What is the most advantageous lavage solution to use for fungal prosthetic joint infections

Fungal prosthetic joint infections (PJI) are increasing yet we have a poor understanding on the proper treatment of these complex infections especially with respect to most advantageous lavage solutions to use clinically. Consequently, the objective of this study was to determine which commonly used lavage solutions are most advantageous at dispersing fungal biofilms.

Nine clinical isolates from past fungal prosthetic joint infections were used to form biofilms in 24 microwell plates. Then different lavage solutions were instilled, and residual biofilm were measured and compared to normal saline lavage solutions. Moreover, fungal biofilms were directly observed with scanning electron microscopy.

All lavage solutions evaluated significantly (p < 0.05) reduced fungal biofilms compared to normal saline. However, chlorhexidine gluconate and sodium hypochlorite were able to disperse fungal biofilms significantly (p˂0.05) more than the other lavage solutions. As well, scanning electron microscopy showed fungal biofilms are typically composed of hyphae and yeast forms for most Candidal species.

All lavage solutions can reduce Candidal biofilms, but chlorhexidine gluconate and sodium hypochlorite were the most advantageous agents in disrupting Candidal biofilms. Yet given the potential tissue toxicity associated with sodium hypochlorite should prioritize the use of chlorohexidine as lavage solutions in the clinical treatment of fungal PJI to help degrade biofilms on retained hardware and tissues. However, further studies are needed to determine the mechanism associated with degradation of fungal biofilms as well as evaluating novel ways to prevent Candidal hyphae formation in PJI.