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Bacterial biofilm formation is variably inhibited by different formulations of antibiotic-loaded bone cement in vitro

  • Experimental Study
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of the present study was to quantitatively assess biofilm growth on the surface of bone cements discs containing different antibiotics, including colistin and linezolid. Biofilms of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Staphylococcus epidermidis were grown on bone cement discs for 96 h.

Methods

Biofilm amounts were measured by confocal laser microscopy using live/dead staining and dedicated software at different time intervals (48, 72, and 96 h).

Results

Bone cement containing vancomycin was not effective at reducing MRSA biofilm formation 96 h following bacterial inoculation. At a comparable time interval, linezolid-, clindamycin-, and aminoglycoside-loaded cement was still active against this biofilm. At the 72- and 96-h observations, S. epidermidis biofilm was present only on tobramycin and gentamicin discs. P. aeruginosa biofilms were present on cement discs loaded with colistin at all time intervals starting from the 48-h observation, whereas no biofilms were detected on tobramycin or gentamicin discs.

Conclusion

Bone cements containing different antibiotics have variable and time-dependent windows of activity in inhibiting or reducing surface biofilm formation. The effectiveness of bone cement containing vancomycin against MRSA biofilm is questionable. The present study is clinically relevant, because it suggests that adding the right antibiotic to bone cement could be a promising approach to treat periprosthetic infections. Indeed, the antibiofilm activity of different antibiotic-loaded bone cements could be preoperatively assessed using the current methodology in two-stage exchange procedures.

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Abbreviations

ALBC:

Antibiotic-loaded bone cement

BHI:

Brain–heart infusion

CLSM:

Confocal laser scanning microscopy

3D:

Three dimensions

MRSA:

Methicillin-resistant Staphylococcus aureus

PBS:

Phosphate-buffered saline

PI:

Propidium iodide

PMMA:

Polymethylmethacrylate

SCVs:

Small colony variants

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Section of Orthopaedic Surgery, Department of Public Health, School of Medicine, Federico II University, Naples. Via S. Pansini 5, 80131, Naples, Italy

    Giovanni Balato & Massimo Mariconda

  2. Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy

    Emanuela Roscetto, Adriana Vollaro & Maria Rosaria Catania

  3. Division of Orthopaedic and Trauma Surgery, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy

    Olimpio Galasso & Giorgio Gasparini

  4. Department of Infectious Disease, AORN dei Colli, Naples, Italy

    Tiziana Ascione

Authors
  1. Giovanni Balato
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  2. Emanuela Roscetto
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  3. Adriana Vollaro
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  4. Olimpio Galasso
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  5. Giorgio Gasparini
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  6. Tiziana Ascione
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  7. Maria Rosaria Catania
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  8. Massimo Mariconda
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Contributions

GB, MRC, ER, OG, GG, and MM worked on conception and study design. GB, ER, and AV performed sample acquisition and data testing. All authors played a role in data analysis and interpretation. GB, ER, MRC, TA, and MM drafted the manuscript. All authors played a role in critical review and revision of final manuscript.

Corresponding author

Correspondence to Giovanni Balato.

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Conflict of interest

The authors declare that they have no competing interests.

Research ethics committee

Institutional Review Board (IRB) approval is not required due to in vitro study design.

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Balato, G., Roscetto, E., Vollaro, A. et al. Bacterial biofilm formation is variably inhibited by different formulations of antibiotic-loaded bone cement in vitro. Knee Surg Sports Traumatol Arthrosc 27, 1943–1952 (2019). https://doi.org/10.1007/s00167-018-5230-x

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  • DOI: https://doi.org/10.1007/s00167-018-5230-x

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