title: Cathodic voltage-controlled electrical stimulation of titanium implants as treatment for methicillin-resistant Staphylococcus aureus periprosthetic infections.
abstract: Effective treatment options are often limited for implant-associated orthopedic infections. In this study we evaluated the antimicrobial effects of applying cathodic voltage-controlled electrical stimulation (CVCES) of -1.8 V (vs. Ag/AgCl) to commercially pure titanium (cpTi) substrates with preformed biofilm-like structures of methicillin-resistant Staphylococcus aureus (MRSA). The in vitro studies showed that as compared to the open circuit potential (OCP) conditions, CVCES of -1.8 V for 1 h significantly reduced the colony-forming units (CFU) of MRSA enumerated from the cpTi by 97% (1.89 × 106 vs 6.45 × 104 CFU/ml) and from the surrounding solution by 92% (6.63 × 105 vs. 5.15 × 104 CFU/ml). The in vivo studies, utilizing a rodent periprosthetic infection model, showed that as compared to the OCP conditions, CVCES at -1.8 V for 1 h significantly reduced MRSA CFUs in the bone tissue by 87% (1.15 × 105 vs. 1.48 × 104 CFU/ml) and reduced CFU on the cpTi implant by 98% (5.48 × 104 vs 1.16 × 103 CFU/ml). The stimulation was not associated with histological changes in the host tissue surrounding the implant. As compared to the OCP conditions, the -1.8 V stimulation significantly increased the interfacial capacitance (18.93 vs. 98.25 μF/cm(2)) and decreased polarization resistance (868,250 vs. 108 Ω-cm(2)) of the cpTi. The antimicrobial effects are thought to be associated with these voltage-dependent electrochemical surface properties of the cpTi.
authors.affiliation: Department of Biomedical Engineering, State University of New York at Buffalo, 162 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA; Department of Orthopedics, State University of New York at Buffalo, 162 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA. Electronic address: mte@buffalo.edu.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Ehrensberger
authors.affiliation: Department of Orthopedics, State University of New York at Buffalo, 162 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Menachem E
authors.initials: ME
authors.lastname: Tobias
authors.affiliation: Department of Orthopedics, State University of New York at Buffalo, 162 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Nodzo
authors.affiliation: Department of Microbiology and Immunology, State University of New York at Buffalo, 140 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Hansen
authors.affiliation: Department of Microbiology and Immunology, State University of New York at Buffalo, 140 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Nicole R
authors.initials: NR
authors.lastname: Luke-Marshall
authors.affiliation: Department of Orthopedics, State University of New York at Buffalo, 162 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Ross F
authors.initials: RF
authors.lastname: Cole
authors.affiliation: Department of Pathology and Anatomical Sciences, State University of New York at Buffalo, 204 Farber Hall, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Wild
authors.affiliation: Department of Microbiology and Immunology, State University of New York at Buffalo, 140 Biomedical Research Building, 3435 Main Street, Buffalo, NY 14214, USA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Campagnari
mesh_terms: D000818:Animals; D003114:Colony-Forming Units Assay; D058266:Dielectric Spectroscopy; D025802:Electric Capacitance; D004558:Electric Stimulation; D004560:Electricity; D004566:Electrodes; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology*; D020318:Rats, Long-Evans; D014025:Titanium / Q000494:pharmacology* / Q000627:therapeutic use*
chemical_list: D014025:Titanium
keywords: Antimicrobial; Bacteria; Biofilm; Electrical Stimulation; Infection; Titanium