [49][50][51] moreover, these beads are completely re-absorbable, leaving no substrate for the proliferation of pathogens. 1 great advantage of calcium sulphate beads is their flexibility in terms of being mixed with antibiogram driven antibiotics: heat labile antibiotics can be added because there are no exothermic reactions during calcium sulphate beads preparation on the back table.…”