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J Shoulder Elbow Surg. 2017 Apr;26(4):553-563. doi: 10.1016/j.jse.2016.09.042. Epub 2016 Dec 15.

Prevention of Propionibacterium acnes biofilm formation in prosthetic infections in vitro.

Author information

1
Southampton National Institute for Health Research Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton General Hospital, Southampton, UK; Centre for Biological Sciences, Faculty of Natural and Environmental Sciences and Institute for Life Sciences, University of Southampton, Southampton, UK. Electronic address: rph@soton.ac.uk.
2
Centre for Biological Sciences, Faculty of Natural and Environmental Sciences and Institute for Life Sciences, University of Southampton, Southampton, UK.
3
Biomedical Imaging Unit, Southampton General Hospital, Southampton, UK.
4
Southampton National Institute for Health Research Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton General Hospital, Southampton, UK; Centre for Biological Sciences, Faculty of Natural and Environmental Sciences and Institute for Life Sciences, University of Southampton, Southampton, UK.
5
Biocomposites Ltd, Keele, UK.
6
Department of Orthopaedics, Ohio State University Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
7
Southampton National Institute for Health Research Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton General Hospital, Southampton, UK; National Centre for Advanced Tribology, Faculty of Engineering and Institute for Life Sciences, University of Southampton, Southampton, UK; Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, The Ohio State University, Columbus, OH, USA; Department of Orthopaedics, The Ohio State University, Columbus, OH, USA.

Abstract

BACKGROUND:

The role of Propionibacterium acnes in shoulder arthroplasty and broadly in orthopedic prosthetic infections has historically been underestimated, with biofilm formation identified as a key virulence factor attributed to invasive isolates. With an often indolent clinical course, P acnes infection can be difficult to detect and treat. This study investigates absorbable cements loaded with a broad-spectrum antibiotic combination as an effective preventive strategy to combat P acnes biofilms.

METHODS:

P acnes biofilm formation on an unloaded synthetic calcium sulfate (CaSO4) bone void filler cement bead was evaluated by scanning electron microscopy over a period of 14 days. Beads loaded with tobramycin alone or vancomycin alone (as comparative controls) and beads loaded with a vancomycin-tobramycin dual treatment were assessed for their ability to eradicate planktonic P acnes, prevent biofilm formation, and eradicate preformed biofilms using a combination of viable-cell counts, confocal microscopy, and scanning electron microscopy.

RESULTS:

P acnes surface colonization and biofilm formation on unloaded CaSO4 beads was slow. Beads loaded with antibiotics were able to kill planktonic cultures of 106 colony-forming units/mL, prevent bacterial colonization, and significantly reduce biofilm formation over periods of weeks. Complete eradication of established biofilms was achieved with a contact time of 1 week.

CONCLUSIONS:

This study demonstrates that antibiotic-loaded CaSO4 beads may represent an effective antibacterial and antibiofilm strategy to combat prosthetic infections in which P acnes is involved.

KEYWORDS:

Propionibacterium acnes; antibiotics; biofilm; calcium sulfate; prosthetic infection; shoulder arthroplasty

PMID:
27989720
DOI:
10.1016/j.jse.2016.09.042
[Indexed for MEDLINE]

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