title: Energy-dependent stimulatory and inhibitory effects of extracorporeal shock waves on bacteria and on gentamicin activity.
abstract: BACKGROUND
  Local infection is considered a contraindication for extracorporeal shock wave (ESW) application, although the antibacterial effects of ESW have been clearly demonstrated in vitro. This study aimed to assess the effects of ESW on bacteria under growth-promoting conditions and to evaluate interactions with the activity of gentamicin.
  
  
  METHODS
  Standardized suspensions of Staphylococcus aureus were exposed to 4000 shock wave impulses of various energy flux densities (EFD) both at 37 degrees C in growth medium and at 20 degrees C in saline. Bacterial viability of treatment groups and controls were quantified. Furthermore, the MICs of gentamicin against ESW-treated and untreated suspensions of S. aureus were compared. Finally, suspensions of S. aureus containing graded concentrations of gentamicin were exposed to ESW and bacterial growth was assessed.
  
  
  RESULTS
  Antibacterial effects of ESW (0.59-0.96 mJ/mm2) were confirmed with bacteria suspended in normal saline (20 degrees C, p<0.05). However, bacteria suspended in growth medium at 37 degrees C demonstrated significantly increased proliferation (p=0.009) after treatment with shock waves of lower EFD (0.59 mJ/mm2). At higher EFD a significant reduction of bacteria was observed (p=0.009). The MIC of gentamicin against S. aureus was not altered by ESW application. Furthermore, the combination of gentamicin and ESW did not alter gentamicin activity (p>0.05). Nevertheless, a growth-promoting effect of ESW at 0.59 mJ/mm(2) was demonstrated despite simultaneous administration of gentamicin.
  
  
  CONCLUSIONS
  This is the first study reporting energy-dependent stimulation of bacterial growth by ESW. Also important is that ESW did not alter the activity of gentamicin.
authors.affiliation: Clinic of Orthopedics and Traumatology, Technical University Munich, Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Horn
authors.forename: Ludger
authors.initials: L
authors.lastname: Gerdesmeyer
authors.forename: Christof
authors.initials: C
authors.lastname: von Eiff
authors.forename: Reiner
authors.initials: R
authors.lastname: Gradinger
authors.forename: Hans
authors.initials: H
authors.lastname: Gollwitzer
mesh_terms: D005839:Gentamicins / Q000494:pharmacology*; D019220:High-Energy Shock Waves; D011312:Pressure; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development / Q000528:radiation effects*; D013997:Time Factors
chemical_list: D005839:Gentamicins