Efficacy of Different Irrigation Solutions on Bacterial Biofilm in Periprosthetic Joint Infections: A Systematic...

Background: Chemical debridement with an irrigating solution associated with surgical debridement has proven to be useful in the treatment of periprosthetic joint infection (PJI). The aim of the study was to perform a systematic review and meta-analysis of the current literature regarding the efficacy of different irrigation solutions on bacterial biofilm. Methods: This study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Network Meta-Analysis (PRISMA-NM) checklist. A Network Meta-Analysis was performed to analyze which irrigation solution achieved a greater reduction in colony-forming units (CFU) after specific exposure times in vitro. Effect size was measured using the log ratio of means (logRoM) and 95% confidence intervals (95% CI). The rank probability for each treatment was calculated using P-values. Results: After discarding duplicates, screening, and reviewing the full texts, four studies with 10 irrigation solutions for different exposure durations were included. The solutions were studied on mature biofilms of the most frequent bacteria. The greatest effect was achieved with 10% povidone-iodine for 5 min (est.: -12.02; 95% CI: -14.04, -9.99). The best-ranked solutions were 10% povidone-iodine for 5, 3, and 1 min (respective p-values: 0.977, 0.932, 0.887), and its combination with hydrogen peroxide for 3 min (p-score: 0.836). Povidone-iodine 0.3% for 5 min completed the top five ranked solutions in this study (p-score: 0.761). Conclusions: Our results show that 10% povidone-iodine is the best antiseptic solution when studied in vitro in the context of prosthetic joint infection. Further research in these areas is necessary to determine whether these results are reproducible with in vivo situations.