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Early Biofilm Formation on the Drain Tip after Total Knee Arthroplasty Is Not Associated with Prosthetic Joint
Marco Grassi1, Marco Senarighi1, Luca Farinelli1
1Clinical Orthopedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica Delle Marche, 60121 Ancona, Italy.
Background:
Periprosthetic joint infection (PJI) is a devastating complication of arthroplasties that could occur during the surgery. The purpose of this study was to analyze the biofilm formation through microbiological culture tests and scanning electron microscopy (SEM) on the tip of surgical drainage removed 24 h after arthroplasty surgery.
Methods:
A total of 50 consecutive patients were included in the present prospective observational study. Drains were removed under total aseptic conditions twenty-four hours after surgery. The drain tip was cut in three equal parts of approximately 2-3 cm in length and sent for culture, culture after sonication, and SEM analysis. The degree of biofilm formation was determined using a SEM semi-quantitative scale.
Results:
From the microbiological analysis, the cultures of four samples were positive. The semi-quantitative SEM analysis showed that no patient had grade 4 of biofilm formation. A total of 8 patients (16%) had grade 3, and 14 patients (28%) had grade 2. Grade 1, scattered cocci with immature biofilm, was contemplated in 16 patients (32%). Finally, 12 patients (24%) had grade 0 with a total absence of bacteria. During the follow-up (up to 36 months), no patient showed short- or long-term infectious complications.
Conclusions:
Most of the patients who underwent primary total knee arthroplasty (TKA) showed biofilm formation on the tip of surgical drain 24 h after surgery even though none showed a mature biofilm formation (grade 4). Furthermore, 8% of patients were characterized by a positivity of culture analysis. However, none of the patients included in the study showed signs of PJI up to 3 years of follow-up.
Insights
Most total knee arthroplasty patients developed early biofilm on surgical drains, but none had mature biofilms or later infections. This suggests early biofilm presence may not predict periprosthetic joint infection (PJI).
Area of Science:
- Orthopedic Surgery
- Microbiology
- Biomaterials Science
Background:
- Periprosthetic joint infection (PJI) is a serious complication following arthroplasty.
- Biofilm formation on surgical drains can be an early indicator of infection.
- Early detection of biofilm is crucial for preventing PJI.
Purpose of the Study:
- To investigate biofilm formation on surgical drain tips 24 hours after arthroplasty.
- To correlate early biofilm presence with the development of PJI.
Main Methods:
- Prospective observational study of 50 patients undergoing arthroplasty.
- Surgical drains removed aseptically 24 hours post-surgery.
- Drain tips analyzed via microbiological culture and scanning electron microscopy (SEM) for biofilm quantification.
Main Results:
- Microbiological cultures were positive in 8% of patients.
- SEM analysis revealed varying degrees of biofilm formation, with no mature biofilms (Grade 4).
- 16% had Grade 3, 28% Grade 2, 32% Grade 1, and 24% Grade 0 biofilm.
Conclusions:
- Early biofilm formation on drain tips is common after primary total knee arthroplasty (TKA).
- Despite early biofilm presence, no patients developed PJI within 36 months.
- These findings suggest that early drain tip biofilm may not be a reliable predictor of subsequent PJI.
