Contaminated rabbit patellar tendon grafts. In vivo analysis of disinfecting methods.
In Part 1 of our study, 40 central-third bone-patellar tendon-bone grafts were harvested from 20 adult California White rabbits under strict sterile conditions. Ten grafts were placed directly into a thioglycolate broth, incubated, and subcultured; no growth was noted in any specimen. The next 6 grafts were contaminated 20 seconds each with 2 different species of coagulase-negative staphylococci. Organisms were grown with cultures obtained from an operating room floor during anterior cruciate ligament reconstruction. Marked growth of both species was noted in all 6 grafts within 24 hours. A subsequent 3 series of 8 grafts each were harvested sterilely, contaminated as described above, and soaked in 1 of 3 solutions 30 minutes before culture. Both 10% povidone-iodine and a triple-antibiotic solution (gentamicin, clindamycin, polymyxin) were 100% ineffective as both organisms grew; 4% chlorhexidine gluconate effectively decontaminated 8 grafts in all cases. Part 2 involved contamination of harvested grafts with 5 common, virulent organisms: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecalis. Elimination of all except Klebsiella pneumoniae was successful with 4% chlorhexidine gluconate alone for 8 grafts. Using a triple-antibiotic solution after chlorhexidine gluconate in 6 grafts eliminated this organism also.
Louisiana State University Knee, Shoulder, and Sports Medicine Fellowship Program, Lake Charles Memorial Hospital.
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Goebel
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Drez
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Heck
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Stoma
D000818:Animals; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D004202:Disinfectants / Q000627:therapeutic use*; D004203:Disinfection; D004338:Drug Combinations; D013293:Enterococcus faecalis; D004927:Escherichia coli Infections / Q000517:prevention & control; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control*; D007710:Klebsiella Infections / Q000517:prevention & control; D007711:Klebsiella pneumoniae; D008297:Male; D017847:Patellar Ligament / Q000382:microbiology* / Q000637:transplantation*; D011113:Polymyxins / Q000008:administration & dosage / Q000627:therapeutic use; D011206:Povidone-Iodine / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000517:prevention & control; D011550:Pseudomonas aeruginosa; D011817:Rabbits; D013203:Staphylococcal Infections / Q000517:prevention & control; D013530:Surgical Wound Infection / Q000382:microbiology / Q000517:prevention & control*
D004202:Disinfectants; D004338:Drug Combinations; D005839:Gentamicins; D011113:Polymyxins; D002981:Clindamycin; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine