title: Pseudomonas aeruginosa biofilm formation and slime excretion on antibiotic-loaded bone cement.
abstract: BACKGROUND
  Infection is an infrequent but serious complication of prosthetic joint surgery. These infections will usually not clear until the implant is removed and re-implantation has a high failure rate, especially when Pseudomonas aeruginosa is involved.
  
  
  METHODS
  We examined Pseudomonas aeruginosa biofilm formation on plain and gentamicin-loaded bone cement with confocal scanning laser microscopy (CSLM). Two different stains were applied in order to visualize and quantify the distribution of bacterial cells and extracellular polymeric substances (slime) from the bone cement surface to the top of the biofilm. Staining with LIVE/DEAD viability stain differentiated between live and dead bacteria within the biofilm, and slime production was evaluated after staining with Calcofluor white.
  
  
  RESULTS
  CSLM showed that the biofilm was a nonuniform structure of variable thickness, with differences in local bacterial cell and slime densities. Incorporation of gentamicin in bone cement resulted in a 44% reduction in bacterial viability, while the slime density increased significantly. In addition, conventional plate counting showed the development of small-colony variants on gentamicin-loaded bone cement with a decreased sensitivity for gentamicin (MIC: 8 m/L), as compared with normal-sized colonies taken from plain and gentamicin-loaded bone cement (MIC: 3 m/L). The enhanced slime production on antibiotic-loaded bone cement, together with the formation of small-colony variants, resulted in decreased susceptibility to antibiotics--probably concomitant with the onset of persistent and relapsing infections.
  
  
  CONCLUSIONS
  In the clinical situation, our findings help to explain the frequent re-implantation failure of joint replacements infected with P. aeruginosa when the procedure has been performed using antibiotic-loaded bone cement.
authors.affiliation: Department of Biomedical Engineering, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands.
authors.forename: Daniëlle
authors.initials: D
authors.lastname: Neut
authors.forename: Johannes G E
authors.initials: JG
authors.lastname: Hendriks
authors.forename: Jim R
authors.initials: JR
authors.lastname: van Horn
authors.forename: Henny C
authors.initials: HC
authors.lastname: van der Mei
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Busscher
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001422:Bacterial Adhesion / Q000187:drug effects*; D018441:Biofilms / Q000187:drug effects*; D001843:Bone Cements; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000517:prevention & control; D011552:Pseudomonas Infections / Q000382:microbiology* / Q000517:prevention & control; D011550:Pseudomonas aeruginosa / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins