title: Optimal Irrigation and Debridement of Infected Total Joint Implants with Chlorhexidine Gluconate.
abstract: Previous study at our institution demonstrated that scrubbing a methicillin-resistant Staphylococcus aureus (MRSA)-coated titanium disk with chlorhexidine gluconate (CG) solution achieved superior biofilm eradication compared to alternative solutions. The current study aimed to identify the minimum CG concentration for effective bacteria eradication of an in vitro periprosthetic joint infection (PJI) model. MRSA colony-forming units (CFUs) were counted following simulated irrigation and debridement with varying CG solutions before and after a 24-hour reincubation period. Significant decrease was noted on all disks before reincubation. Postreincubation, significant decrease in CFUs was found in the 4% and 2% groups. This study demonstrated that I+D of an infected PJI model with 4% CG solution was effective at treating MRSA biofilm at concentrations as low as 2%.
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Department of Orthopaedic Surgery, Bronx, New York.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Smith
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Department of Orthopaedic Surgery, Bronx, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Maiman
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Department of Orthopaedic Surgery, Bronx, New York.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Schwechter
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Department of Orthopaedic Surgery, Bronx, New York.
authors.forename: Sun Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Albert Einstein College of Medicine, Montefiore Medical Center, Department of Orthopaedic Surgery, Bronx, New York.
authors.forename: David M
authors.initials: DM
authors.lastname: Hirsh
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage; D058491:Bacterial Load; D018441:Biofilms; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003646:Debridement / Q000379:methods*; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology*; D055624:Methicillin-Resistant Staphylococcus aureus; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery; D007507:Therapeutic Irrigation / Q000379:methods*; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D014025:Titanium; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: MRSA biofilm; chlorhexidine gluconate; infection; irrigation and debridement; total knee arthroplasty