Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials

Ramage, Gordon; Tunney, Michael; Patrick, Sheila; Gorman, Seán; Nixon, James R.

doi:10.1016/s0142-9612(03)00173-x

Cited by 221 publications

(132 citation statements)

References 17 publications

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“…Gentamicin has a broad spectrum of activity against Gram-negative and Gram-positive microbes encountered in orthopaedic infection. Although gentamicin is not commonly used clinically as the primary parenteral agent to manage Grampositive infection, roughly 94% of antibiotic-naïve orthopaedic infections are caused by gram-negative or grampositive bacteria which are susceptible to gentamicin at concentrations achievable with local delivery [11,53]. Finally, susceptibility to aminoglycosides, both concentration-and duration-dependent, is reduced but not eliminated in microbes that have organized into biofilms in vivo [63].…”

Section: Discussionmentioning

confidence: 99%

Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Overstreet

McLaren

Calara

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Local delivery can achieve the high antimicrobial concentrations necessary to kill biofilm-related microbes. Degradation times for resorbable carriers are too long. Hydrogels (gels of hydrophilic polymer in water) can degrade faster but release antimicrobials too quickly. We previously developed hydrogels based on the copolymer poly(N-isopropylacrylamide-co-dimethyl-c-butyrolactone acrylate-co-Jeffamine 1 M-1000 acrylamide) (PNDJ) with delivery times of several days with complete degradation in less than 6 weeks. Questions/purposes We asked: (1) What is the elution profile of gentamicin from PNDJ hydrogels? (2) Is gentamicin released from gentamicin-loaded PNDJ (G-PNDJ) hydrogel effective for treatment of orthopaedic infection? (3) Does local gentamicin delivery from G-PNDJ hydrogel cause renal dysfunction? Methods (1) Two formulations of G-PNDJ, lower dose (1.61 wt%) and higher dose (3.14 wt%), five samples each, were eluted in buffered saline under infinite sink conditions. (2) Infections were induced in 16 New Zealand White rabbits by inserting a Kirschner wire in a devascularized radius segment and inoculating with 7.5 9 10 6 colony-forming units Staphylococcus aureus. At 3 weeks, débridement was performed and a new Kirschner wire was placed in the dead space. Treatment was randomized to higher-dose G-PNDJ or no hydrogel. No systemic antimicrobials were used. Positive culture and acute inflammation on histology were used to determine the presence of infection 4 weeks postdébridement. (3) 3.14 wt% G-PNDJ, 0.75, 1.5, or 3.0 mL, was injected subcutaneously in nine Sprague-Dawley rats, three of each dose. Serum gentamicin, blood urea nitrogen, and creatinine were measured on Days 1, 3, 7, 14, and 28. Results (1) Gentamicin release was sustained over 7 days with the higher-dose formulation release profile similar to release from high-dose antimicrobial-loaded bone cement.(2) Four weeks postdébridement, infection was present in eight of eight no-hydrogel rabbits but zero of eight rabbits treated with G-PNDJ hydrogel (p \ 0.001). (3) Blood urea nitrogen and creatinine were transiently elevated

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Section: Discussionmentioning

confidence: 99%

Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Overstreet

McLaren

Calara

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…These data support the results of previous studies which showed that high gentamicin concentrations were required to kill P. acnes growing both planktonically and in biofilm and that P. acnes were susceptible to cephalosporins such as cefuroxime. 5,11 Our results, therefore, indicate that if overt infection is present at the time of revision hip surgery, a combination of gentamicin-loaded bone cement for implant fixation and cefuroxime pre-and postoperatively may not eradicate the existing infection and prevent infection of the newly implanted device. This finding in conjunction with the fact that prolonged exposure to low levels of gentamicin may increase bacterial resistance to gentamicin may help explain why there is a higher rate of failure of revision arthroplasty when compared with primary arthroplasty.…”

