Márquez-Gómez, M.; Díaz-Navarro, M.; Visedo, A.; Hafian, R.; Matas, J.; Muñoz, P.; Vaquero, J.; Guembe, M.; Sanz-Ruíz, P. An In Vitro Study to Assess the Best Strategy for the Chemical Debridement of Periprosthetic Joint Infection. Antibiotics2023, 12, 1507.
Márquez-Gómez, M.; Díaz-Navarro, M.; Visedo, A.; Hafian, R.; Matas, J.; Muñoz, P.; Vaquero, J.; Guembe, M.; Sanz-Ruíz, P. An In Vitro Study to Assess the Best Strategy for the Chemical Debridement of Periprosthetic Joint Infection. Antibiotics 2023, 12, 1507.
Márquez-Gómez, M.; Díaz-Navarro, M.; Visedo, A.; Hafian, R.; Matas, J.; Muñoz, P.; Vaquero, J.; Guembe, M.; Sanz-Ruíz, P. An In Vitro Study to Assess the Best Strategy for the Chemical Debridement of Periprosthetic Joint Infection. Antibiotics2023, 12, 1507.
Márquez-Gómez, M.; Díaz-Navarro, M.; Visedo, A.; Hafian, R.; Matas, J.; Muñoz, P.; Vaquero, J.; Guembe, M.; Sanz-Ruíz, P. An In Vitro Study to Assess the Best Strategy for the Chemical Debridement of Periprosthetic Joint Infection. Antibiotics 2023, 12, 1507.
Abstract
Irrigation and debridement using an irrigation solution is a fundamental step during the surgi-cal treatment of both acute and chronic periprosthetic joint infection (PJI). However, there is no consensus on the optimal solution, nor is there sufficient evidence on optimal irrigation time and combination of solutions. Therefore, it is necessary to determine which solution or combi-nation of solutions is most efficacious against biofilm, as well as the optimal irrigation time. We conducted an experimental in vitro model by inoculating stainless steel discs with ATCC strains of methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeru-ginosa, and a clinical strain of Staphylococcus epidermidis. The discs were all irrigated with com-monly used antiseptic solutions (10% and 3% povidone iodine, hydrogen peroxide, 3% acetic ac-id, and Bactisure™) for 1 min, 3 min, and 5 min and their combinations for 9 min (3 min each) vs. sterile saline as a positive control. We evaluated the reduction in biofilm based on colony form-ing unit (cfu) counts and, in combination assays, also based on cell viability and scanning elec-tron microscopy. All antiseptics alone reduced more than 90% of cfu counts after 1 min of irriga-tion; the worst results were for hydrogen peroxide and 3% acetic acid. When solutions were combined, the best results were observed for all those starting with acetic acid, in terms of both reduction of log cfu/ml counts and viable cells. We consider that a combination of antiseptic so-lutions, particularly that comprising the sequence acetic acid+povidone iodine+hydrogen per-oxide, would be the best option for chemical debridement during PJI surgery.
Keywords
biofilm; stainless implant; in vitro model; antiseptic solutions; irrigation; Bactisure™
Subject
Medicine and Pharmacology, Surgery
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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