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Surfactant wound irrigation for the treatment of staphylococcal clinical isolates
Kevin M Marberry1, Pete Kazmier, W Andrew Simpson
1Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, 65212, USA.
Abstract:
Deep wound infection involving an implanted biomaterial is a devastating complication in orthopaedic surgery. Two-thirds of such infections are monomicrobial and the most commonly isolated bacteria in human osteomyelitis and orthopaedic device infection are Staphylococcus aureus and Staphylococcus epidermidis. The purpose of the current study was to examine the effectiveness of the previously reported sequential surfactant irrigation protocol against human-isolated clinical strains of Staphylococcus aureus and Staphylococcus epidermidis in the rat model of orthopaedic implant contamination. The infectivity rate of human-isolated clinical strains of Staphylococcus aureus in a contaminated complex orthopaedic wound was reduced effectively by a sequential surfactant irrigation protocol. Also, in this model, the infectivity of Staphylococcus epidermidis was reduced by normal saline irrigation alone when compared with no irrigation. Therefore, the sequential surfactant irrigation protocol may represent an effective method of wound irrigation in monomicrobial Staphylococcus aureus orthopaedic implant contamination, and normal saline irrigation may suffice in cases of monomicrobial Staphylococcus epidermidis contamination. Additional studies are necessary to determine the clinical use of surfactant irrigation.
Insights
A new sequential surfactant irrigation protocol effectively reduced Staphylococcus aureus infections in a rat orthopaedic implant model. Normal saline irrigation also showed benefits for Staphylococcus epidermidis contamination.
Area of Science:
- Orthopaedic Surgery
- Biomaterial Science
- Infectious Diseases
Background:
- Deep wound infections involving implanted biomaterials are severe complications in orthopaedic surgery.
- Monomicrobial infections, primarily by Staphylococcus aureus and Staphylococcus epidermidis, account for two-thirds of these cases.
- Effective irrigation protocols are crucial for managing orthopaedic implant contamination.
Purpose of the Study:
- To evaluate the efficacy of a sequential surfactant irrigation protocol against clinical strains of Staphylococcus aureus and Staphylococcus epidermidis.
- To compare the protocol's effectiveness in a rat model of orthopaedic implant contamination.
- To determine appropriate irrigation strategies based on bacterial species.
Main Methods:
- Utilized a rat model of orthopaedic implant contamination with human-isolated clinical strains of Staphylococcus aureus and Staphylococcus epidermidis.
- Applied a sequential surfactant irrigation protocol to assess its impact on infection rates.
- Included normal saline irrigation and no irrigation as control groups for comparison.
Main Results:
- The sequential surfactant irrigation protocol significantly reduced the infectivity of Staphylococcus aureus.
- Normal saline irrigation alone effectively reduced the infectivity of Staphylococcus epidermidis compared to no irrigation.
- The study demonstrated differential effectiveness of irrigation methods based on the specific bacterial pathogen.
Conclusions:
- The sequential surfactant irrigation protocol shows promise for managing monomicrobial Staphylococcus aureus orthopaedic implant contamination.
- Normal saline irrigation may be sufficient for cases involving monomicrobial Staphylococcus epidermidis contamination.
- Further research is needed to establish the clinical applicability of surfactant irrigation in orthopaedic surgery.