Intraoperative Vancomycin Powder Reduces Staphylococcus aureus Surgical Site Infections and Biofilm Formation on Fixation Implants in a Rabbit Model

Hovis, James P.; Montalvo, Ryan; Marinos, Dimitrius; Joshi, Manjari; Shirtliff, Mark E.; O’Toole, Robert V.; Manson, Theodore T.

doi:10.1097/bot.0000000000001136

Cited by 18 publications

(19 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The animals treated with rifampin show no clinical indications of infection, such as purulence or histological bacteria, thus allowing for natural and endogenous bone fracture repair of the femur. To our knowledge, this is the first time that antibiotic powders, like vancomycin and rifampin, have been evaluated in a preclinical model and shown to have no impact on bone formation …”

Section: Discussionmentioning

confidence: 96%

Topical rifampin powder for orthopaedic trauma part II: Topical rifampin allows for spontaneous bone healing in sterile and contaminated wounds

Shiels

Tennent

Lofgren

et al. 2018

Journal Orthopaedic Research

View full text Add to dashboard Cite

Infectious complications can reduce fracture healing rate. Broad spectrum antibiotics are commonly administered to prevent and treat musculoskeletal infections. Local antibiotics are applied to the wound site to increase therapeutic concentrations without increasing systemic toxicity, however, may hinder local tissue recovery. Rifampin has been shown to eradicate mature Staphylococcal biofilms and its use proven for treating musculoskeletal infections. In this study, a spontaneously healing defect model in a rat was used to investigate the impact rifampin powder has on endogenous bone healing in both a sterile and contaminated wound. No significant differences were identified in bone volume fraction via microcomputed tomography, radiological scoring, or histology between an empty defect and animals that received vancomycin or rifampin powder in a sterile wound. When applied to a contaminated musculoskeletal wound, the rifampin powder had significantly greater bone formation compared to the control, as measured by microcomputed tomography, plain radiology, and histology. In addition, the animals treated with rifampin powder had reduced bacteria, reduced white blood cell count and reduced number of clinical indications of infection. Interestingly, while the vancomycin group still displayed signs of infection via quantitative microbiology, plain radiology, and histology, there was significant bone formation within the defect and reduction of systemic signs of infection. We demonstrated that the use of rifampin powder allows bone to heal in both a sterile and contaminated model of musculoskeletal infection. To our knowledge, this is the first time the direct impact of local antibiotics on bone healing has been investigated. Published 2018. This article is a U.S. Government work and is in the public domain in the USA. J Orthop Res 36:3142-3150, 2018.

show abstract

Section: Discussionmentioning

confidence: 96%

Topical rifampin powder for orthopaedic trauma part II: Topical rifampin allows for spontaneous bone healing in sterile and contaminated wounds

Shiels

Tennent

Lofgren

et al. 2018

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…There is an estimated 220,000 cases of nosocomial infections resulting in more than 8,000 deaths every year in Canada [108]. The most common post-operative complication is surgical site infections (SSIs) that arise at the exposed site of the body where the surgery took place, constituting between one fourth and one-third of all nosocomial infections, which accounted for 6–23% in most studies [109, 110, 111, 112]. In the US, it is estimated that more than 500,000 SSIs occur each year, at a rate of 2.8 per 100 operations [112].…”

Section: Main Textmentioning

confidence: 99%

“…Albumin adsorbed on material surfaces has also been found to inhibit bacterial adhesion to polymers, ceramics, and a variety of metal surfaces [145, 146]. Intraoperative vancomycin powder application at the time of implantation has also shown efficacy in decreasing biofilm formation in a rabbit model [109]. A technique, named as the antimicrobial lock technique, can also be employed to inhibit biofilm formation in catheters [38, 72, 126].…”

Section: Main Textmentioning

confidence: 99%

Bacterial biofilm formation on implantable devices and approaches to its treatment and prevention

