title: Preventing Implant-Associated Infections by Silver Coating.
abstract: Implant-associated infections (IAIs) are a dreaded complication mainly caused by biofilm-forming staphylococci. Implant surfaces preventing microbial colonization would be desirable. We examined the preventive effect of a silver-coated titanium-aluminum-niobium (TiAlNb) alloy. The surface elicited a strong, inoculum-dependent activity againstStaphylococcus epidermidisandStaphylococcus aureusin an agar inhibition assay. Gamma sterilization and alcohol disinfection did not alter the effect. In a tissue cage mouse model, silver coating of TiAlNb cages prevented perioperative infections in an inoculum-dependent manner and led to a 100% prevention rate after challenge with 2 × 10(6)CFU ofS. epidermidisper cage. InS. aureusinfections, silver coating had only limited effect. Similarly, daptomycin or vancomycin prophylaxis alone did not preventS. aureusinfections. However, silver coating combined with daptomycin or vancomycin prophylaxis thwarted methicillin-resistantS. aureusinfections at a prevention rate of 100% or 33%, respectively. Moreover, silver release from the surface was independent of infection and occurred rapidly after implantation. On day 2, a peak of 82 μg Ag/ml was reached in the cage fluid, corresponding to almost 6× the MIC of the staphylococci. Cytotoxicity toward leukocytes in the cage was low and temporary. Surrounding tissue did not reveal histological signs of silver toxicity.In vitro, no emergence of silver resistance was observed in several clinical strains of staphylococci upon serial subinhibitory silver exposures. In conclusion, our data demonstrate that silver-coated TiAlNb is potent for prevention of IAIs and thus can be considered for clinical application.
authors.affiliation: Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland richardalexander.kuehl@usb.ch nina.khanna@usb.ch.
authors.forename: Richard
authors.initials: R
authors.lastname: Kuehl
authors.affiliation: Department of Chemistry, University of Fribourg, Fribourg, Switzerland.
authors.forename: Priscilla S
authors.initials: PS
authors.lastname: Brunetto
authors.affiliation: Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland.
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Woischnig
authors.affiliation: Department of Chemistry, University of Fribourg, Fribourg, Switzerland.
authors.forename: Massimo
authors.initials: M
authors.lastname: Varisco
authors.affiliation: Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland.
authors.forename: Zarko
authors.initials: Z
authors.lastname: Rajacic
authors.affiliation: Institute of Pathology, University Hospital of Basel, Basel, Switzerland.
authors.forename: Juerg
authors.initials: J
authors.lastname: Vosbeck
authors.affiliation: Institute of Pathology, University Hospital of Basel, Basel, Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Terracciano
authors.affiliation: Department of Chemistry, University of Fribourg, Fribourg, Switzerland.
authors.forename: Katharina M
authors.initials: KM
authors.lastname: Fromm
authors.affiliation: Infection Biology Laboratory, Department of Biomedicine, University and University Hospital of Basel, Basel, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland richardalexander.kuehl@usb.ch nina.khanna@usb.ch.
authors.forename: Nina
authors.initials: N
authors.lastname: Khanna
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000494:pharmacology*; D002470:Cell Survival / Q000187:drug effects; D020099:Coated Materials, Biocompatible / Q000494:pharmacology*; D017576:Daptomycin / Q000494:pharmacology; D003722:Dental Alloys / Q000494:pharmacology*; D065546:Drug Liberation; D005260:Female; D007700:Kinetics; D007962:Leukocytes / Q000187:drug effects; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D051379:Mice; D008810:Mice, Inbred C57BL; D008826:Microbial Sensitivity Tests; D019736:Prostheses and Implants / Q000382:microbiology*; D012834:Silver / Q000493:pharmacokinetics / Q000494:pharmacology*; D012867:Skin; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000254:growth & development; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D003722:Dental Alloys; C516027:titanium-niobium-aluminum alloy; D012834:Silver; D014640:Vancomycin; D017576:Daptomycin