A scanning electron microscope characterisation of biofilm on failed craniofacial osteosynthesis miniplates.
BACKGROUND
Between 3 and 18% of craniofacial osteosynthesis plates are removed due to chronic infection. Removal of the plate is necessary to manage the chronic infective state i.e. miniplate removal results in resolution of the infection. These observations are suggestive of a biofilm-related infection. The aim of this retrospective study was to characterise the presence of biofilm on the removed miniplates from oral and maxillofacial surgery.


METHODS
A total of 12 plates and associated screws were recovered from eleven patients suffering from persistent, trauma site infection. The recovered plates plus 1 control plate were imaged using scanning electron microscopy (SEM). One recovered plate was also imaged using confocal microscopy (CM) for comparative purposes.


RESULTS
Of the 12 plates, 3 (25%) demonstrated highly localised polymicrobial biofilms, five (42%) demonstrated coccal biofilms, one possessed a filamentous biofilm and one showed attached yeast. Overall, 75% of the plates and 82% of the patients exhibited evidence of biofilm to varying degrees. All of the infections resolved following removal of the plates and antibiotic treatment.


CONCLUSIONS
Microbial biofilms can explain the clinical course of chronic infections associated with miniplates.
Faculty of Medicine, University of Southampton, Southampton S016 6YD, United Kingdom.
Aneka K
AK
Jhass
Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
David Annandale
DA
Johnston
Department of Oral & Maxillofacial Surgery, University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
Aakshay
A
Gulati
Queen Alexandra Hospital, Portsmouth PO6 3LY, United Kingdom.
Rajiv
R
Anand
Microbial Tribology, National Centre for Advanced Tribology, Engineering Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom; Microbial Infection and Immunity and Orthopedics, Center for Microbial Interface Biology, The Ohio State University, 43210, USA. Electronic address: paul.stoodley@osumc.edu.
Paul
P
Stoodley
Department of Oral & Maxillofacial Surgery, University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
Sanjay
S
Sharma
D001419:Bacteria / Q000145:classification; D018441:Biofilms / Q000145:classification; D001860:Bone Plates / Q000382:microbiology*; D001863:Bone Screws / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery; D063168:Mandibular Osteotomy / Q000295:instrumentation; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D008904:Miniaturization; D019647:Oral Surgical Procedures / Q000295:instrumentation; D019340:Osteotomy, Le Fort / Q000295:instrumentation; D016459:Prosthesis-Related Infections / Q000473:pathology*; D012189:Retrospective Studies; D013499:Surface Properties; D013529:Surgical Wound Dehiscence / Q000382:microbiology; D013530:Surgical Wound Infection / Q000473:pathology*; D015051:Zygomatic Fractures / Q000601:surgery
Biofilm; Infection; Miniplate; Osteosynthesis