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Mapping bacterial biofilm on explanted orthopaedic hardware: An analysis of 14 consecutive cases

Mapping bacterial biofilm on explanted orthopaedic hardware: An analysis of 14 consecutive cases
Mapping bacterial biofilm on explanted orthopaedic hardware: An analysis of 14 consecutive cases
Hardware implanted during primary total joint arthroplasty carries a serious risk for periprosthetic joint infection (PJI). The formation of bacterial biofilms, which are highly tolerant of antibiotics and host immunity, is recognized as being a major barrier to treatment. It is not known whether some components and their surface features are more prone to biofilm than others. This study attempted to map biofilm on different components and features of orthopedic hardware recovered during revision. Implant surface culture (ISC) was used on 53 components from 14 hip and knee revisions. ISC achieves a thin agar coating over components, followed by incubation and observation for colony outgrowth over 9 days. Recovered organisms were identified by selective culture and 16s rRNA sequencing. Outcomes were compared with clinical culturing and PJI diagnosis based on 2013 Musculoskeletal Infection Society criteria. ISC paralleled clinical culturing with a sensitivity of 100% and a specificity of 57.1%. When compared to Musculoskeletal Infection Society criteria, sensitivity remained at 100% while specificity was 80%. Biofilm accumulation was patchy and heterogeneous throughout different prostheses, though notably the non-articulating surfaces between the tibial tray and polyethylene insert showed consistent growth. On individual components, ridges and edges consistently harbored biofilm, while growth elsewhere was case dependent. ISC successfully identified microbial growth with high sensitivity while also revealing that biofilm growth was commonly localized to particular locations. Understanding where biofilm formation occurs most often on implanted hardware will help guide debridement, retention choices, and implant design.
Mapping Biofilm, Periprosthetic Joint Infection, Total Joint Arthroplasty, Implant Surface Culture, Staphylococcus aureus
0.1111/apm.13295
0903-4641
Brooks, Jacob R.
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Chonko, Douglas
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Pigott, Matthew
7516031a-d28b-4d8d-95f3-b66fe9b073c9
Sullivan, Anne
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Moore, Kelly
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Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f
Brooks, Jacob R.
d82d53dd-aafb-4895-81b8-f5f41b1e2e85
Chonko, Douglas
c2c1ece8-cc3b-4917-b0a2-f0fbd6cd927c
Pigott, Matthew
7516031a-d28b-4d8d-95f3-b66fe9b073c9
Sullivan, Anne
2fc4e087-c92c-405d-9071-18d5873b4cbd
Moore, Kelly
7ce22be7-6d12-4766-8b17-603b79b3a53b
Stoodley, Paul
08614665-92a9-4466-806e-20c6daeb483f

Brooks, Jacob R., Chonko, Douglas, Pigott, Matthew, Sullivan, Anne, Moore, Kelly and Stoodley, Paul (2023) Mapping bacterial biofilm on explanted orthopaedic hardware: An analysis of 14 consecutive cases. Apmis. (0.1111/apm.13295).

Record type: Article

Abstract

Hardware implanted during primary total joint arthroplasty carries a serious risk for periprosthetic joint infection (PJI). The formation of bacterial biofilms, which are highly tolerant of antibiotics and host immunity, is recognized as being a major barrier to treatment. It is not known whether some components and their surface features are more prone to biofilm than others. This study attempted to map biofilm on different components and features of orthopedic hardware recovered during revision. Implant surface culture (ISC) was used on 53 components from 14 hip and knee revisions. ISC achieves a thin agar coating over components, followed by incubation and observation for colony outgrowth over 9 days. Recovered organisms were identified by selective culture and 16s rRNA sequencing. Outcomes were compared with clinical culturing and PJI diagnosis based on 2013 Musculoskeletal Infection Society criteria. ISC paralleled clinical culturing with a sensitivity of 100% and a specificity of 57.1%. When compared to Musculoskeletal Infection Society criteria, sensitivity remained at 100% while specificity was 80%. Biofilm accumulation was patchy and heterogeneous throughout different prostheses, though notably the non-articulating surfaces between the tibial tray and polyethylene insert showed consistent growth. On individual components, ridges and edges consistently harbored biofilm, while growth elsewhere was case dependent. ISC successfully identified microbial growth with high sensitivity while also revealing that biofilm growth was commonly localized to particular locations. Understanding where biofilm formation occurs most often on implanted hardware will help guide debridement, retention choices, and implant design.

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Biofilm mapping manuscript APMIS Accepted Authors version - Accepted Manuscript
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More information

Accepted/In Press date: 18 January 2023
e-pub ahead of print date: 19 January 2023
Keywords: Mapping Biofilm, Periprosthetic Joint Infection, Total Joint Arthroplasty, Implant Surface Culture, Staphylococcus aureus

Identifiers

Local EPrints ID: 474782
URI: http://eprints.soton.ac.uk/id/eprint/474782
DOI: 0.1111/apm.13295
ISSN: 0903-4641
PURE UUID: 12f35d3a-b5b7-46d5-a095-4ef5fdb641d3
ORCID for Paul Stoodley: ORCID iD orcid.org/0000-0001-6069-273X

Catalogue record

Date deposited: 02 Mar 2023 17:48
Last modified: 17 Mar 2024 07:39

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Contributors

Author: Jacob R. Brooks
Author: Douglas Chonko
Author: Matthew Pigott
Author: Anne Sullivan
Author: Kelly Moore
Author: Paul Stoodley ORCID iD

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