Section: Discussionmentioning

confidence: 79%

“…The cement sections were then placed in PBS and bacteria retained on the section dislodged by mild ultrasonication (5 min) in a 150 W ultrasonic bath operating at a nominal frequency of 50 Hz followed by rapid vortex mixing (30 s). Initial experiments in this and a previous study 11 revealed that these conditions were optimal to ensure maximum dislodgement of bacteria without compromising viability. Serial 10-fold dilutions were performed and viable counts estimated.…”

Section: Biofilm Formation On Unloaded and Gentamicin-loaded Bone Cementmentioning

confidence: 76%

Biofilm formation by bacteria isolated from retrieved failed prosthetic hip implants in an in vitro model of hip arthroplasty antibiotic prophylaxis

Tunney

Dunne

Einarsson

et al. 2006

Journal Orthopaedic Research

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Bacterial infection primarily with Staphylococcus spp. and Propionibacterium acnes remains a significant complication following total hip replacement. In this in vitro study, we investigated the efficacy of gentamicin loading of bone cement and pre-and postoperative administration of cefuroxime in the prevention of biofilm formation by clinical isolates. High and low initial inocula, representative of the number of bacteria that may be present at the operative site as a result of overt infection and skin contamination, respectively, were used. When a high initial inoculum was used, gentamicin loading of the cement did not prevent biofilm formation by the 10 Staphylococcus spp. and the 10 P. acnes isolates tested. Similarly, the use of cefuroxime in the fluid phase with gentamicin-loaded cement did not prevent biofilm formation by four Staphylococcus spp. and four P. acnes isolates tested. However, when a low bacterial inoculum was used, a combination of both gentamicin-loaded cement and cefuroxime prevented biofilm formation by these eight isolates. Our results indicate that this antibiotic combination may protect against infection after intraoperative challenge with bacteria present in low numbers as a result of contamination from the skin but would not protect against bacteria present in high numbers as a result of overt infection of an existing implant. ß

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“…The cement mixture was immediately placed between two glass plates covered with nonadhesive backing paper, which were pressed together to form a sheet of cement approximately 1mm thick. Following hardening of the cement, 1 cm 2 sections were cut with a sterile scalpel blade and stored under dark, sterile conditions at room temperature (Ramage et al, 2003).…”

Section: In Vitro Development Of Bacterial Biofilms On Orthopedic Biomentioning

confidence: 99%

In-vitro adhesion of Staphylococcus spp. tocertain orthopedic biomaterials and expression ofadhesion genes

Gamal¹

2012

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The present study evaluated biofilm forming capacity, the adherence of Staphylococci spp. to different orthopedic biomaterials and the presence of both icaA and icaD genes among staphylococci strains isolated from patients suffering from orthopedic implant infections. We studied 53 Staphylococcal strains from infections related to orthopedic implants, as regards their ability to form biofilm by using microtitre plate method (MTP), in vitro evaluation of the ability of the biofilm forming strains to adhere to certain biomaterials that used in orthopedic surgery and detection of ica A and ica D among the isolates. 90.9% of S. aureus strains were biofilm positive while, 95% of Coagulase negative staph. were biofilm forming, PMMA demonstrated a significantly highest adherence (P<0.05) followed by stainless steel while, the lowest adherence exhibited by titanium and Biofilm producing strains were positive for icaA and icaD genes while, biofilm negative strains were negative for both genes. Staphylococcus spp. are the major pathogens in orthopedic implants infections. Titanium biomaterials are less susceptible for adherence by bacteria . Biofilms are considered the key factor in the development of implantrelated infections.

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Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials

Cited by 221 publications

References 17 publications

Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Biofilm formation by bacteria isolated from retrieved failed prosthetic hip implants in an in vitro model of hip arthroplasty antibiotic prophylaxis

In-vitro adhesion of Staphylococcus spp. tocertain orthopedic biomaterials and expression ofadhesion genes

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