Khatoon

McTiernan

Suuronen

et al. 2018

Heliyon

917

652

View full text Add to dashboard Cite

In living organisms, biofilms are defined as complex communities of bacteria residing within an exopolysaccharide matrix that adheres to a surface. In the clinic, they are typically the cause of chronic, nosocomial, and medical device-related infections. Due to the antibiotic-resistant nature of biofilms, the use of antibiotics alone is ineffective for treating biofilm-related infections. In this review, we present a brief overview of concepts of bacterial biofilm formation, and current state-of-the-art therapeutic approaches for preventing and treating biofilms. Also, we have reviewed the prevalence of such infections on medical devices and discussed the future challenges that need to be overcome in order to successfully treat biofilms using the novel technologies being developed.

show abstract

“… 36 Despite this 1000x˙ range, clinicians are known to apply vancomycin powder directly onto sensitive infected tissue in extreme cases. 37 , 38 This implies that microbial tolerance to vancomycin in these likely biofilm cases exceeds its cytotoxicity, and clinicians must balance causing tissue damage against decreasing microbial bioburden, possibly with little success. 38 , 39 , 40 In point of fact, we are unaware of how a clinician could request evaluation of the biofilm equivalent of MIC, the minimum biofilm eradication concentration (MBEC), of vancomycin or any other antibiotic for a patient in distress.…”

Section: A History Of Biofilm Infectionmentioning

confidence: 99%

“… 37 , 38 This implies that microbial tolerance to vancomycin in these likely biofilm cases exceeds its cytotoxicity, and clinicians must balance causing tissue damage against decreasing microbial bioburden, possibly with little success. 38 , 39 , 40 In point of fact, we are unaware of how a clinician could request evaluation of the biofilm equivalent of MIC, the minimum biofilm eradication concentration (MBEC), of vancomycin or any other antibiotic for a patient in distress. 41 A paucity of standards, regulation, and guidance for the diagnosis and treatment of biofilm-related infection must be addressed concurrent to ongoing research.…”

Section: A History Of Biofilm Infectionmentioning

confidence: 99%

Improve Integration of In Vitro Biofilm Body of Knowledge to Support Clinical Breakthroughs in Surgical Site Infection

et al. 2021

View full text Add to dashboard Cite

Prosthetics increase the risk of deep surgical site infections in procedures intended to restore function. In orthopaedics, prosthetic joint infections can lead to repetitive surgeries, amputation, or worse. Biofilm formation both in vitro and in vivo involves stages of attachment, accumulation, and maturation. The level of maturation affects susceptibility to antibiotics, the immune system, and the success of surgical interventions. A review of the literature indicates that orthopedic publications are less likely to mention biofilm. We have reviewed animal models of infection to assess in vivo models of prosthetic infection. Although most prosthetic infections seem to originate from local skin microbiota, clinically representative biofilm inocula are unusual. Biofilm-related end points are more widely adopted, but studies rarely include both quantification of adherent microbial burden and imaging of the in vivo biofilm. Failure to differentiate between planktonic and biofilm infections can skew research away from needed chronic disease models. In this review, we address prosthetic joint infections as an important model for chronic biofilm infection research, identify critical requirements for in vivo models of chronic infection, and propose that resistance to the terminology of biofilm research exists within both research and regulation, which could limit progress toward important orthopaedic targets.

show abstract

Intraoperative Vancomycin Powder Reduces Staphylococcus aureus Surgical Site Infections and Biofilm Formation on Fixation Implants in a Rabbit Model

Abstract: Infection is a common complication of surgery, especially with implants. Simple methods to prevent or decrease the occurrence of infection would benefit the patient and the health care system.

Cited by 18 publications

References 30 publications

Topical rifampin powder for orthopaedic trauma part II: Topical rifampin allows for spontaneous bone healing in sterile and contaminated wounds

Topical rifampin powder for orthopaedic trauma part II: Topical rifampin allows for spontaneous bone healing in sterile and contaminated wounds

Bacterial biofilm formation on implantable devices and approaches to its treatment and prevention

Improve Integration of In Vitro Biofilm Body of Knowledge to Support Clinical Breakthroughs in Surgical Site Infection

Contact Info

Product

Resources

About