Lavage with Allicin in Combination with Vancomycin Inhibits Biofilm Formation by Staphylococcus epidermidis in a Rabbit Model of Prosthetic Joint Infection

Abstract

Background and AimThe present anti-infection strategy for prosthetic joint infections (PJI) includes the use of antibiotics and surgical treatments, but the bacterial eradication rates are still low. One of the major challenges is the formation of biofilm causing poor bacterial eradication. Recently it has been reported that allicin (diallyl thiosulphinate), an antibacterial principle of garlic, can inhibit bacteria adherence and prevent biofilm formation in vitro. However, whether allicin could inhibit biofilm formation in vivo is unknown. The aim of this study was to investigate the effects of allicin on biofilm formation, and whether allicin could potentiate the bactericidal effect of vancomycin in a rabbit PJI model.MethodsA sterile stainless-steel screw with a sterile ultra-high molecular weight polyethylene washer was inserted into the lateral femoral condyle of the right hind knee joint of rabbit, and 1 mL inoculum containing 104 colony-forming units of Staphylococcus epidermidis was inoculated into the knee joint (n = 32). Fourteen days later, rabbits randomly received one of the following 4 treatments using continuous lavages: normal saline, vancomycin (20 mcg/mL), allicin (4 mg/L), or allicin (4 mg/L) plus vancomycin (20 mcg/mL). Three days later, the washer surface biofilm formation was examined by scanning electron microscopy (SEM). The bacterial counts within the biofilm of implanted screws were determined by bacterial culture.ResultsThe lowest number of viable bacterial counts of Staphylococcus epidermidis recovered from the biofilm was in the rabbits treated with allicin plus vancomycin (P<0.01 vs. all other groups). The biofilm formation was significantly reduced or undetectable by SEM in rabbits receiving allicin or allicin plus vancomycin.ConclusionIntra-articular allicincan inhibit biofilm formation and enhance the bactericidal effect of vancomycin on implant surface in vivo. Allicin in combination with vancomycin may be a useful anti-infection strategy for the treatment of PJI.

Activity of preparations from Spilanthes oleracea, propolis, Nigella sativa, and black garlic on different microorganisms involved in oral diseases and on total human salivary bacteria: A pilot study

“…Lavage with lipophilic allicin combined with vancomycin inhibited biofilm formation by S. epidermidis in a rabbit model of prosthetic joint infection (Zhai, Pan, Pang, & Bai, ). In a pilot study of patients with denture stomatitis, a mouthwash with garlic aqueous extract was superior to nystatin primarily due to less adverse effects (Bakhshi, Taheri, Shabestari, Tanik, & Pahlevan, ).…”

“…The time-kill assay revealed that aqueous garlic extract showed better antiproteolytic effects on total Porphyromonas gingivalis protease activity compared with ethanolic garlic extract (Shetty, Thomas, Shetty, Bhandary, & Shetty, 2013 Lavage with lipophilic allicin combined with vancomycin inhibited biofilm formation by S. epidermidis in a rabbit model of prosthetic joint infection (Zhai, Pan, Pang, & Bai, 2014). In a pilot study of patients with denture stomatitis, a mouthwash with garlic aqueous extract was superior to nystatin primarily due to less adverse effects (Bakhshi, Taheri, Shabestari, Tanik, & Pahlevan, 2012).…”

Garlic extract in prosthesis-related infections: a literature review

“…Many studies have shown that GE, as a naturally occurring antibacterial substance, has a good antibiofilm effect. 11,17,41,42 A previous study reported the eradication of biofilms of MDR bacteria. 36 Garlic ointment prevented biofilm formation of S. aureus, S. epidermidis, P. aeruginosa, Acinetobacter baumannii and K. pneumoniae.…”

“…12 There are many reports about allicin inhibiting bacterial adherence and preventing biofilm formation in vitro. 11,41,42 However, whether this property still works in vivo remains unknown. A previous study established an artificial knee joint infection model in rabbits and divided the rabbits into four groups, which were lavaged with normal saline, allicin, vancomycin or allicin plus vancomycin for 14 days.…”

“…It has been reported that garlic extract (GE) has many biological activities including antibacterial, 6,7 antiviral, 6 antifungal 6,8,9 and antiparasitic activities; 10 especially anti-MDR bacterial and antibiofilm activities. 6,11,12 Additionally, with the development of drug-loaded nanoparticle technology, 13,14 the prospect of the clinical application of garlic extract has been greatly improved. This review explores the antibacterial and antibiofilm activities of GE and its potential to be used in the treatment of PJI.…”