title: Staphylococcal persistence due to biofilm formation in synovial fluid containing prophylactic cefazolin.
abstract: Antibiotic prophylaxis is standard for patients undergoing surgical procedures, yet despite the wide use of antibiotics, breakthrough infections still occur. In the setting of total joint arthroplasty, such infections can be devastating. Recent findings have shown that synovial fluid causes marked staphylococcal aggregation, which can confer antibiotic insensitivity. We therefore asked in this study whether clinical samples of synovial fluid that contain preoperative prophylactic antibiotics can successfully eradicate a bacterial challenge by pertinent bacterial species. This study demonstrates that preoperative prophylaxis with cefazolin results in high antibiotic levels. Furthermore, we show that even with antibiotic concentrations that far exceed the expected bactericidal levels, Staphylococcus aureus bacteria added to the synovial fluid samples are not eradicated and are able to colonize model implant surfaces, i.e., titanium pins. Based on these studies, we suggest that current prophylactic antibiotic choices, despite high penetration into the synovial fluid, may need to be reexamined.
authors.affiliation: Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Sana S
authors.initials: SS
authors.lastname: Dastgheyb
authors.affiliation: The Rothman Institute, Philadelphia, Pennsylvania, USA.
authors.forename: Sommer
authors.initials: S
authors.lastname: Hammoud
authors.affiliation: Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA The Rothman Institute, Philadelphia, Pennsylvania, USA.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Ketonis
authors.affiliation: Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Andrew Yongkun
authors.initials: AY
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Fitzgerald
authors.affiliation: The Rothman Institute, Philadelphia, Pennsylvania, USA.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.affiliation: The Rothman Institute, Philadelphia, Pennsylvania, USA.
authors.forename: James
authors.initials: J
authors.lastname: Purtill
authors.affiliation: The Rothman Institute, Philadelphia, Pennsylvania, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ciccotti
authors.affiliation: Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Irving M
authors.initials: IM
authors.lastname: Shapiro
authors.affiliation: National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Otto
authors.affiliation: Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA noreen.hickok@jefferson.edu.
authors.forename: Noreen J
authors.initials: NJ
authors.lastname: Hickok
mesh_terms: D000497:Alloys; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D019072:Antibiotic Prophylaxis; D001422:Bacterial Adhesion; D018441:Biofilms / Q000187:drug effects*; D001858:Bone Nails / Q000382:microbiology; D002437:Cefazolin / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D013211:Staphylococcus aureus / Q000187:drug effects*; D013582:Synovial Fluid / Q000382:microbiology*; D014025:Titanium
chemical_list: D000497:Alloys; D000900:Anti-Bacterial Agents; C031462:titanium alloy (TiAl6V4); D014025:Titanium; D002437:Cefazolin