title: Optimal irrigation and debridement of infected joint implants: an in vitro methicillin-resistant Staphylococcus aureus biofilm model.
abstract: Acute postoperative and acute, late hematogenous prosthetic joint infections have been treated with 1-stage irrigation and debridement with polyethylene exchange. Success rates, however, are highly variable. Reported studies demonstrate that detergents are effective at decreasing bacterial colony counts on orthopedic implants. Our hypothesis is that the combination of a detergent and an antiseptic would be more effective than using a detergent alone to decrease colony counts from a methicillin-resistant Staphylococcus aureus biofilm-coated titanium alloy disk simulating an orthopedic implant. In our study of various agents tested, chlorhexidine gluconate scrub (antiseptic and detergent) was the most effective at decreasing bacterial colony counts both prereincubation and postreincubation of the disks; pulse lavage and scrubbing were not more effective than pulse lavage alone.
authors.affiliation: Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York 10467, USA.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Schwechter
authors.forename: David
authors.initials: D
authors.lastname: Folk
authors.forename: Avanish K
authors.initials: AK
authors.lastname: Varshney
authors.forename: Bettina C
authors.initials: BC
authors.lastname: Fries
authors.forename: Sun Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: David M
authors.initials: DM
authors.lastname: Hirsh
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D058491:Bacterial Load; D018441:Biofilms / Q000254:growth & development*; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D003646:Debridement / Q000379:methods*; D006801:Humans; D066298:In Vitro Techniques; D007595:Joint Prosthesis / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development / Q000302:isolation & purification / Q000502:physiology*; D008954:Models, Biological; D016459:Prosthesis-Related Infections / Q000628:therapy*; D013203:Staphylococcal Infections / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods*; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D014025:Titanium; C010882:chlorhexidine gluconate; D002710:Chlorhexidine