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Prevention of Propionibacterium acnes biofilm formation in prosthetic infections in vitro

Prevention of Propionibacterium acnes biofilm formation in prosthetic infections in vitro
Prevention of Propionibacterium acnes biofilm formation in prosthetic infections in vitro
Background: The role of Propionibacterium acnes in shoulder arthroplasty and broadly in orthopaedic prosthetic infections (PIs) 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. The present study investigates absorbable cements loaded with a broad-spectrum antibiotic combination as an effective preventative 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 (SEM) over 14 days. Beads loaded with tobramycin alone, vancomycin alone (as comparative controls) and a vancomycin & tobramycin dual treatment were assessed for their ability to eradicate planktonic P. acnes, prevent biofilm formation and eradicate preformed biofilms was also evaluated using viable cell counts, confocal microscopy and SEM.

Results: P. acnes surface colonisation and biofilm formation on unloaded CaSO4 beads was slow. Beads loaded with antibiotics were able to kill planktonic cultures of 106 CFU/ml, prevent bacterial colonisation and significantly reduce biofilm formation over periods of weeks. Complete eradication of established biofilms was achieved with a contact time of one week.

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

Level of Evidence: Basic Science Study

Propionibacterium acnes, biofilm, shoulder arthroplasty, prosthetic infection, calcium sulfate, antibiotics
1058-2746
1-33
Howlin, Robert
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Winnard, Chris
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Angus, Elizabeth
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Frapwell, Connor
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Webb, Jeremy
ec0a5c4e-86cc-4ae9-b390-7298f5d65f8d
Cooper, John
b577beb1-6451-4a23-82df-d4d93879d91f
Aiken, Sean
c029c46b-baad-4ff3-8d4f-f38807024a93
Bishop, Julie
a40e4637-6851-4bb9-b81a-60109f60ec95
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f
Howlin, Robert
f3c84990-6196-47d4-ad8a-80954ea46c7f
Winnard, Chris
23a6fa57-b2b3-465c-9fda-9b358d54bddd
Angus, Elizabeth
cb1ffad4-713d-4f8a-8331-88a89db5ac3e
Frapwell, Connor
687070ab-1e5c-46ef-8450-9f3f5a566e7f
Webb, Jeremy
ec0a5c4e-86cc-4ae9-b390-7298f5d65f8d
Cooper, John
b577beb1-6451-4a23-82df-d4d93879d91f
Aiken, Sean
c029c46b-baad-4ff3-8d4f-f38807024a93
Bishop, Julie
a40e4637-6851-4bb9-b81a-60109f60ec95
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f

Howlin, Robert, Winnard, Chris, Angus, Elizabeth, Frapwell, Connor, Webb, Jeremy, Cooper, John, Aiken, Sean, Bishop, Julie and Stoodley, Paul (2016) Prevention of Propionibacterium acnes biofilm formation in prosthetic infections in vitro. Journal of Shoulder and Elbow Surgery, 26 (4), 1-33. (doi:10.1016/j.jse.2016.09.042).

Record type: Article

Abstract

Background: The role of Propionibacterium acnes in shoulder arthroplasty and broadly in orthopaedic prosthetic infections (PIs) 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. The present study investigates absorbable cements loaded with a broad-spectrum antibiotic combination as an effective preventative 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 (SEM) over 14 days. Beads loaded with tobramycin alone, vancomycin alone (as comparative controls) and a vancomycin & tobramycin dual treatment were assessed for their ability to eradicate planktonic P. acnes, prevent biofilm formation and eradicate preformed biofilms was also evaluated using viable cell counts, confocal microscopy and SEM.

Results: P. acnes surface colonisation and biofilm formation on unloaded CaSO4 beads was slow. Beads loaded with antibiotics were able to kill planktonic cultures of 106 CFU/ml, prevent bacterial colonisation and significantly reduce biofilm formation over periods of weeks. Complete eradication of established biofilms was achieved with a contact time of one week.

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

Level of Evidence: Basic Science Study

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More information

Accepted/In Press date: 27 September 2016
e-pub ahead of print date: 15 December 2016
Keywords: Propionibacterium acnes, biofilm, shoulder arthroplasty, prosthetic infection, calcium sulfate, antibiotics
Organisations: Centre for Biological Sciences

Identifiers

Local EPrints ID: 401155
URI: http://eprints.soton.ac.uk/id/eprint/401155
ISSN: 1058-2746
PURE UUID: a4160eac-205d-4f28-b1c3-5de42c48917c
ORCID for Jeremy Webb: ORCID iD orcid.org/0000-0003-2068-8589
ORCID for Paul Stoodley: ORCID iD orcid.org/0000-0001-6069-273X

Catalogue record

Date deposited: 10 Oct 2016 11:40
Last modified: 17 Dec 2019 06:36

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